Objective
Mastectomy can damage the sensory nerves of the breast. Pharmacological therapies, including chemotherapy with known neurotoxicity, may further impair sensory recovery. Although breast neurotization has been reported to improve sensory outcomes after reconstruction, the impact of adjuvant or neoadjuvant systemic therapy on neurotization efficacy remains unclear.

Material and Methods
We reviewed patients from July 2021 to September 2024 who underwent immediate breast reconstruction with primary neurotization. Sensory function was assessed using the monofilament test, performed preoperatively and during follow-up beyond one year. All procedures were performed by one breast reconstruction surgeon with assistance from two peripheral nerve specialists at a single center. The primary endpoint was the time to recovery of baseline sensory function.

Results
A total of 73 patients with 76 reconstructed breasts (including 3 bilateral cases) were analyzed. No significant differences were observed in baseline demographics such as age, BMI, and comorbidities. Treatment allocation was closely associated with cancer stage. Among innervated breasts, sensory recovery within 40 months of follow-up was not significantly influenced by neoadjuvant (n=14, p=0.324), adjuvant (n=23, p=0.618), targeted (n=17, p=0.669), or hormone therapy (n=62, p=0.212).

Conclusions
Adjuvant and neoadjuvant systemic therapies, despite their neurotoxic potential, did not significantly alter sensory recovery after breast neurotization. These results support the feasibility of combining neurotization with systemic therapy. Definitive evaluation of neurotization’s incremental benefit will require external or historical controls and prospective validation.

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