Breast Sensation Restoration After Nipple Nerve Allograft Reconstruction and Postmastectomy Radiation.

Breast sensation loss after mastectomy is known to reduce patients' psychosocial and sexual well-being. Nipple allograft reinnervation has been reported as an effective technique for breast sensation restoration after mastectomy. Most reported outcomes on this technique are on patients who underwent prophylactic, risk-reducing mastectomy or had early-stage breast cancer and did not require postoperative radiation. The effects of postmastectomy radiation on nipple allograft reinnervation and sensation restoration are unknown. Our aim was to evaluate the effects of radiation on sensation restoration after nipple nerve allograft reconstruction. Four patients with locally advanced breast cancer underwent neoadjuvant chemotherapy followed by bilateral nipple- and skin-sparing mastectomy with prepectoral direct-to-implant reconstruction and nipple allograft reinnervation between 2022 and 2023. All patients received postmastectomy chest wall and regional nodal radiation therapy to the affected side. At a median of 8 months postcompletion of therapy, patients completed the BREAST-Q 2.0 patient-reported outcomes questionnaire and underwent objective sensory examination using the Semmes-Weinstein monofilament test, which was repeated at 19 months postoperatively. We found postoperative Semmes-Weinstein monofilament test scores and BREAST-Q 2.0 Rasch breast sensation scores were similar between radiated and nonradiated reconstructed breasts, and overall breast satisfaction scores were above normative values. Our experience suggests that sensory restoration following nipple allograft innervation during bilateral nipple- and skin-sparing mastectomy with direct-to-implant reconstruction may not be negatively impacted by postmastectomy radiation therapy, representing an option for women with loco-regionally advanced breast cancers desiring breast sensation restoration.