Nerve Repair

The sensory nerves to the nipple arise from the intercostal nerves coming off the spinal cord traveling on the under surface of the ribs. They give off posterior branches in the axilla and anterior branches just lateral to the sternum. We often dissect the 4th and/or 5th posterior intercostal nerves for 5 to 7 centimeters at the time of mastectomy. A sensory nerve on the DIEP flap can be connected to the breast nipple nerve to restore sensation to the new breast. Also the anterior branch can be coapted to the DIEP sensory nerve. Even without a nerve repair, the sensory nerves slowly grow into the DIEP flap resulting in some sensation in most patients over 12-24 months.

Most of my patients today have nipple sparing mastectomies. It is very important for the Breast Oncologic Surgeon to spare the medial intercostal nerves and blood vessels during the mastectomy. The most important one arises between the 2nd and 3rd rib cartilage just medial to the breast tissue being removed and just lateral to the sternum. This allows for better return of nipple sensation.

Sincerely,
Bob Allen,MD The sensory nerves to the nipple arise from the intercostal nerves coming off the spinal cord traveling on the under surface of the ribs. They give off posterior branches in the axilla and anterior branches just lateral to the sternum. We often dissect the 4th and/or 5th posterior intercostal nerves for 5 to 7 centimeters at the time of mastectomy. A sensory nerve on the DIEP flap can be connected to the breast nipple nerve to restore sensation to the new breast. Also the anterior branch can be coapted to the DIEP sensory nerve. Even without a nerve repair, the sensory nerves slowly grow into the DIEP flap resulting in some sensation in most patients over 12-24 months.

Most of my patients today have nipple sparing mastectomies. It is very important for the Breast Oncologic Surgeon to spare the medial intercostal nerves and blood vessels during the mastectomy. The most important one arises between the 2nd and 3rd rib cartilage just medial to the breast tissue being removed and just lateral to the sternum. This allows for better return of nipple sensation.

Sincerely,
Bob Allen,MD