Breast Sensation After Abdominal Free Flap Reconstruction With or Without Neurotization: A Systematic Review and Meta-analysis

Background: The effectiveness of neurotization in restoring breast sensation remains unclear due to a lack of high-quality studies and methodological heterogeneity. We conducted a meta-analysis of studies published through 2024 comparing postoperative breast sensation between neurotized and nonneurotized abdominal free flap reconstruction. Methods: A systematic literature search was conducted in Embase, PubMed, MEDLINE, Cochrane Library, and EBSCO through November 2024. The primary meta-analysis evaluated the effect of neurotization on total breast skin sensation, combining studies regardless of sensory testing method. Sensitivity analyses were performed for studies using Semmes-Weinstein monofilaments or the Pressure-Specified Sensory Device. Secondary meta-analyses assessed the impact of neurotization on flap and native breast skin sensation. Standardized mean differences (SMDs) were calculated for primary and secondary meta-analyses, whereas mean differences (MDs) were used in sensitivity analyses. Results: A total of 563 abdominal free flaps (295 neurotized, 268 nonneurotized) from 9 studies were included. Neurotized reconstructions resulted in a significantly lower pressure threshold for fine sensation in the total breast (SMD: −0.87 [95% confidence interval (CI): −1.33 to −0.41]; P = 0.0002). The effect remained statistically significant regardless of sensory testing method—Semmes-Weinstein monofilaments (MD: −0.76 [95% CI: −1.23 to −0.28]; P = 0.002) or Pressure-Specified Sensory Device (MD: −10.21 [95% CI: −19.24 to −1.17]; P = 0.03). Significant improvements in sensation were observed in both flap (SMD: −0.93 [95% CI: −1.47 to −0.39]; P = 0.0007) and native breast skin over the flap (SMD: −0.51 [95% CI: −0.84 to −0.18]; P = 0.002). Conclusions: Flap neurotization significantly improves sensory outcomes following abdominal free flap reconstruction, including total breast, flap, and native skin sensation.