What happens during implant breast reconstruction with Resensation^®?

Nerves may not be the first thing on your mind when you’re facing mastectomy and breast reconstruction. Nerves in your breast tissue allow you to feel sensation in your chest, but after mastectomy, many people are surprised to find that one side effect—partial or full numbness in the breast—is permanent.¹ Read more about why this happens.

Without sensation, you may not be able to feel a hug, a cool breeze or a soft blanket. This numbness can also pose a safety hazard, leaving you unable to feel a sunburn or splatters from a hot stove due to a lack of protective sensation.^2,3

But you might not have to accept sensation loss as your new normal after mastectomy. A surgical technique called Resensation, or breast nerve repair, allows plastic surgeons to repair a nerve cut during a mastectomy as part of an implant breast reconstruction. This gives the nerve a chance to regenerate, which, over time, may return some level of sensation.

Understanding breast nerve anatomy and mastectomy

A basic understanding of nerve anatomy can be helpful. There is an intricate network of sensory nerves along the outside edge of your ribcage. These nerves run through your skin and breast tissue and provide sensation to the breast, nipple and areola (Figure 1). When a mastectomy is performed, a breast surgeon must inevitably transect (or cut) and remove the nerves that run through the breast tissue. Unfortunately, there’s no way to remove breast tissue without cutting nerves, even in a nipple-sparing mastectomy (Figure 2).^2,3 Read more about the impact on nerves during a mastectomy.

How does implant breast reconstruction with Resensation work?

Two different surgeons will perform the mastectomy and implant reconstruction with Resensation, working together as a team throughout the procedures.

First, the breast surgeon will perform the mastectomy with careful dissection. During the mastectomy, the breast surgeon looks for nerves and identifies a potential grafting option for the plastic surgeon to perform Resensation. When possible, they will aim to preserve as much length of the identified intercostal nerve as is safe and appropriate (Figure 3). The location of this nerve can vary from person to person based on breast size or other differences in anatomy.³

Once the mastectomy is complete and nerve target is identified, the plastic surgeon will get started on the breast reconstruction and Resensation. The plastic surgeon will place a breast implant or tissue expander and performs Resensation by connecting a nerve allograft between the identified nerve targets using microsurgical techniques. The nerve allograft acts as a bridge between the gap of a cut nerve on the chest wall and the cut nerves in the breast or nipple and areola (Figure 4). Final breast reconstruction adjustments are then made by the plastic surgeon to complete the operation.

The purpose of the nerve allograft is to provide the necessary structure and environment that your nerve fibers need to regrow. As the nerve fibers regenerate through the allograft, it becomes part of your own body, and you may regain some level of sensation (Figure 5).

How do nerves regenerate?

It’s likely and normal that you will experience a period of numbness after surgery, but your body will be hard at work beginning the healing process. Nerves regenerate slowly and it will take time for them to regrow. You may start noticing sensation returning several months after surgery, with feeling continuing to develop for up to two years.⁴ Some patients report this can feel a little weird at times. It’s normal to feel small shocks or zaps at first. That may be good news and a sign that your nerve is starting to work again.

Breast sensation is different for everyone prior to mastectomy and it’s unlikely that you will return to the same level of sensation you had before surgery. The amount of sensation regained may depend on a variety of factors, including your diagnosis and treatment plan, age, anatomy, and whether your reconstruction is immediate or delayed. In addition to implant-based breast reconstruction, Resensation may be possible during autologous flap reconstruction, aesthetic flat closure and some revision implant reconstruction procedures.

Your doctor may ask you to support your recovery by performing a sensory retraining protocol. Sensory retraining is a set of simple exercises designed to encourage your brain’s ability to create new neural pathways as your nerves heal. It can also help you reconnect with your body after surgery. To learn how it works, read our guide or watch the how-to video.

By repairing sensory nerves, Resensation enables nerves to regenerate and potentially restore sensation to the chest—so you can feel more like yourself again.

As you consider your breast reconstruction plan, keep in mind that not every surgeon offers Resensation. If you are interested in taking the next step and discussing your options with a Resensation surgeon, you can find a trained provider through our surgeon locator tool.

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References

1. Crohan S, Campbell A. Breast sensation research report. Inspired Health. October 2020. Report on file at Axogen (MKTG-0302 R00).
2. O’Neill RC, et al. Modern approaches to breast neurotization. Clin Plast Surg. 2023;50(2):347-355. doi:10.1016/j.cps.2022.10.003
3. Coopey S, et al. Careful where you cut: strategies for successful nerve-preserving mastectomy [published correction appears in Plast Reconstr Surg Glob Open. 2024 May 28;12(5):e5943. doi: 10.1097/GOX.0000000000005943]. Plast Reconstr Surg Glob Open. 2024;12(5):e5817. Published 2024 May 15. doi:10.1097/GOX.0000000000005817
4. Yano K, et al. Breast reconstruction using the sensate latissimus dorsi musculocutaneous flap. Plast Reconstr Surg. 2002;109(6):1897-1903. doi:10.1097/00006534-200205000-00018

 

This information, including illustrations, is noncommercial, provided for educational purposes only and does not constitute medical advice or substitute for professional medical advice. Always talk with your healthcare provider before starting sensory retraining. The level of sensation restored following use of the Resensation technique may vary and cannot be guaranteed, due to unique anatomy and other considerations. Please consult your surgeon for more detailed information.

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