Restoring Breast Sensation After Mastectomy

By Constance M. Chen, MD, MPH

Each year in the United States, more than 100,000 women have mastectomies. Advances in surgical techniques today offer women the hope of a soft, warm breast that may look similar and feel much like her original breast, especially if she undergoes natural tissue breast reconstruction. As a result, more and more women now choose breast reconstruction, either at the time of the mastectomy or later. However, in some cases, women who undergo breast reconstruction learn that the natural “look and feel” of her restored breast actually relates to how the breast will look and feel to someone else. Some women report that their reconstructed breasts do not feel at all natural to her and moreover that the reconstructed breast lacks all feeling and is completely numb to touch and sexual arousal. 

The prevalence of social media and zoom conferences has led some women to be more self-conscious about how they look. While our capability to reconstruct a woman’s breast after a mastectomy has come a long way, the emphasis has been on rebuilding her appearance, with less focus on how she feels. In fact, after mastectomy, many women discover that their breasts are numb – a reality for which they were unprepared. The positive news today is that new techniques in breast reconstruction allow specially trained surgeons to reconnect nerves with the possibility of restoring sensation.   

Why the loss of sensation

In a mastectomy the nerves that provide feeling to the breast and nipple are cut, resulting in a loss of sensation in the remaining skin, regardless of whether or not the woman undergoes breast reconstruction. In the case of breast reconstruction using implants, the artificial breast implant may actually form a physical barrier that prevents nerves from growing through it to reach the skin. However, with natural tissue breast reconstruction, microsurgeons can suture together nerves from a woman’s own tissue to create a new sensate breast. In these cases, rejoining blood vessels and nerves allows them to grow through the transferred tissue to reach the skin and increase the potential return of sensation.

There are different types of sensation – deep pressure, light touch, pain, and temperature – and they each come back at different rates. Deep pressure sensation usually returns most quickly and temperature most slowly. Moreover, regenerated nerves can take months or even years to reach the skin, and the quality of sensation is variable. Since nerve growth is slow and the return of sensation is not ensured, not all surgeons prioritize reconnecting the nerves to restore sensation. However, taking the time in surgery to carefully repair the nerves can result in the return of feeling and improved sensation. Innovative microsurgical techniques that use neural tubes and nerve grafts have provided some patients with excellent sensation and even erectile function of the nipple.

Restoring sensation is on the frontline in breast reconstruction. Sensory restoration can help a woman feel more normal after mastectomy. Each woman will have a unique experience and result, but it is important for surgeons to do their best to restore a woman’s body as fully as possible to help her regain her health and sense of self.

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Chief of Microsurgery at New York Eye and Ear Infirmary of Mount Sinai. She is also Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com