Thermal versus tactile sensory recovery following alloplastic and neurotized autologous breast reconstruction

Authors: Qin N, Gundlach C, Kochheiser M, McVeigh AB, Vaeth AM, Wei L, Zhang A, Arbuiso S, Chinta M, Wang ML, Huang H, Otterburn DM

Affiliation: Weill Cornell Medicine; Division of Plastic Surgery, New York

Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery. 2025;109:160-170

PMID: 40882602

Key takeaways

-Neurotized DIEP had better tactile recovery than alloplastic reconstruction.

-Alloplastic reconstruction had better cold and heat perception at later time points than neurotized DIEP.

Background

Breast sensation is important for quality of life. Neurotization has been shown to improve sensory outcomes in autologous reconstruction in the past, but thermal recovery has been less studied.

Methods

• Design: Prospective, single-surgeon, single-institution cohort study from 2019-2024.

• Cohorts:

  • Immediate neurotized DIEP flap after mastectomy. Neurotization using thoracoabdominal nerve (T10/11/12) coapted to third intercostal nerve.

  • Two-stage implant-based reconstruction after mastectomy

• Outcomes:

  • Tactile sensation: pressure-specified device across 9 breast regions, converted to 0-100 scores.

  • Thermal sensation: correct identification of hot 52°C and cold 12°C stimuli across 5 regions.

  • Postoperative outcomes measured at 4 different time points (1-6 months, 6-12 months, 12-24 months, and 24-48 months).

• Exclusions: Preoperative or postoperative radiation, peripheral neuropathy, and complications causing flap or implant loss.

Results

• 269 total patients: 123 patients in DIEP cohort, 146 patients in alloplastic cohort.

• Characteristics were similar between cohorts, but DIEP patients had higher BMI and larger preoperative cup size.

• Adjusted tactile sensation favored DIEP at 1-6 months, 6-12 months, and 12-24 months; the 24-48 month difference narrowed and was no longer statistically significant after adjustment.

  

• Thermal sensation:

  • Cold perception: No early difference, but alloplastic outperformed DIEP later:

    • 12-24 months: 65.0% vs 48.6%, P = 0.040

    • 24-48 months: 83.3% vs 57.1%, P = 0.001

  • Heat perception: No early difference, but alloplastic outperformed DIEP later:

    • 12-24 months (77.3% vs 54.3%, P = 0.024)

    • 24-48 month trend persisted but was not significant.

Conclusion

In uncomplicated, nonradiated patients undergoing immediate reconstruction, neurotized DIEP restored tactile sensation better than two-stage alloplastic reconstruction, whereas alloplastic reconstruction showed better temperature perception at later time points. Although these thermal findings were underpowered, they underscore how incompletely we understand the complex biology of sensory recovery.