Quantifying Thermal and Tactile Recovery in Dual-Neurotized Breast Flaps

Background Dual-nerve neurotization of deep inferior epigastric perforator (DIEP) flaps may enhance postmastectomy reinnervation, but the early timeline and regional patterns of tactile and thermal recovery remain incompletely defined. Methods We conducted a prospective, single-institution study (January 2024–September 2025) of women undergoing immediate dual-neurotized DIEP flap breast reconstruction. Anterior and lateral intercostal branches (T3/T4) were coapted to medial and lateral flap donor nerves (T10–T12). Objective sensory testing was performed preoperatively and at 3, 6, and 9 months. Tactile thresholds were normalized to each breast's baseline and reported as percent recovery. Thermal perception (hot 52°C; cold 12°C) was analyzed as regional accuracy. All analyses were performed within-breast. Results Twenty-three patients (43 breasts) were included. Composite tactile recovery increased from 44.9% ± 29.2% at 3 months to 55.5% ± 27.0% at 6 months and 64.2% ± 24.8% at 9 months (all P < 0.001). Regional recovery followed a superomedial pattern. By 9 months, outer-superior (85.6%) and outer-medial (85.9%) regions were not different from baseline ( P > 0.05), whereas the NAC (46.0%) and inferior regions (41%–65%) remained reduced ( P < 0.001). Thermal recovery improved over time. Cold accuracy increased to 48% ± 20% by 9 months ( P < 0.001), with only the superior region approaching baseline ( P > 0.05). Hot accuracy recovered more robustly (9 months: 67% ± 28%; P < 0.001), with superior, medial, and inferior regions reaching baseline equivalence ( P > 0.05). Conclusions Dual-neurotization yields progressive tactile and thermal recovery within 9 months, most pronounced in the superior and medial breast, establishing early benchmarks for sensory outcomes after dual-neurotized DIEP reconstruction.