Breast reconstruction after mastectomy can aim to restore how the breast feels as well as how it looks. When nerves are cut and not repaired, some patients develop painful neuromas.
Dr. Patrick Garvey, chair of the Division of Plastic Surgery at Mayo Clinic in Arizona, made this case in his talk Are You Feeling Nerve-us? Achieving Sensate Breast Recon and Pain Control (TMR) at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS), in Houston, Texas.
Preservation starts with anatomy and with the breast surgeon. "We have to start from anatomy," Dr. Garvey said. He described the nerve supply beneath the nipple as complex. Collaborating with breast surgeons can help identify nerves worth sparing, including those that supply the nipple. When nerves cannot be spared, repair matters: in comparisons he reported, patients with nerve repair generally had better sensory recovery than those without it.
Sensory Re-education
Sensation often takes a year or longer to return, and consistent practice partly determines the result. He advises starting sensory re-education a few weeks after surgery. Patients touch each breast quadrant and the nipple, run a finger over each area while watching in a mirror, and vary textures and temperature. The mirror helps the brain remap sensation by linking where the finger touches with where the feeling should register. The routine may also help manage edema. "By touching the breast, [patients] will feel better and better," he said.
Managing Persistent Pain
For pain lasting more than 1 year after mastectomy and reconstruction, his pathway starts with the breast multidisciplinary team (breast imaging, medical oncology, and medical breast specialists) to rule out cancer-related causes and weigh nerve injury and treatment history. Referral for plastic surgery evaluation follows. "Patients jump in pain when you touch the neuroma," he said.
Nonsurgical care is coordinated with physical and occupational therapy, pain medicine, physical medicine and rehabilitation, and lymphedema care, and includes scar and soft-tissue therapy, medications, and therapeutic blocks. When examination points to a peripheral nerve, a diagnostic intercostal block can help confirm the target. Relief after the block suggests that nerve repair or neurotization may help. For a painful neuroma, he described locating and removing it, then reconnecting the nerve directly or performing targeted muscle reinnervation (TMR).
He closed by noting that knowing the anatomy and technical options improves function and quality of life along with appearance.
Key takeaway: Dr. Garvey pairs nerve preservation or repair with early sensory re-education. For persistent pain, his pathway rules out cancer first and uses a diagnostic block to identify candidates for neuroma excision with direct repair or TMR.
Abbreviations: TMR, targeted muscle reinnervation.