Abstract
BACKGROUND: Breast and nipple-areolar complex (NAC) sensation after breast reconstruction impacts postoperative quality of life. Autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBBR) are standard techniques. Neurotization has shown promise in improving sensory outcomes. METHODS: A computerized search was conducted on March 20, 2024, using the following databases: PubMed (1994-2024), MEDLINE (1996-2024), Embase (1988-2024), Web of Science (1997-2024), Scopus (2004-2024), and CINAHL (1994-2024). The following terms were used: "Semmes-Weinstein" and "mastectomy" OR "Semmes-Weinstein" and "breast reconstruction." Studies that reported objective results from Semmes-Weinstein monofilament testing by breast and NAC quadrant at least 12 months postoperatively were included. Statistical analysis was performed using multivariate regression analysis incorporating variables that were found to be significant on univariate regression analysis. This was followed by pairwise comparisons using Tukey tests to directly compare ABR, IBBR, and ABR with neurotization. RESULTS: Thirteen studies reporting on sensory outcomes of 764 reconstructed breasts met the aforementioned criteria. ABR with neurotization resulted in better sensation outcomes on the breast and NAC compared with either ABR or IBBR. When controlling for radiation, ABR without neurotization resulted in more sensate NAC region/central mound compared with IBBR. These findings suggest that ABR with neurotization following skin-sparing mastectomy results in better sensation at the new NAC compared with nipple-sparing mastectomy with ABR without neurotization. CONCLUSIONS: ABR with neurotization may result in superior breast sensation, which is associated with increased quality of life and satisfaction, compared with ABR without neurotization and IBBR.