SENSATION PRESERVING MASTECTOMY

With over 16 years of experience as a plastic, reconstructive, and peripheral nerve surgeon, I have seen many aspects of this diverse and interesting field of medicine.  One particular area of passion and commitment is my focus on sensation-preserving mastectomy, a field I have been fortunate to develop and collaborate on with my wife Anne, herself an equally accomplished & talented plastic, reconstructive and breast surgeon.  Our partnership, both professionally and personally, has allowed us to develop a unique approach to breast surgery that truly sets us apart.

Following a mastectomy and most types of reconstruction, most women are completely numb because remarkably, little attention is paid to the nerves providing sensation to this important area of the body.  Historically, this lack of sensation following a mastectomy is the aspect of their medical journey with which women are most dissatisfied, often leading to long-term, negative psychological and emotional effects.  This lack of sensation is also important from a functional and safety standpoint because loss of protective sensibility can result in undetected wounds to the area, potentially having a severe and detrimental impact on any underlying reconstruction.

WHO IS A CANDIDATE FOR SENSATION PRESERVING MASTECTOMY?

Therefore, sensation-preserving mastectomy is a surgical procedure that is appropriate both for women undergoing cancer treatment for a previously-diagnosed malignancy or those patients who have elected to undergo a risk-reducing mastectomy for cancer prevention (i.e., a BRCA mutation carrier).

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.

First, nerves that provide sensation to the central breast mound can pass completely outside the breast tissue and if identified appropriately, can be completely preserved in some cases while simultaneously allowing for removal of the necessary breast tissue (see single figure).  Secondly, in yet other cases, the relevant nerve(s) are attached to the breast tissue such that at some point, for oncologic reasons, some portion needs to be removed.  In those cases, as much native nerve length is preserved as is safe and a downstream target is identified under the nipple/areolar complex.  Once the implant is in position, the nerve is reconstructed using nerve grafts (see triple figure below).  In virtually all cases, patients spend one night in the surgical facility before going home.  Following the operation, we carefully monitor patients on their road to sensation recovery with periodic evaluations. Neurosensory testing is repeated at specific intervals to monitor the extent and degree of sensation recovery. In addition, we have patients begin a sensory rehabilitation protocol designed to enhance nerve recovery several weeks after their procedure.

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.  These results have been published in several journals1-3 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, we need a new focus on the quality of life lived.  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.

  1. https://journals.lww.com/prsgo/fulltext/2023/12000/sensory_outcomes_after_neurotization_in.8.aspx
  2. https://journals.lww.com/prsgo/fulltext/2019/07000/nerve_preservation_and_allografting_for_sensory.30.aspx
  3. https://gs.amegroups.org/article/view/123498/html

MEMBER OF

SCHEDULE A CONSULTATION

We provide a range of emergency, medical, general, residential, and community health services.

SCHEDULE A CONSULTATION