Impact of Chemotherapy and Radiation on Breast Sensation After Immediate Reconstruction.

[PURPOSE] This study explores the impact of chemotherapy and radiation therapy (XRT) on breast sensation in patients undergoing mastectomy with immediate reconstruction.

[METHODS] This prospective study, conducted from 2019 to 2024, focused on patients undergoing mastectomy with immediate implant-based or neurotized deep inferior epigastric perforator (DIEP) flap reconstruction. Neurosensory testing was performed preoperatively and at defined postoperative intervals using a pressure-specified sensory device. Patients were stratified by type of reconstruction and oncologic treatment: neoadjuvant chemotherapy, adjuvant chemotherapy, preoperative XRT, and adjuvant XRT. Sensation scores were compared between each treatment group and its corresponding control group using an unpaired two-sample t test. Subsequently, a mixed-effects backward linear regression model was used to assess the relative impact of each treatment.

[RESULTS] A total of 291 patients were analyzed, including 154 patients (274 breasts) who underwent implant-based reconstruction and 137 patients (248 breasts) who underwent DIEP flap reconstruction. Neoadjuvant chemotherapy and preoperative XRT were associated with temporary reductions in outer breast sensation at 3 to 12 months postoperatively, whereas adjuvant XRT resulted in widespread and persistent sensory deficits. Adjuvant chemotherapy had no impact on sensation in implant-based reconstructions but was associated with long-term decreased sensation in the outer breast regions of DIEP flap reconstructions. Regression analysis identified adjuvant XRT (β = 13.06), neoadjuvant chemotherapy (β = 5.99), and higher BMI (β = 0.71) as significant risk factors for diminished breast sensation (P = 0.05), whereas neurotized DIEP flap reconstruction (β = -7.82) and a greater time since surgery (β = -1.56) were protective factors (P < 0.001).

[CONCLUSIONS] These findings highlight the detrimental impacts of adjunctive oncologic therapies, particularly adjuvant XRT, on breast sensation. This information can aid in preoperative counseling and help establish realistic expectations for breast cancer patients considering mastectomy and reconstruction.