Saving sensation after a mastectomy

For many womencopingwith breast cancer, a loss of feeling in their breasts after a mastectomy isa common side-effect.

However, Sydney's Chris O'Brien Lifehouse hospital is trying to change that, leading the way with ground-breaking sensation-preserving surgery.

Dr Joe Dusseldorp, a specialist plastic and reconstructive surgeon, said the procedure aimed to help women retain as much sensation and feeling in their breasts as possible.

"Sensation-preserving surgery involves efforts from both the breast surgeon and the plastic surgeon to preserve the sensory nerves that supply the skin of the breast, and to minimise the numbness that can occur after mastectomy," he said.

"When the nerves have to be sacrificed due to the location of a breast cancer, then a plastic surgeon may be able to reconstruct those nerves in an effort to restore some feeling to the breast that may otherwise have been lost."

Dr Dusseldorp said it was "very common" for women to experience numbness after having a mastectomy – which can be a partial or full removal of the breast.

"In some cases, this is only temporary, but in many cases, this is permanent numbness," he said.

"This can be particularly evident when having radiotherapy and breast reconstruction with implants or tissue expanders, as the feeling of the breast is less likely to recover in this scenario."

Dr Dusseldorp said the team at Chris O'Brien Lifehouse offered an alternative to implants known as DIEP flap, which uses the patient's stomach tissue to reconstruct the breasts.

"We expect the sensation of the reconstructed breast to be superior when using the DIEP flap, and improved slightly when reconstructing nerves at the same time," he said.

Sensation-preserving surgery takes a little longer to perform, but there is no difference in recovery time for the patient.

"The surgery itself may be slightly longer because of the need to identify the tiny sensory nerves, and to use microsurgical techniques to reconstruct them," Dr Dusseldorp said.

"As Associate Professor Cindy Mak has said, 'What may be an additional 20-30 minutes in the operating room is a woman's entire life of sensation'. 

"Our opinion is that refining efforts to improve sensation is a worthwhile endeavour."

While the data available on how successful the surgery can be remains unclear for now, Dr Dusseldorp believes it is making a difference to women's lives.

"Efforts are underway to study this scientifically," he said.

"Butit is clear from talking to women who have undergone mastectomy that sensation of the breast is very important to them and any efforts we can make to try to improve this outcome are appreciated."

He said Chris O'Brien Lifehouse had been supportive of the surgical technique, helping to spread information about the early results at research meetings. 

"It's not clear how many centres are offering sensation reconstruction at the time of breast reconstruction," Dr Dusseldorp said.

"There are certainly many surgeons who perform this technique routinely around the world and as it becomes more well understood it will be more commonly performed.

"Sensation-preserving surgery is just one of many innovative approaches that surgeons at Chris O'Brien Lifehouse are currently undertaking. 

"As a group, our goal is to improve the experience of breast cancer and the outcomes following breast reconstruction for women undergoing mastectomy."

Read more: Helping cancer patients to rebuild their lives

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