Breast reconstruction is the process of rebuilding the breast mound following a mastectomy, often performed due to cancer or for risk reduction. While modern surgical techniques achieve aesthetically pleasing results, the restoration of physical sensation remains a profound concern for many patients. The loss of feeling is a significant psychological and physical element of recovery, affecting body image, intimacy, and overall quality of life. Whether a reconstructed breast can feel is complex, depending heavily on the type of surgery performed and the body’s natural ability to heal.
The Baseline Sensory State After Mastectomy
A standard mastectomy results in a near-total loss of sensation in the chest area, causing numbness. This sensory deficit occurs because the procedure severs the primary sensory nerves, mainly the intercostal nerves, which supply the breast skin and nipple. Cutting these nerves disrupts the communication pathway that transmits sensory signals to the brain.
The loss of sensation includes fine-touch feeling and protective sensation. Protective sensation is the ability to feel pain, heat, or cold, which guards against injury. Although the skin tissue remains, its connection to the central nervous system is broken, leaving the area functionally numb.
How Reconstruction Type Influences Sensation
The choice of reconstruction method significantly impacts the potential for sensory return. Autologous tissue procedures offer a better natural pathway for nerve regeneration than implant-based methods.
Implant or tissue expander reconstruction relies on the existing skin envelope stretching over a synthetic device. This skin, already denervated during the mastectomy, has a limited capacity for nerve regrowth. Any sensation that returns is usually peripheral, stemming from nerves growing in from the edges of the chest wall.
Autologous, or flap, reconstruction, such as the DIEP (Deep Inferior Epigastric Perforator) flap, involves transferring tissue from another part of the body to create the new breast mound. Although this transferred tissue is initially numb, it provides a more regenerative environment than an implant. Nerves from the chest wall can eventually grow into the transferred flap tissue, gradually restoring some feeling.
Surgical Techniques for Nerve Restoration
Specialized surgical techniques, known as neurotization or sensory nerve grafting, can be performed to proactively improve sensation beyond passive nerve regrowth. This procedure is most commonly performed during autologous reconstruction, but it is increasingly adapted for use with implant-based procedures. The goal is to create a bridge for severed nerves to regrow into the new breast tissue.
The process involves identifying a sensory nerve cut during the mastectomy and surgically connecting it to a donor nerve. In some flap procedures, a sensory nerve traveling with the transferred tissue is coapted (reconnected) to a nerve remnant in the chest wall. Alternatively, a nerve allograft (processed donor nerve tissue) or a small, non-essential sensory nerve from the patient may be used to bridge the gap. This specialized step can significantly improve the speed and quality of sensory recovery compared to reconstruction without nerve repair.
The Quality of Returning Sensation
Sensation recovery is a slow process, as nerve fibers grow at a rate of approximately one to two millimeters per month. Therefore, the return of feeling can take many months to several years to reach its maximum extent. The sensation that returns is often not the same as the feeling the breast had before the mastectomy.
Patients commonly report paresthesia, such as tingling or “pins and needles,” which are signs of active nerve regrowth. Dysesthesia, or unpleasant/painful sensations, can also occur as the nerves heal. The primary goal of nerve restoration is the return of protective sensation, allowing the patient to detect pressure, pain, or temperature changes. While some patients report improved fine-touch sensation, the return of erogenous or highly sensitive feeling is rare, even with nerve grafting.