Predictable Location of Breast Sensory Nerves for Breast Re-innervation

Background: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during a mastectomy. Providing re-innervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps due to the difficulty of locating a recipient nerve. We have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Materials and Methods: Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distance from sternum, mid-clavicular line, and lateral pectoralis minor, as well as nerve diameter, was measured. Results: The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16/20) exited from under the 4th rib. The average distance from the sternum was 13.1cm (range 10-15cm, standard deviation 1.3cm) and from the mid-clavicular line was 11.8cm (range 8-16cm, standard deviation 2.2cm). The nerve exited at the lateral border of the pectoralis minor or within 2cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. Conclusion: We provide the predictable location of the lateral intercostal nerve providing sensation to the breast. We hope that by enabling surgeons to locate this nerve, more well-done studies will be performed investigating technqiues and outcomes for breast re-innervation. Disclosures: none Corresponding Author: Risal Djohan, MD, Cleveland Clinic Foundation, Crile Building, Mail Code A60, 2049 East 100th Street, Cleveland, OH 44195, Email: Djohanr@ccf.org, Phone: 216-445-2433 ©2018American Society of Plastic Surgeons

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