The Plastic Surgery Room
Neurotization of the Reconstructed Breast — Restoring Sensation After Mastectomy, One Nerve at a Time
Aug 4, 202622 min
The reconstructed breast looks like a breast. It feels like a foreign object. One intercostal nerve, one nerve coaptation, and 12 months of patience might give her back sensation — or might not. The intercostal nerve anatomy from T2 to T6, why mastectomy destroys sensation, the DIEP flap's thoracodorsal nerve and why it does not naturally innervate the breast, direct coaptation versus nerve graft versus nerve transfer, the sural nerve harvest and permanent calf numbness, the 3–6 month delay before sensation returns, monofilament testing and sensory recovery quantification, neuroma formation at coaptation sites, patient expectations and realistic outcomes, and the 12–24 month timeline before sensory plateau.
