Opinion: Surgeon Collaboration Is Key to Mitigating Post-Mastectomy Chest Numbness 

An all-too-common — but not often talked about — side effect of mastectomy is chest numbness. In one study, 65% of patients consistently reported numbness in the 12 months after breast cancer surgery.¹

Thanks to advances in nerve repair surgery, there is hope for this statistic to improve, especially if breast surgeons and plastic reconstructive surgeons work together as a team to care for nerves in the breasts during surgery. Planning the incisions, finding the nerves, and addressing them together is the key. 

Establishing a routine and case flow requires some time upfront but quickly evolves into an organic rhythm that adds minimal time overall but may have a profound impact on patients’ quality of life. They shouldn’t have to live life feeling disconnected from a central part of their body.   

Collaboration should start before the first incision is made. Together, breast and plastic surgeons should review the patient’s information, including any preoperative imaging, as well as discuss the reconstruction type, incision types, and tumor location. 

The surgeons should discuss the potential for any nerve preservation during dissection, as well as which nerves must be cut but may be candidates for nerve allograft reconstruction.  

For a bilateral mastectomy and immediate reconstruction case, the breast surgeon can start the mastectomy while the plastic surgeon is available to help identify nerves and prepare for the reconstruction. 

Together, the surgeons can review any subcutaneous nerves deemed to be oncologically safe to preserve, as well as nerves that run through the breast tissue that must be removed and may be candidates for nerve grafting during the reconstruction. 

With the first mastectomy complete, the plastic surgeon begins the reconstruction and microsurgical nerve repair while the breast surgeon transitions to begin the contralateral mastectomy. Being across the table from each other allows each to continue their separate work while communicating about the nerves and details of the case.

It’s important for surgeons and patients alike to have reasonable expectations for regaining sensation, including an idea of the individual patient’s level of preoperative breast sensation. 

Performing mastectomies will always require cutting and removing tissue, including nerves. Therefore, sensation won’t be 100% of what it was before surgery, and it will take time for the grafted nerves to heal and regenerate, typically several months and up to 2 years. 

Keep in mind that every patient is different, and nerves are some of the slowest regenerating tissue in the body, growing around 1 millimeter per day.

As awareness about post-mastectomy chest numbness increases, more and more patients are asking for surgeons with experience in breast nerve repair surgery, also known as breast neurotization. 

Soon, we hope this will become the new gold standard because patients deserve to feel whole again after breast cancer. Together as a team, breast and plastic surgeons can work to make that happen. 

This article was written by Jonathan Bank, MD, and Craig B. Larsen, MD, in their personal capacities. The opinions expressed in this article are their own and do not necessarily reflect the views of Cancer Therapy Advisor or Haymarket Media. Neither author has any relevant disclosures.

Dr Bank is a board-certified plastic surgeon who practices at NYBRA Plastic Surgery in Great Neck, New York. Dr Larsen is a breast surgeon with New York Breast Health in Bronx, New York.  

Reference

1. Flowers KM, Beck M, Colebaugh C, Haroutounian S, Edwards RR, Schreiber KL. Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery. Pain Rep. 2021. 22;6(4):e976. doi:10.1097/PR9.0000000000000976