Dual-Nerve Coaptation Improves Sensory Recovery in DIEP Flap Reconstruction

Mastectomy frequently results in a complete loss of breast sensation, a deficit that significantly impairs a patient's quality of life and body image [1, 2]. To address this, surgeons increasingly utilize flap neurotization (the surgical reconnection of donor and recipient nerves) to restore tactile and protective sensation [3, 4]. Meta-analyses of autologous reconstructions show that neurotized flaps significantly improve sensory outcomes, with one study of 662 reconstructions reporting a mean difference of -1.552 in Semmes-Weinstein monofilament scores (p = 0.0001) compared to non-neurotized controls [3]. In a double-blind randomized controlled trial of deep inferior epigastric perforator (DIEP) flaps, patients receiving coaptation of the second or third intercostal nerve demonstrated significantly better thermal recovery, as heat pain was imperceptible in only 10.3% of innervated flaps compared to 42.1% of non-innervated controls (p = 0.004) [5]. While techniques range from direct neurorrhaphy (the suturing of nerve ends) to the use of allografts or conduits, the optimal number of neural connections required for maximal sensory return remains a subject of clinical investigation [6, 1, 7].