Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast:

Abstract

Introduction

Better sensation in the reconstructed breast improves quality of life. Sensory nerve coaptation is a valuable addition to autologous breast reconstruction. There are few publications concerning the sensory nerves of the breast and the nipple‐areola complex and reports are contradictory, so it is unknown which nerve is best suited as recipient for coaptation. The current study serves as a proof of concept.

Materials and Methods

The areas innervated by the anterior cutaneous branches (ACBs) of the intercostal nerves (ICNs) were studied on two separate occasions in two healthy women. First, the ACBs of ICNs 2–5 were individually blocked using ultrasound. Next, the ACBs of all levels were blocked simultaneously. Sensation was measured using Semmes‐Weinstein monofilaments. The numbed areas corresponding to the ICNs were drawn in a raster of 2 cm x 2 cm.

Results

The largest area was supplied by the ACB of the fourth ICN, located in the upper (UIQ) and the lower (LIQ) inner quadrants of the breast. The second largest area was supplied by the ACB of the third ICN. Blockage of ACBs 2–5 affected sensation in the nipple and the areola.

Conclusions

Blockage of all levels 2–5 partially affected sensation in the nipple‐areola complex, suggesting innervation by a nerve plexus consisting of both ACBs and lateral cutaneous branches (LCBs). ACB4 supplied the largest area of the breast in the UIQ and LIQ and could be best suited for sensory nerve coaptation to optimize sensation in the autologously reconstructed breast.

This article is protected by copyright. All rights reserved.