Q:I’m looking to do a prophylactic bilateral mastectomy due to BRCA2. I want to learn more about nerve reconnection options. Thanks!

A: Thank you for contacting us.

We are involved in a trial with Axogen (company that sells processed nerve grafts) to investigate whether connecting nerves with grafts during perforator flap breast reconstruction improves the return of sensation. As of this time, there have been no definitive results published, but we are very enthusiastic about this process nonetheless, as we believe it may ultimately represent a significant advance in the quality of breast reconstruction.

While blood vessels of the flap and the breast area can be connected directly, it is rarely possible to get enough length with nerve ends to do this. Various techniques to bridge this gap have been tried, but none with great success. It is reasonable to think that human nerve grafts may represent a better option, and that is why we are participating in the project. Placing the nerve grafts adds about 30 minutes to the operative time for a bilateral reconstruction, which is not really significant. We are still working with insurance companies and hospitals to achieve universal coverage for the costs of the grafts, and we are making progress in this regard. We have done about 1500 DIEP flaps (and about 300 of other types) for breast reconstruction, with a flap survival rate of 99.01%. I would be delighted to speak with you by phone about your options, if you wish, or see you in consultation any time. Thanks again for your question, and have great day! Richard M. Kline, Jr., MD