engleski

The potential role of trastuzumab in sensory recovery enhancement after free TRAM flap breast reconstruction

Aims: Breast sensation following autologous breast reconstruction impacts patients’ quality of life. Although spontaneous reinnervation in free flaps was documented by many authors, there are efforts to further improve restoration of breast sensation. Interestingly, animal studies indicated that trastuzumab, a monoclonal antibody used to treat HER2-positive breast cancer, has several beneficial effects on transected peripheral nerves, most evident being enhancement of axonal sprouting. This study aimed to compare spontaneous sensory recovery after free TRAM flap breast reconstruction between patients who were and were not treated with trastuzumab. Subjects and Methods: The study included fourteen subjects who underwent tactile sensation examination within five-year period after non-innervated free microvascular muscle-sparing TRAM flap breast reconstruction at the University Hospital Centre Zagreb, Croatia. Small and large flap skin islands and contralateral healthy breasts were tested with Semmes-Weinstein type monofilaments. Three sensory scores were created to more accurately compare breast sensation. Results: All subjects but one, who was not treated with trastuzumab, regained detectable tactile sensation in at least one tested region. In subjects receiving trastuzumab, the recovery early extended to at least four of five large skin island regions and was always present in the central flap area in comparison with subjects who were not administered trastuzumab (p=0.0476). As indicated by total sensory scores, trastuzumab-treated subjects restored sensation better resembling healthy control breasts (54% vs. 39% in large skin islands ; 95% vs. 71% in small skin islands). Conclusions: To the authors’ knowledge, the current study for the first time demonstrated trastuzumab’s potential to improve sensory outcomes after free flap breast reconstruction. Further research is necessary to examine effects of HER2 targeting agents on neuroregeneration. Henceforth, immunotherapy should be given greater importance while evaluating new strategies for enhancement of sensory recovery in breast reconstructions.

breast reconstruction ; free tissue flaps ; immunotherapy ; nerve regeneration ; sensation ; trastuzumab

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