This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.
Question: Is your team capable of reconnecting nerves as well as oxygenated blood supply during DIEP flap?
Answer: Yes, any DIEP surgeon is easily capable of connecting nerves, if the situation is favorable. Firstly, DIEP flaps must be designed based on optimizing the blood supply, not the nerves – otherwise, the flap would not survive. Having said that, many, but not all, DIEP flaps will have a usable sensory nerve as part of the flap, which can be connected to an intercostal or pectoral cutaneous nerve during the procedure, if the geometry of the flap is favorable for it.
If the flap has a useful sensory nerve which will not reach the intercostal nerve, a nerve graft can be used to bridge the gap, but this takes additional time, and could potentially impact the overall flap success rate.
Connecting nerves is technically significantly less demanding than connecting blood vessels, but the results are less consistent – even in the face of what looks like a technically adequate nerve repair, the nerve fibers may not grow through the anastomosis, resulting in a “nerve success rate” significantly less than the 99% vascular success rate obtained by most DIEP surgeons.
Achieving erogenous sensation in a reconstructed breast is a very worthwhile goal, and I am sure that progress will continue to be made in this area. However, while we are happy to attempt it if the patient desires it, we do not want to overstate the chances of success.
Thanks again for your question!
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