Nipple-Areola Complex Reinnervation Using Intercostal Nerve Grafts in Implant-Based Reconstruction.

Abstract

Despite successful aesthetic outcomes, immediate breast reconstruction is frequently accompanied by significant sensory loss, compromising patient quality of life. While neurotization techniques are established for autologous flaps, a standardized solution for implant-based reconstructions remains limited. Current options, such as allografts or sural nerve autografts, are limited by high costs, regulatory challenges, or donor-site morbidity. We present a proof-of-concept case of robotic-assisted implant-based reconstruction using the anterior divisions of the lateral cutaneous branches of intercostal nerves (ICN-II, ICN-III, and ICN-IV) as autografts to construct a neural bridge. A 40-year-old female underwent bilateral nipple-sparing mastectomy with immediate prepectoral direct-to-implant reconstruction. At approximately five months postoperatively, the 2.83 (0.07 g) filament was recorded as the lightest detected filament at all nine tested sites on each breast. Patient-reported outcomes assessed with the BREAST-Q showed a Satisfaction with Breasts score of 100/100 and 85/100 on Physical Well-Being: Chest. This unusually favorable sensory finding requires cautious interpretation and may reflect residual native innervation, greater preservation of dermal/subdermal sensory pathways, favorable case selection, spontaneous or collateral reinnervation, central sensory adaptation, or measurement effects. This proof-of-concept case demonstrates the technical feasibility of constructing a robotic-assisted intercostal nerve graft bridge; the sensory observation requires cautious interpretation and validation in larger prospective studies with standardized baseline and longitudinal testing.