Why Feeling is Lost After Mastectomy and How Sensation Can Be Restored

By Constance M. Chen, MD, MPH

Autologous reconstruction – using a woman’s own tissue to create a new breast – has become the “gold standard” for breast reconstruction, either immediately following mastectomy or later. Nipple-sparing mastectomy with autologous tissue breast reconstruction delivers a soft, warm, natural breast that is often barely distinguishable from a woman’s original breast.

Sometimes, however, the natural look and feel of the reconstructed breast may be more apparent to others than it is to the woman herself. While pleased with the appearance of her new breasts, some women are disappointed to realize that to her reconstructed breast is numb to touch and sexual arousal.As breast reconstruction techniques have been developed, the emphasis until now has been on how the woman would look. The next frontier in reconstructive surgery is to reconnect nerves and restore sensation to the breast. New techniques show great promise and many women are now experiencing varying degrees of restored feeling.Here are my answers to questions about loss and restoration of feeling in reconstructed breasts.

“Why is feeling lost after mastectomy? Can it return?”

During a mastectomy, the nerves that provide feeling to the breast and nipple are severed, causing loss of sensation in the remaining skin. Some women experience a limited return of sensation over time, dependent in part on the type of reconstruction they have. Implants form a physical barrier that prevents nerves from growing through to the skin. Autologous reconstruction, which transfers blood vessels and nerves along with fat and skin, offers the best opportunity for nerve regeneration since nerves are more likely to grow in natural tissue.Of the four different types of nerve sensation – deep pressure, light touch, pain, and temperature – deep pressure sensation returns most quickly and temperature most slowly. But nerves grow very slowly and even when the regenerated nerves reach the skin after months or years, the quality of sensation is variable.

“How can sensation be restored?”

Because nerve regeneration is slow and results are unpredictable, reconnecting nerves has not always been a surgical priority. But new, meticulous microsurgical techniques that use neural tubes and nerve grafts have enabled surgeons to offer each woman the best possible chance for restoration of feeling.Two specific methods of autologous reconstruction offer the best opportunity for successfully reconnecting nerves via a procedure called neurorrhaphy, a microsurgical technique that attaches two nerves. In perforator flap breast reconstruction, the skin, fat, and blood vessels (the “flap”) are transferred from a donor site, often the abdomen or upper inner thighs, to create the new breast. During the flap surgery, a sensory nerve that provides feeling to the lower abdominal skin can be included and transferred with the flap to the chest. Surgeons specially trained in this technique can then connect this nerve to nerves that were severed during the mastectomy. This additional surgical step has shown great promise in restoring feeling better and faster than waiting and hoping for nerves to regenerate.

“How can I ensure that I have the best possible chance to have feeling restored?”

One of the most distressing aspects of loss of feeling is that many women were assured that their reconstructed breast would look and feel natural but weren’t told that they would lose most or all of the feeling in the breast.

The importance of the return of sensation is different for every woman and should be discussed in the initial surgical consultation so she knows what to expect and has the opportunity to ensure that her surgeon is trained in the techniques that will provide the best outcome.

What constitutes feeling “herself” again after breast cancer is an individual matter that has both physical and emotional aspects. Our responsibility to each patient is to ensure that her expectations are realistic and to offer her choices that let her decide what is the best way for her to regain her confidence and preserve her 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 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.