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"Sensory Outcomes for Nipple-areola Complex Reinnervation" скачать в хорошем качестве

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"Sensory Outcomes for Nipple-areola Complex Reinnervation"

“Prospective Sensory Outcomes for Targeted Nipple-areolaComplex Reinnervation in Gender-affirming Double IncisionMastectomy With Free Nipple Grafting’ Reviewed by Reza Lankarani M.D Volume 282, Number 1, July 2025 DOI: 10.1097/SLA.0000000000006192 Annals of Surgery Summary: This prospective cohort study by Remy et al. (2025) presents a significant contribution to gender-affirming surgery by rigorously evaluating the novel technique of Targeted Nipple-Areola Complex Reinnervation (TNR) during double-incision mastectomy with free nipple grafting (FNG). The primary strength lies in its comprehensive, prospective design, meticulously tracking sensory outcomes (quantitative monofilament testing and patient-reported questionnaires) in 25 patients (50 mastectomies) at multiple time points up to 12 months postoperatively. This longitudinal approach robustly demonstrates that TNR facilitates restoration of NAC and chest sensation to baseline within 3 months, with significant improvement over baseline observed at 12 months – a finding with profound implications for patient quality of life. Furthermore, the study provides crucial, previously unavailable anatomical data on intercostal nerves (ICNs), confirming comparable axon/fascicle counts across branches (3rd-6th lateral ICNs) and establishing a median of 2 nerves utilized per mastectomy. The analysis linking surgical technique to outcomes is particularly valuable; it conclusively shows that direct coaptation of ≥2 ICN branches to the NAC yields superior and faster sensory recovery compared to using allografts alone or coapting only a single branch. Results: A median of 2 ICN branches were found and used per mastectomy. Preoperatively, a higher Body Mass Index (BMI \ge30 g) and mastectomy weight (\ge800 g) were associated with significantly worse sensation. Postoperatively, NAC sensation was initially worse at 1 month but comparable to preoperative values at 3, 6, and 9 months, and significantly better at 12 months. Chest sensation followed a similar trend, becoming significantly better at 12 months. Direct coaptation of the ICN to the NAC resulted in significantly better NAC sensation compared to using allografts only. Utilizing two or more ICN branches for direct coaptation led to superior sensory outcomes compared to a single branch. At 12 months postoperatively, 95.6% of patients had equal or improved NAC monofilament values, and 100% had equal or improved chest skin sensation. Patient-reported outcomes showed good subjective return of sensory functions, with 88% of patients reporting a return of some degree of erogenous sensation at 12 months post-surgery. Nipple hypersensitivity decreased over time, from 42% at 3 months to 8.0% at 12 months. Chronic pain was reported in 32% of patients throughout the study period, decreasing to 10% at 12 months, while phantom pain was absent at 12 months. It demonstrates TNR effectively restored NAC and chest sensation within 3 months postoperatively. The study concluded that using multiple ICN branches and direct coaptation techniques yielded the best sensory outcomes. Future Directions : Comparative trials against pedicle-sparing techniques and integration with MIS platforms could refine TNR’s role. Additionally, exploring cortical reorganization post-TNR using neuroimaging might elucidate mechanisms behind erogenous sensation recovery. In conclusion, Remy et al. have provided robust prospective data supporting the efficacy of targeted nipple-areola complex reinnervation in improving sensory outcomes after gender-affirming mastectomy with free nipple grafting. The study's strengths lie in its detailed methodology and comprehensive sensory assessment, particularly its focus on multiple nerve coaptation and patient-reported erogenous sensation. While generalizability might be limited by its single-center nature and lack of a concurrent control group, this research undoubtedly sets a new benchmark for sensory preservation in GAM and will serve as an important reference for future studies and clinical practice. Further multicenter studies with larger cohorts and longer follow-up are warranted to solidify these promising findings and refine surgical protocols. Reza Lankarani M.D #sensoryoutcomes #nipple-areolacomplex #reinnervation #doubleincisionmastectomy #freenipplegraft #breastreconstruction #nervepreservation #breastsurgery #sensoryrecovery #mastectomytechniques #nipplesensation #breastcancersurgery #reconstructivesurgery #nerveregeneration #aestheticbreastreconstruction #rezalankarani #Lankaranimd #DrLankarani @RezaLankaraniM.D https://lankarani.substack.com/p/prospecti...

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