Restoring Sensation, Reclaiming Self: Nerve-Sparing Mastectomy and Breast Reconstruction With Valerie Brutus, MD, FACS

Understanding the Need for Mastectomy and Reconstruction

“Mastectomies are usually done as a treatment for breast cancer,” Dr. Brutus explains, “but we also perform them as prevention for patients with a strong family history or genetic mutations.” While not all women with breast cancer require mastectomy, for those who do, reconstruction is often part of the treatment plan. Dr. Brutus emphasizes the importance of offering options: “I think it’s great that patients have those options available to them at St. Vincent’s Medical Center.”

Nerve-Sparing Mastectomy and Resensation: The Procedures

Traditional mastectomy often results in loss of sensation in the chest wall, even when the skin and nipple are preserved. Dr. Brutus describes the impact: “For a lot of patients, having a completely numb chest wall is difficult. The breast is an organ with many roles, including as a sexual organ, and sensation loss can be very bothersome.”

Nerve-sparing mastectomy aims to preserve key nerves during surgery. Working closely with plastic surgeons, Dr. Brutus identifies and preserves the larger nerves on the lateral aspect of the breast. “By doing that, it’s going beyond preserving the look—we’re also trying to maintain or reestablish some sensation so that the chest wall is not completely numb,” she says. FDA-approved nerve grafts are then used to reconnect these nerves, allowing for the possibility of sensation returning over time.

Patient Experience and Recovery

Dr. Brutus explains how the process is a project involving both breast and plastic surgeons. “When you wake up from surgery, you will not have any sensation in that area because the nerves have been transected. It can take up to two years for the nerves to grow back,” she noted. During this period, patients undergo a re-education process to relearn different types of sensations, such as dull, sharp, warm, or cold. “The sensation is never going to be exactly as it was before surgery, but we do want people to at least have some sensation,” Dr. Brutus explains.

Counseling Patients and Provider Considerations

For oncology clinicians, Dr. Brutus stressed the importance of awareness and patient education: “This is something that is safe, we seem to have good results, and patients are very happy to undergo the procedures. The nerve identification and reconstruction add about 45 minutes per side to the procedure, so it’s not a significant increase in operative time.” She encourages providers to discuss these options with eligible patients, highlighting the benefits and safety of nerve-sparing and resensation techniques.

Women’s Health Week Message

Dr. Brutus concluded with a call to action: “Please get screened. Breast cancer is so common, and getting screened is something you do for yourself. Don’t be afraid to ask questions—there are a lot of options available, and these procedures are very safe and keep patients satisfied long-term.”

Key Takeaways

• Nerve-sparing mastectomy and resensation offer improved quality of life by preserving or restoring chest wall sensation after mastectomy
• Patient education is crucial; clinicians should inform patients about all available reconstruction options and set realistic expectations for recovery
• These procedures are safe and add minimal operative time, with high patient satisfaction
• Regular screening and open communication remain essential for early detection and optimal outcomes in breast cancer care

About Dr. Brutus

Valerie Brutus, MD, FACS, is a Breast Surgical Oncologist and the Director of Breast Surgery at St. Vincent’s Medical Center of Hartford HealthCare in Connecticut. She specializes in the treatment of patients with all stages of breast cancer, with particular interest in genetic testing, oncoplastic surgery, breast reconstruction, neoadjuvant chemotherapy, and sentinel node procedures. Dr. Brutus is a member of the American Association of Breast Surgeons and a member of the Society of Surgical Oncology.