Split Chest Breast Neurotization

Several members of the scientific community have suggested that breast neurotization can help return nipple sensation to patients undergoing implant-based breast reconstruction. There has been no randomized controlled study assessing the validity of these claims. The goal of this study is to evaluate if performing breast neurotization can help restore or improve return of nipple sensation to patients undergoing implant-based breast reconstruction. This will be a single-blinded, randomized controlled trial where patients undergoing bilateral reconstruction will serve as their own controls by receiving an intervention on one breast but not the other breast.

Inclusion Criteria:Women undergoing bilateral nipple-sparing mastectomy (prophylactic or therapeutic) at a single institutionWomen receiving implant-based reconstruction (either direct to implant or tissue expander-based implant reconstruction of any size)Age 18 or olderExclusion Criteria:Women with history of prior breast surgery given concern for potentially damaged nerves by prior intervention that could impact the procedure and results. Procedures include but are not limited to: prior breast reduction, prior breast augmentation, prior lumpectomyPre-operative radiation or anticipated post-operative radiationBody Mass Index (BMI) > 30 kg/m2 or patients with macromastia (larger breasts) as these patients frequently require larger implants that will not accommodate the longest nerve graft available (70 mm)Current tobacco or nicotine useHistory of diabetes mellites with a HgbA1c > 7% due to lower rates of wound healingHistory of auto-immune diseaseHistory of allergy, sensitivity, or intolerance to porcine-derived materialsIntraoperatively, patients may have to be excluded if during the mastectomy the lateral nerve targets were severely damaged or removed as part of the mastectomy. While these patients will be excluded from the formal analysis, we will continue to follow them as a subgroup for analysis and comparison.Men as they infrequently receive bilateral mastectomies due to breast cancer. Male breast cancer is <1% of all breast malignancies.Pregnancy as determined by urine pregnancy test on day of surgery