SENSORY REINNERVATION OF AUTOLOGOUS TISSUE TRAM FLAPS AFTER BREAST RECONSTRUCTION

The use of the transverse rectus abdominis musculocutaneous (TRAM) fla p has come to the forefront for breast reconstruction following mastec tomy. Despite our ability to create surgically a supple breast mound, simulate the nipple with local skin flaps, and pigment the skin to cre ate an areola, one of the last drawbacks has been the reestablishment of normal sensation. Some patients have anecdotally reported some sens ory return in the reconstructed breast mound, We sought to quantitate the pattern of sensory return in TRAM flaps in 24 patients to identify factors that favor sensory reinnervation of the flap. Patients were r ecalled for sensory testing after unilateral or bilateral breast recon struction following mastectomy for cancer or premalignant mastopathy, The interval from surgery varied from 3 to 41 months. Sensation was ev aluated using the Semmes-Weinstein monofilament test, hot/cold recogni tion, and vibratory sensation measured in 16 segments of the reconstru cted breast mound and compared to the opposite, unoperated breast or t o volunteer controls. Thirty-four flaps were evaluated, The Semmes-Wei nstein measurements demonstrated measurable sensation in 32 of 34 flap s with 2 flaps developing sensation equal to the control unoperated br east, The return of hot recognition occurred in 21 of 34 flaps, cold r ecognition in 22 of 34 flaps, and vibratory sensation in 26 of 34 flap s, Our findings suggest that excellent sensory return occurs in the ma jority of patients via nerve ingrowth into the flap from the mastectom y bed, It would appear that a natural breast reconstruction with some sensation can be a reality for the majority of patients in the absence of additional complex surgical maneuvers such as nerve preservation o r nerve-nerve coaptation.