Split Chest Breast Neurotization
A Single-Blind, Split-Chest, Single-Center Study of the Effects of Breast Neurotization in Implant Based Breast Reconstruction
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Thomas Calahan
- Phone Number: 929-455-5826
- Email: thomas.calahan@nyulangone.org
Study Locations
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-
New York
-
New York, New York, United States, 10016
- NYU Langone Health
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Women undergoing bilateral nipple-sparing mastectomy (prophylactic or therapeutic) at a single institution
- Women receiving implant-based reconstruction (either direct to implant or tissue expander-based implant reconstruction of any size)
- Age 18 or older
Exclusion Criteria:
- Women with history of prior breast surgery given concern for potentially damaged nerves by prior intervention that could impact the procedure and results. Procedures include but are not limited to: prior breast reduction, prior breast augmentation, prior lumpectomy
- Pre-operative radiation or anticipated post-operative radiation
- Body Mass Index (BMI) > 30 kg/m2 or patients with macromastia (larger breasts) as these patients frequently require larger implants that will not accommodate the longest nerve graft available (70 mm)
- Current tobacco or nicotine use
- History of diabetes mellites with a HgbA1c > 7% due to lower rates of wound healing
- History of auto-immune disease
- History of allergy, sensitivity, or intolerance to porcine-derived materials
- Intraoperatively, patients may have to be excluded if during the mastectomy the lateral nerve targets were severely damaged or removed as part of the mastectomy. While these patients will be excluded from the formal analysis, the investigators will continue to follow them as a subgroup for analysis and comparison.
- Men as they infrequently receive bilateral mastectomies due to breast cancer. Male breast cancer is <1% of all breast malignancies.
- Pregnancy as determined by urine pregnancy test on day of surgery
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Neurotized Breast
For patients undergoing bilateral implant-based breast reconstruction following nipple-sparing mastectomy, one breast will be neurotized by connecting the lateral intercostal nerve to the nipple with interposing standard nerve grafting techniques.
The neurotized breast will serve as the "experimental" breast.
The other breast will not receive any breast neurotizing procedure.
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Nerve reconstruction will employ an off-the-shelf nerve graft coapted to the donor anterior intercostal nerve branch laterally and medially at the underside of the nipple.
The anterior intercostal nerve branch and nerve graft coaptation will be performed in a standard fashion with a 1 mm gap between the ends of the graft and the donor nerve.
Medially, the nerve graft will be inset into the underside of the preserved nipple-areola complex using 8-0 or 9-0 epineural stitches from the nerve allograft.
All nerve coaptations will be performed under loupe magnification as is standardly performed.
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No Intervention: Non-Neurotized Breast
For patients undergoing bilateral implant-based breast reconstruction following nipple-sparing mastectomy, one breast will not receive any breast neurotizing procedure.
The non-neurotized breast will serve as the "control" breast.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Semmes-Weinstein Monofilament Testing (SWMT) Score in the Nipple (Area 9)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 12 Post-Surgery
|
|
SWMT Score in the Nipple (Area 9)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 24 Post-Surgery
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
SWMT Score in the Mastectomy Superior (Area 1)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 12 Post-Surgery
|
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SWMT Score in the Mastectomy Superior (Area 1)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
|
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SWMT Score in the Mastectomy Lateral (Area 2)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 12 Post-Surgery
|
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SWMT Score in the Mastectomy Lateral (Area 2)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
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SWMT Score in the Mastectomy Inferior (Area 3)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 12 Post-Surgery
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SWMT Score in the Mastectomy Inferior (Area 3)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
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SWMT Score in the Mastectomy Medial (Area 4)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 12 Post-Surgery
|
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SWMT Score in the Mastectomy Medial (Area 4)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 24 Post-Surgery
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SWMT Score in the Flap Superior (Area 5)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 12 Post-Surgery
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SWMT Score in the Flap Superior (Area 5)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
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SWMT Score in the Flap Lateral (Area 6)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 12 Post-Surgery
|
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SWMT Score in the Flap Lateral (Area 6)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
|
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SWMT Score in the Flap Inferior (Area 7)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 12 Post-Surgery
|
|
SWMT Score in the Flap Inferior (Area 7)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 24 Post-Surgery
|
|
SWMT Score in the Flap Medial (Area 8)
Time Frame: Month 12 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
|
Month 12 Post-Surgery
|
|
SWMT Score in the Flap Medial (Area 8)
Time Frame: Month 24 Post-Surgery
|
SWMT will be used for assessment of breast sensation by applying the monofilament to a given anatomic region.
Based on the monofilament size, a score of 0-6 is assigned.
Scores are classified as follows: 6 = normal; 5 = diminished light touch; 4 = diminished protective sensation; 3 = loss of protective sensation; 2 = Loss of protective/sensation; 1 = Deep pressure sensation only; and 0 = Loss of sensation.
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Month 24 Post-Surgery
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Mihye Choi, NYU Langone Health
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
Other Study ID Numbers
- 22-01026
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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