Nipple reinnervation (nerve grafting)
Has anyone had this done? Can you tell me where, and what your experience has been as far as nipple sensation? And to be very frank, specifically sexually related sensation?
I'm very interested in having this procedure if I am able to keep my nips, but so far I have not located a surgical team near me (in the DC area) that is doing it. If I travel for surgery, I would probably have to pay for it out of pocket, so I'm trying to determine how likely I am to have an outcome that would justify the extreme expense of doing so.
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Sleepylibrarian - My microsurgeon will be performing procedure called Resensation on me https://www.resensation.com I unfortunately do not have my nipples, but I believe that is what you are referring to.
I'm curious to hear if anyone has had experience with this as well.
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My nipple sparing DMX included nerve grafting with a donor graft to the 4th intercostal nerve. This was only my plastics' second surgery and my breast surgeon's first. He estimated 6-12 months for the nerve to grow, possibly longer. I had pressure sensation after surgery (hugs were not blank nothings that I feared), feeling around the edges of the breasts and a little on the top of my non cancer breast. Sometimes tissue expansion pricks hurt. At 3 months (which just happened) I started to get back feeling in my nipple when they are erect and there is a dragging sensation, like a washcloth or a tongue (TMI!). I have to be paying attention and reduce other stimuli to be aware of it. It is not sexual at all. No temperature detection either. Still, emotionally this was a really really good thing and I am hopeful for more in the future.
My understanding is that the Da Vinci mastectomies being done through clinical trials are naturally less destructive (while oncologically awesome) and save sensation automatically. Also, the nerve sparing vs. nerve grafting done by the very busy Peled team in San Francisco has very good outcomes with direct to implant. Neither of these were options for me in Massachusetts and my insurance. So, this is what I got and I am hopeful for something.
I found Dr Cassileth plastics blog post to be very interesting on the topic if you google it since I cant post a link.
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The Peleds call the surgery nerve-sparing, but it is exactly the technique you described: a donor graft reattaching the nipple to the fourth intercostal nerve, which supplies the majority of sensation to the nipple and areola. That nerve pokes out from the muscle at your fourth rib, and runs right up the middle of the breast to the nipple, so there is no way to avoid severing it during surgery, but they preserve as much length as possible and then use the donor nerve to make up the difference.
They are also careful to preserve the subcutaneous fatty layer under the skin so as not to damage the nerves that run through that. In theory, any skin sparing mastectomy should preserve these, but some surgeons scrape this layer too thin and damage the nerves in that process.
Where in Mass did you have yours done? I've seen publications from Harvard teams at Mass General and Brigham and Women's, so I'm curious to know if it has spread past those specialists. I know of only seven or eight places in the country to get the surgery right now, but I'm hoping more surgeons are actually offering it and just not "advertising" it.
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Mine was done at Baystate in Springfield, MA and both my breast surgeon and plastics were in the OR together for the whole day. My anatomy is actually fairly unusual and my never was NOT located in the expected place. It was higher up requiring a longer graft. It look them quite a long time to find it on my non cancer side and then it was in the same darn place on my cancer side (being the right nerve was confirmed with pathology as they sent a snip to them). That also added a lot of extra time to the surgery (scheduled for 8 and done in 11). I am sure if they knew that going in... I would not have been a candidate. I saw my plastics yesterday and he hasn't done any more since - maybe still recovering from me.
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I didn't have any nerve spearing surgery that I know of but I do want to say that my double mastectomy has way more feeling than I anticipated. I couldn't save the nipples but I have a lot of feeling around the skin area. A good surgeon with or without specific nerve spearing surgery can do wonders. I had no pain, easy healing with very little bruising, the skin saved looks fantastic, and ironically more feeling in my cancerous one than the other. No idea why but maybe it's just healing sooner. I'm about seven weeks out of surgery. Just an FYI. My reconstruction will be early next year and my plastic surgeon thinks I'll have a great cosmetic result due to the skill of my surgeon.
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kaynotrealname,
Most women who have mastectomies, particularly skin sparing, do regain skin sensation as the skin is still there and the nerves recover. It really has less to do with a “good surgeon” than the fact that your skin, is still there and will recover just like skin at any other surgical site (there may still be some numbness). I have skin sensation on my “breasts” as well as my remaining nipple, but no deeper sensation as there is no underlying breast tissue. I think sleepylibrarian is writing about a very different thing which is relatively new and a fascinating development.
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