Alex N. Mesbahi, MD

There is hope in breast cancer care. While an active diagnosis or genetic testing results can still bring an onslaught of emotions and decisions, a lot more is possible today than once was.

Patients no longer have to accept a one-size-fits-all care plan approach. With advancements in therapeutic and surgical options, removing cancer or decreasing its risk is now much more effective. And with survival rates increasing, it’s becoming more and more important that patients know what quality of life post-surgery means for them.

One area I talk with my patients about is post-mastectomy chest numbness and the importance of sensation. Being able to feel is something many of us take for granted — until we can’t feel part of our bodies anymore. Think of when you’ve been to the dentist and left with a numb mouth. It’s annoying that your mouth might feel like it’s really swollen, you can’t feel if it’s fully closed or that there might be food on your face, but the annoyance goes away after a few hours as the feeling starts to return.

Imagine if it didn’t return. Imagine that feeling — or lack thereof — being permanent and spanning a larger part of your body. A part of your body that is deeply tied to your sense of self. Its effects can be devastating.

A life-changing surgical advancement I bring to my patients is breast neurotization. It has the potential to mitigate post-mastectomy chest numbness, restoring sensation to the chest over time. If you’re having a mastectomy and considering what options might enable your best quality of life, here’s what you need to know.

Why Breast Neurotization Is Worth Considering

Nerves are what allow us to feel touch, temperature, pain and pressure. When cut or damaged, they can’t send the accurate signals to our brains that we need to safely navigate and connect with the world around us.

I often put the roles that sensory nerves play into two categories: protective sensation and intimate sensation.

Mesbahi emphasized the importance of receiving breast neurotization for breast cancer survivors who underwent mastectomies. 

Intimate sensation tends to be the one that most people think of first. It’s the feeling of a child or loved one’s head on your chest, the feeling of a hug or the feeling of more intimate moments with a partner. It’s what enables us to connect with others and ourselves.

Protective sensation helps keep us safe. Because of it, we’re able to feel when a sunburn is happening, if a curling iron touches our skin or if we’re being pinched or rubbed by our clothing. Without it, we’re at a higher risk of experiencing everyday injuries that are avoidable.

Patients who are living with post-mastectomy chest numbness have shared they feel like part of them has been deleted; that their numbness is a daily reminder of what they went through. With breast neurotization, this no longer has to be a reality we accept — restoring sensation is possible.

In breast cancer care, we’ve long perfected reconstruction options that can help patients look like themselves again. We’ve focused on form. And now, we can focus on function too, by restoring sensation with breast neurotization. Here’s some foundational information to know.

Breast neurotization is a surgical technique that reconnects nerves in the breast using a nerve allograft during reconstruction. It enables the nerve to regrow and for sensation to return over time. The technique requires a breast surgeon and a plastic reconstructive surgeon, both trained in the technique, to complete.

During the mastectomy, the breast surgeon identifies nerves that may be good candidates for neurotization while removing the breast tissue. Then, during reconstruction, the plastic reconstructive surgeon repairs the nerves using the nerve allografts.

Whether the mastectomy and reconstruction surgeries happen back-to-back on the same day or separately in a delayed procedure, neurotization can still be an option, so talk with your care team about what’s possible.

How fast nerves regrow and where feeling starts returning varies from person to person. Generally speaking, nerves are slow to regrow, so it’s common for it to take up to 18 months to two years for sensation to return. But for some, it starts to return earlier, growing over time. As for where sensation returns first, this can vary based on reconstruction type, size and the individual’s treatment plan, but it’s typically on the periphery of the chest, moving into the central area of the breast with more time. Some patients, however, have begun to feel again around the nipple area first. It is truly different for everyone.

To understand a patient’s specific sensation levels, most care teams will test sensation pre-operatively to get a baseline and then test at various times post-operatively to understand where, how fast and how much sensation is returning.

All of that said, most patients I talk to about breast neurotization are eager to give it a shot because, when compared to never feeling again, the minimal additional operative time to possibly have some level of sensation return is worth it.

Removing the cancer and reducing risk will always be the top priority in breast cancer surgery. Taking time to consider what you want your quality of life to be after surgery and treatment is important. If you’re curious to learn more about breast neurotization and whether it fits how you envision your life following surgery, I encourage you to:

Continue researching breast neurotization and keep learning about the technique to help decide how important it is to you.

Get connected with patients who’ve had it done. They’ll be able to provide you with a lived perspective that most surgeons can’t.

Look into surgeons who offer it in your area. If you’re interested in talking with a care team trained in the technique, explore surgeon locator tool options to find trained surgeons in your area to schedule a consultation.

Dr. Alex Mesbahi is a board-certified plastic surgeon and co-founder of the National Center for Plastic Surgery. He is on the editorial board for the Plastic & Reconstructive Surgery Journal and specializes in cosmetic and reconstructive surgery of the breast and cancer reconstruction.

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