Complications and Donor Site Morbidity in Harvesting the Intercostal Main Nerve as a Graft for Breast Neurotization in Microsurgical Breast Reconstruction

Breast neurotization using autologous grafts has been indicated to be effective. Previous studies focused mainly on restoring sensation and optimizing the operative techniques of neurotization in microsurgical breast reconstruction. There are few studies on the adverse effects and potential risks associated with simultaneous microsurgical breast reconstruction and neurotization procedures. The rates of overall and pulmonary complications in patients receiving neurotization during autologous breast reconstruction were examined in this study.A retrospective comparative study was conducted between two groups of patients: 100 consecutive patients (reinnervation group) underwent neurotization procedures during deep inferior epigastric perforator (DIEP) breast reconstruction, while the other 100 patients (control group) underwent DIEP breast reconstruction alone. The patients' demographic data, reconstructive methods, postoperative complications, specific pulmonary complications, and length of hospital stay were reviewed.The overall complication rates were 23% in the reinnervation group and 20% in the control group (p = 0.731), and this difference was not statistically significant. The incidence rates of vascular insufficiency (7% vs. 9%), pneumothorax (5% vs. 3%), hematoma/seroma (2% vs. 3%), and wound infection (1% vs. 2%) were similar between the reinnervation group and the control group. A greater percentage of patients in the reinnervation group developed pleural effusion than did those in the control group (12% vs. 4%, p = 0.037), whereas the majority of the patients in the reinnervation group were asymptomatic and managed conservatively.Although harvesting the main intercostal nerve for breast neurotization may irritate the pleura, the effect was minimal and manageable. This procedure is safe and feasible and can be widely applied in breast reconstruction.