Thermal versus tactile sensory recovery following alloplastic and neurotized autologous breast reconstruction.

[BACKGROUND] Loss of sensation after mastectomy impacts long-term satisfaction, yet thermal sensory outcomes remain understudied. This study compares tactile and thermal recovery following two-stage alloplastic versus neurotized autologous breast reconstruction.

[METHODS] In this prospective single-institution study, patients underwent mastectomy with either two-stage alloplastic or immediate neurotized DIEP flap reconstruction. Tactile sensation was assessed in nine regions using a pressure-specified device, and thermal sensation was tested in five regions using standardized hot (52 °C) and cold (12 °C) stimuli across four postoperative intervals (1-6, 6-12, 12-24, and 24-48 months).

[RESULTS] 269 patients (440 breasts) underwent tactile testing, consisting of 123 DIEP patients (209 breasts) and 146 alloplastic patients (231 breasts). A subset of 105 patients (174 breasts) underwent thermal testing. Preoperative scores were similar between groups (p > 0.05). DIEP patients demonstrated significantly higher tactile sensation scores at every postoperative interval: 1-6 (35.7 vs. 25.7, p = 0.001), 6-12 (43.4 vs. 33.9, p = 0.015), 12-24 (46.3 vs. 35.2, p = 0.039), and 24-48 months (56.5 vs. 46.4, p = 0.048). Alloplastic patients showed significantly better cold perception at 12-24 (65.0% vs. 48.6%, p = 0.040) and 24-48 months (83.3% vs. 57.1%, p = 0.001), and heat perception at 12-24 months (77.3% vs. 54.3%, p = 0.014).

[CONCLUSION] Neurotized DIEP reconstruction yielded superior tactile recovery, while alloplastic was associated with better thermal perception. This discrepancy may reflect the enhanced thermal conduction properties of breast implants and the limited influence of neurotization on thermal sensory fibers.