Post-breast cancer breakthrough: repairing patients’ nerve damage

Nerve transplant surgery is giving patients sensation in their reconstructed breasts.

Breast cancer patients lose feeling in their chest after mastectomies, Cleveland Clinic has the fix

CLEVELAND, Ohio (WOIO) - Feeling “whole” or "normal’ again after breast cancer is something many women who’ve have mastectomies struggle with.

But the Cleveland Clinic team that pioneered face transplants is now transplanting nerves from patients’ own bodies to help them truly put cancer behind them and feel themselves again.

Mariann Lotenero was diagnosed with triple negative breast cancer, a particularly aggressive form, in 2011. She didn’t think twice about having a double mastectomy.

“I had implants, and it was OK. I didn’t have cancer,”she said.

She got through chemo, and radiation, but was uncomfortable and unhappy with her reconstruction.

“I had some scarring, and had to have them replaced twice because of scarring, pulling and tightness,” she said.

Mastectomy patients are left with a common numbness, and lack of sensation, as a result of removing the cancer.

“There’s a nerve within the breast tissue that’s removed,” said Dr. Risal Djohan, Vice Chair of Cleveland Clinic’s Plastic Surgery Department.

He has been working with his team for months to perfect a way to transplant patients’ own tissue, and nerves, from their abdominal wall.

Patients' own nerves are transplanted from the abdomen to their breast.
Patients' own nerves are transplanted from the abdomen to their breast. (Source: woio)

They also utilize nerve grafts from cadavers, and create a bridge when the patients nerves aren’t long enough. This reconstruction affords them sensation again.

Ahead of operation, microsurgeons team up with the Clinic’s biomedical engineering department to create 3D printed models of each patient’s abdominal wall.

3D model of patient's abdomen created by The Cleveland Clinic's biomedical engineering department
3D model of patient's abdomen created by The Cleveland Clinic's biomedical engineering department (Source: WOIO)

“These are our road maps to find our which vessel we want to take,” Dr. Djohan said.

When the 11-12 hour surgery is complete, the transplanted tissue is alive along with the connected nerve. But it does take about a year for feeling to be restored.

“After you connect the nerve, it does not spontaneously come back. You have to do rehab,” said Dr. Djohan.

Surgeons learned from the Clinic’s face transplant patients, and are assigning patients extensive, daily rehab exercises using mirrors, and touch.

“Trying to retrain your brain, that if you touch with your finger in certain area of the breast, that’s where’s it’s supposed to be, remapping in the brain,”

Lotenero says it was several painful months before she bounced back.

“The worst part of the recovery is abdominal part,” she recalled.

But, she continues to feel better, and says this went a long way toward putting cancer behind her.

“I forget I had cancer. I seriously forget that I had cancer. It’s a huge gift,” she said.

Right now reconnecting nerves and restoring feeling in the breast is not possible with patients who have implants, only with their own tissue. But Dr. Djohan (is working to change that.

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