Studies highlight varied reconstruction goals and newer sensation-preserving mastectomy techniques

Women undergoing breast reconstruction after mastectomy have varied goals for the procedure that may not be limited to physical restoration, according to findings reported in Clinical Breast Cancer. Starting in 2018, some surgeons began using new techniques to preserve and repair sensory nerves in the chest during a mastectomy or a delayed breast reconstruction surgery, and they found that, for some, the techniques could successfully restore sensation in the breast area and nipples and prevent chronic pain from nerve damage.

A cross-sectional, mixed-methods analysis evaluated the goals of breast reconstruction for women who had participated in the preference arm regarding reconstructive technique of the GoBreast II trial (NCT06195865), conducted at a university hospital in Sweden. Before surgery, patients had participated in a PEGASUS consultation to clarify their goals. The research team assessed comparisons involving reconstructive technique, timing, and mastectomy indication.

A total of 89 women participated in the study, and they had a median age of 48 years, with a range of 26 to 72. Most patients, 60%, were undergoing therapeutic mastectomies, while 40% were undergoing risk-reducing mastectomies. In total, 36 participants were undergoing bilateral risk-reducing mastectomy and immediate breast reconstruction, 11 were undergoing unilateral therapeutic mastectomy and immediate breast reconstruction, and 42 were undergoing unilateral therapeutic mastectomy and delayed breast reconstruction.

The researchers identified five main categories of goals: achieving a feeling, just wanting the breast back, aesthetic wishes, practical matters, and the process. Achieving a feeling and just wanting the breast back were the most prominent categories. Goals related to aesthetic wishes were reported at a higher rate among women choosing implant-based reconstruction compared with those who chose autologous reconstruction (P = .049). Those who chose to delay reconstruction expressed more goals associated with practical matters, compared with those undergoing immediate reconstruction (P < .001).

Women who were undergoing bilateral mastectomy for risk reduction tended to express goals more related to aesthetic wishes (P = .004), and fewer goals related to practical matters (P < .001), than were observed among women undergoing unilateral therapeutic procedures. The findings provide a foundation for future research, including longitudinal studies that link preoperative goals to postoperative satisfaction, psychosocial outcomes, and quality of life.

Many people who get a mastectomy are surprised and distressed to find that afterwards they have little to no feeling in their chest because the nerves that provide sensation to the breast and nipple are cut or damaged when the breast tissue is removed in the traditional way. This can result in permanent chest numbness and in some cases pain from nerve damage. Sensation-preserving mastectomies are a newer option that is still being studied and refined, and among surgeons there is some disagreement about how well it works.

The biggest question surrounding sensation-preserving mastectomies is whether they help restore enough sensation. There have not been long-term studies yet looking at recurrence rates in people who had sensation-preserving mastectomies because the procedures are so new, although most surgeons say they consider the procedures to be safe. More breast and plastic surgeons are getting trained in how to do sensation-preserving mastectomies, but the procedures are not widely available yet.

Where they are available, many people who are getting a mastectomy are candidates, depending on the location and stage of any tumors in the breast. The surgery is most commonly done in people who are getting a nipple-sparing mastectomy and breast reconstruction with implants or flaps. Usually it is done at the time of the mastectomy, though it can also be done in a separate surgery, typically a flap reconstruction procedure, up to a year later.