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Physician Update - Can Breast Reconstruction Also Preserve Sensation?

Physician Update Winter 2010

Can Breast Reconstruction Also Preserve Sensation?

Date: January 31, 2010

Gedge Rosson
Gedge Rosson and other Johns Hopkins breast surgeons say pioneering techniques are opening doors once thought impassable.

During his seven years in breast reconstruction, Gedge Rosson has worked with the assumed priorities of most breast cancer patients. First, save the patient's life; second, restore her bustline; and third, maybe, preserve physical sensation in the reconstructed breast.

But increasingly, says Rosson, he sees patients who would rank physical sensation equally with appearance, if not above it. The more fluid hierarchy, he adds, rests on how each patient defines her emotional quality of life. Is it more important to look better in clothes, or is it more important to retain some aspect of physical sensation?

One of Rosson's recent patients, who faced a double-mastectomy at 48, thinks it's high time both goals were given equal footing. "I actually would say that sensation is at least as important to me," she says. "I'd rather feel good than look good."

Rosson, who directs Johns Hopkins' breast plastic surgery unit, says the trend toward sensate-preserving reconstructions has become more prominent as surgeons have made gains in both nerve-sparing and nerve-connection techniques. Though his group offers the full range of approaches for postmastectomy patients, his younger patients are increasingly inclined to ask for an approach that can retain feeling.

His group sometimes succeeds in preserving sensation, says Rosson, but he's quick to adjust expectations. Even in the best outcomes, he says, patients who retain breast sensation do not experience a full return of erogenous feeling. Many do, however, often retain a sense of physical contact on the surface of the reconstructed breast, a sensation much preferred over no sense of touch at all. Rosson says the preservation of erogenous sensation is a worthy goal but one that's still on the horizon.

Rosson says the progress in sensate-preserving techniques builds on the advances made in maintaining the motor nerve systems that underlie patients' abdominal muscles. Many surgeons still offer procedures that harvest tissue from a patient's abdomen in a range of techniques that also take portions of the underlying muscle tissue and its associated nerves. Although patients are generally happy with the improved figure that results from a trimmer waist and restored bustline, those approaches also "mess up their bellies," says Rosson. The loss of abdominal muscles means poor torso control, requiring patients to use their arms just to sit up.

To answer that challenge, Rosson's group most prefers an approach called the deep inferior epigastric artery perforator flap procedure, or DIEP. With DIEP, he explains, they harvest the patient's belly tissue in a way that completely preserves their abdominal muscles and nerve tissue. This growing mastery for preserving motor nerves, says Rosson, also now extends to preserving the sensory nerves in skin.

In general, Rosson says, sensate-preserving techniques work in one of two ways: through a skin-sparing or nipple-sparing mastectomy technique, or by connecting nerve tissues in the transplanted surface skin of the reconstructed breast. Rosson estimates that his group has succeeded in restoring some sensation in about one-fourth of their 300 breast reconstruction procedures over the past year.

No matter which procedure suits a patient best, says Rosson, virtually every approach is enhanced by his group's routine use of CT scan angiograms. By capturing each patient's tissues in advance, he explains, surgeons can more skillfully plan their approaches, decreasing operating room time while improving outcomes.

Call 443-997-9466 to refer a patient.

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