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Sensation Preserving Mastectomy

Dr. Ziv Peled and his wife, Dr. Anne Peled have developed the innovative technique known as Sensation-Preserving Mastectomy. Many women are unaware and often not told that they are likely to be completely numb throughout their chest wall following traditional mastectomy procedures. Fortunately, this outcome is no longer inevitable. With Sensation-Preserving Mastectomy techniques, sensation can be manitained or restored so that numbness and chronic pain will not be constant reminders of your diagnosis.

FAQs

Sensation Preserving Mastectomy is a surgical technique performed during a mastectomy and implant breast reconstruction operation.  It allows surgeons to reconnect patients’ nerves that are cut during a mastectomy using nerve conduits or their own nerve tissue. Over time, the nerves regenerate and restore sensation to the breasts and nipple areolar complex.

Sensation-preserving mastectomies can be offered to those who are diagnosed with breast cancer or those who are at high risk for future breast cancer and are considering prophylactic mastectomy. Each person’s situation is unique, so an evaluation to determine the best choice for your mastectomy and breast reconstruction is key to coming up with an optimal surgical plan. Dr. Ziv Peled sees patients in-person and through virtual consultation (contact us here) to discuss options and take patients through their surgical journey.

The first step is usually to meet with Dr. Anne Peled who will determine if you are a candidate for a mastectomy or if other cancer treatment options such as a lumpectomy are more appropriate.  If a mastectomy is the appropriate oncologic choice, you will then meet with Dr. Ziv’s team who will explain the process for sensation preservation.

Drs. Anne and Ziv Peled were the first to publish data about this type of operation with implants. They have found that over 80% of women have sensation that is similar to what they had before surgery on sensibility testing, with many women reporting that they often forget they even had a mastectomy and reconstruction surgery because their reconstructed breasts feel so much like their breasts prior to surgery. 

Dr. Ziv Peled is out of network with all insurances expect for Medicare. In addition, most insurance companies still do not recognize this procedure as medically necessary although we are working diligently to change their minds.  We believe in transparency regarding any up front costs and part of the initial consultation will involve a discussion with our Sensation-Preserving Mastectomy Coordinator, Alejandra (alejandra@peledsurgey.com) who can explain the relevant financial details.

Why is this procedure so critical and unique?

The journey towards sensation-preserving mastectomy starts with a comprehensive history going over the background leading you to this decision. Because Drs. Anne and Ziv Peled see many patients from around the United States and internationally, this step can be done virtually. Wherever feasible, we schedule very specialized nerve testing to gauge your baseline sensibility in multiple areas of the breast, areola, and nipple.

The surgical procedure itself is performed at the same time as a nipple sparing mastectomy in a patient who has elected to have an implant-based reconstruction above the muscle. From a sensation/nerve perspective, the procedure is designed with a dual purpose.

The journey towards a Sensation-Preserving Mastectomy starts with a comprehensive history going over the background leading you to this decision. Because Drs. Anne and Ziv Peled see many patients from around the United States and internationally, this step can be done virtually. Wherever feasible, Dr. Ziv schedules very specialized nerve testing to gauge your baseline sensibility in multiple areas of the breast, areola, and nipple.

The surgical procedure itself is performed at the same time as a nipple sparing mastectomy in a patient who has elected to have an implant-based reconstruction above the muscle. From a sensation/nerve perspective, the procedure is designed with a dual purpose. First is to preserve nerves whenever possible if your anatomy is such that the relevant nerves pass outside the breast tissue. Second, if the nerves pass through the breast tissue and must be sacrificed for oncologic reasons, they are reconstructed so that sensation has an optimal chance of returning over the ensuing months.

At this point, we have performed over 700 sensation-preserving mastectomies. 6-12 months following their procedure, over 80% of patients demonstrate good-to-excellent sensibility on neurosensory testing. Moreover, many patients report erogenous sensation in the nipple/areolar complex and say that they feel like their pre-surgical selves. In addition, post-mastectomy pain which is unfortunately common following traditional mastectomy techniques, has been virtually eliminated. These results have been published in several journals (see references below) and Drs Anne and Ziv Peled lecture frequently both nationally and internationally about their work.

In summary, sensation preservation following mastectomy is not a luxury – it is essential for many reasons. Since patients can avoid cancer altogether with prophylactic mastectomy and others now live many years following their cancer diagnosis and treatment, a true focus on the quality of the life lived is essential. Having sensation following a mastectomy can significantly improve that quality of life for those who have to make the difficult decision to have that operation. It improves one’s feeling of connection with one’s body and can prevent damage to a numb area that might not otherwise be noticed, thus preserving the quality of the reconstruction as well. From self-esteem and body image to sexual health, preserving sensation plays a fundamental role in well-being. We have seen first-hand how our focus on sensation preservation significantly contributes to our patients’ overall health and recovery.

Please reach out to us if you wish to learn more about sensation-preserving mastectomies. We believe in a comprehensive, patient-centered approach to breast surgery and sensation preservation. Each patient is unique, and we tailor our strategies to meet their individual needs and goals. Our commitment extends from the initial consultation, through the surgical procedure, and into the recovery process. Our team is dedicated to providing our patients with the highest level of care and support throughout their journey, making sure they feel informed and confident every step of the way.

Sources:

  1. Peled, Anne Warren MD, von Eyben, Rie PhD, Peled, Ziv M. MD. Sensory Outcomes after Neurotization in Nipple-sparing Mastectomy and Implant-based Breast Reconstruction. Plastic & Reconstructive Surgery-Global Open 2023;11(12:) e5437
  2. Peled, Anne Warren MD, Peled, Ziv M. MD, Sensate Immediate Breast Reconstruction, Peled, Gland Surgery 2024;3(4) 552-560.
  3. Peled, Anne Warren MD, Peled, Ziv M. MD. Nerve Preservation and Allografting for Sensory Innervation Following Immediate Implant Breast Reconstruction. Plastic & Reconstructive Surgery-Global Open 2019; 7(7):p e2332,
  4. Rochlin, Danielle H. MD; Brazio, Phil MD; Wapnir, Irene MD; Nguyen, Dung MD, PharmD. Immediate Targeted Nipple–Areolar Complex Reinnervation: Improving Outcomes in Gender-affirming Mastectomy. Plastic and Reconstructive Surgery – Global Open 8(3):p e2719, March 2020.
  5. Hu, Allison C. MD; Makarewicz, Nathan S. BA; Sharma, Ayushi MD; Nguyen, Dung H. MD, PharmD. Impact of Nipple Areolar Complex Reinnervation on Sensory Outcomes Following Gender-Affirming Mastectomy. Plastic & Reconstructive Surgery-Global Open 12(1S1):p 63, January 2024.
  6. Remy, Katya MD; Packowski, Kathryn; Kozanno, Liana; Winograd, Jonathan MD; Carruthers, Katherine MD; Tomczyk, Eleanor MD; Austen, William Gerald Jr. MD; Valerio, Ian MD, MS, MBA, FACS; Gfrerer, Lisa MD, PhD. Intraoperative Anatomy and Postoperative Sensation of Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting. Plastic & Reconstructive Surgery-Global Open 11(10S):p 75, October 2023.
  7. Naides, Alexandra BFA1; Cece, John MD1; Doshi, Kathryn PA-C2; Keith, Jonathan D. MD, FACS, MD, FACS3,2. QS14. Neurotized Chest Masculinization for Improving Nipple Sensation: Survey Results. Plastic and Reconstructive Surgery – Global Open 10(6S):p 97, June 2022.