Quality of Life, Breast Sensation, and Symptoms in Unilateral Breast Reconstruction with Direct Neurotization (Tommy Transfer) DIEP Free Flap: A Case Series
Abstract
Background: Loss of breast sensation after mastectomy can affect patient's quality of life (QoL). Direct neurotization has been proposed to enhance sensory recovery and QoL. However, studies reporting objective sensory restoration, symptoms and patient reported outcome (PROMs) remain limited. This case series aims to evaluate sensory recovery and PROMs following unilateral DIEP free flap with direct neurotization.
Case Presentation: Four patients underwent unilateral DIEP free flap breast reconstruction with direct neurotization between February 2024 and April 2025. The lateral cutaneous branch of the fourth intercostal nerve was used as the recipient nerve, with intercostal nerve grafts coapted to the flap dermis or posterior nipple surface. Objective sensory recovery was assessed using Semmes-Weinstein monofilament testing in nine breast regions. Patient reported outcomes were measured using the Indonesia BREAST-Q Sensation Module at 0-6 month and 6-12 months postoperatively. All cases demonstrated gradual objective sensory improvement. However, PROMs symptoms and QoL trajectories varied
Conclusion: Sensory recovery following direct neurotization in unilateral DIEP breast reconstruction improves over time. However, objective sensory improvement does not consistently translate into better symptoms or QoL scores. Postoperative well-being is multifactorial, underscoring the importance of integrating objective sensory testing with patient reported outcomes to comprehensively assess functional recovery.
Keywords: Breast Reconstruction, Deep Inferior Epigastric Perforator Free Flap, Neurotization, Reinnervation.
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