Sensory recovery following free TRAM flap breast reconstruction

The free TRAM flap is now commonly used in breast reconstruction after mastectomy. A number of our patients reported anecdotally return of some sensation in their reconstructed breasts, despite being told beforehand that this was unlikely. This study measured return of sensation in a series of 21 patients, by studying both patients' subjective reporting of sensory return using a standardised questionnaire and objective evaluation of sensation with standard clinical tests. These included temperature and pain threshold and the use of the Semmes-Weinstein method. The study demonstrates that measurable sensory recovery occurred in 16 of our 21 patients (76%). 18 of the 21 patients (86%) reported a subjective feeling of sensation in the reconstructed breast and 7 (33%) claimed it felt the same as their normal contralateral breast. Sensory recovery usually commences about 6 months postoperatively and progressively improves over time. These findings demonstrate that the free tissue transfer method does not necessarily lead to an insensate reconstruction, as might be supposed.