“Sensing Breast” Reconstruction- Free microneurovascular muscle sparing TRAM-method

Doctor Helena Puonti created the Sensing Breast reconstruction as she thinks that the shape of the newly reconstructed breast is important for the patient’s quality of life, but even more important is the fact that the breast also feels.

The MS-TRAM flap (Muscle-Sparing Transverse Rectus Abdominis Myocutaneous flap) is the best transplant for breast reconstruction after mastectomy. It is soft and can acquire the necessary shape. It is possible to reconstruct a round and, if necessary, large breast from it.

In this technique, the skin and fatty tissue from the lower abdominal area are transplanted to the site of the removed breast. Both the blood vessels and the nerves are grafted and connected to the blood vessels and nerves in the chest.

Photo: Totally Sensing breast before and after the reconstruction

Since 2001, Helena Puonti has been developing a method that allows the restoration of a high degree of sensation to the breasts after FREE MS-TRAM-reconstruction. Doctor Puonti finished her study with a dissertation in 2017 and the research included ca. 100 patients.

Her research has shown that even one nerve of the MS-TRAM flap sutured to a healthy nerve of the breast area can bring good skin sensation to a new breast. With 2 nerve coaptations of the flap, the sensation recovery improved even further.
After the nerves are connected, the sensation is restored to the TRAM breast to a much greater extent than without the neural coaptation. According to her research, all breasts regained sensation. On average, the sensation recovery in the whole group was over half (60%) of the normal breast sensation. However, there are cases of complete recovery in which the breast gains normal sensation.

Unfortunately, radiotherapy and surgical scarring may impair sensation in the mastectomy area.

There are cases of complete recovery in which the breast gains normal sensation.

The sensation in the reconstructed breast returns gradually. The first signs of sensation appear within about seven months after the nerves are sutured, and then skin sensation – sensitivity to cold, heat and pain – gradually starts returning for up to 2-3 years.

What is important is that joining the nerves did not cause pain syndromes to the patient. On the contrary, after the use of the this reconstructive microneurovascular technique there was less pain in the new TRAM breast compared to traditional methods of surgery without suturing the nerve endings.

In the figure, the blood vessels are marked in red and blue and nerves in yellow.

Nerve coaptation is covered with the NeuraGen-tube, which prevents the nerves from sprouting.

Intercostal nerves Th XI and XII have been connected to intercostal Th IV and intercostobrachial (ICN) nerve.

Epigastric inferior blood vessels are connected to intramammaric vessels.

Donor site in the abdomen is then closed directly. The abdominal muscles remain almost intact.

A patient of Doctor Puonti’s has even delivered a baby after this procedure.

Helena Puonti’s research is state-of-the-art globally and forms the basis for the PhD thesis she finished in 2017.