Abstract PS2-03-15: Breast Sensitization Techniques in Mastectomies with An Implant-Based Reconstruction: A Systematic Review

Abstract Introduction: Implant-based reconstructions are the most prevalent oncoplastic breast reconstruction globally. Nevertheless, the vast majority of patients undergoing nipple-sparing mastectomies (NSM) or skin-sparing mastectomies (SSM) experience total or significant sensory loss of the breast and nipple-areolar complex (NAC), as well as post-mastectomy breast pain, both key predictors of poor post-operative psychosocial and sexual wellbeing. In recent years, novel surgical techniques have been introduced to preserve sensation or neurotize the breast and NAC in NSMs and SSMs. However, the ease of implementation, reproducibility, and efficacy of such methods remain under investigation. This systematic review aims to evaluate the current literature describing surgical techniques for sensation preservation or neurotization in mastectomies with implant-based reconstructions. This includes a review of sensory outcomes from the available case-control studies, and an analysis of emerging surgical approaches, aiming to guide clinical implementation, and identify future areas of research. Method: A systematic review of open-access, English-language literature published between January 2000 and June 2025 on implant-based reconstructions offering a sensation preservation or neurotization technique was conducted across PubMed, the Cochrane Library, Google Scholar and an external search, utilizing a keyword-based advanced search. Of the 139 screened records, six prospective studies were assessed and included in the review. Results: Four surgical techniques are described across the included records, namely, intercostal nerve preservation, nerve allografting, nerve autografting, and muscle reinnervation. Despite small sample sizes, variation in follow-up duration, lack of surgical controls, and discrepancies in subjective and objective measurements of sensation across the studies, all proposed techniques improve sensory outcomes or pain reduction. Across all four proposed techniques, the data suggests that treatment groups demonstrated superior sensory outcomes. However, larger-scale studies, with prolonged follow-up periods, consistent measures of sensation and patient quality-of-life, and robust complication reporting are required to establish evidence-based guidelines for sensation preserving mastectomies with implant-based reconstruction. Conclusion: Despite limited case-control data, there is growing evidence to support that utilizing one of the following surgical techniques: intercostal nerve preservation, nerve allografting, nerve autografting and muscle reinnervation, improves breast and NAC sensation following a mastectomy with an implant-based reconstruction. This reduces the physical and psychosocial burden associated with diminished or eliminated breast sensation postoperatively. In addition, the reported complications related to these techniques are minimal, suggesting these methods are safe for clinical use. Citation Format: J. El-Taraboulsi, D. Leff, P. Thiruchelvam. Breast Sensitization Techniques in Mastectomies with An Implant-Based Reconstruction: A Systematic Review abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-03-15.