{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T23:10:06Z","timestamp":1747091406673,"version":"3.40.5"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated.<\/jats:p><jats:p>\n          Methods\u2003This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics, outcomes, insurance type, and Area Deprivation Index (ADI) were compared using two-sample t-test or chi-square analysis.<\/jats:p><jats:p>\n          Results\u2003Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps. There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%), operative time (9.43 vs 9.73\u2009h), length of hospital stay (3 d vs 3 d), hospital readmission (9.8% vs 6.8%), or reoperation (12% vs 12%) between patients with and without neurotization. However, access to neurotization differed significantly by patient health insurance type. Patients who received neurotization had a lower median ADI percentile of 40.0, indicating higher socioeconomic advantage compared with patients who did not receive neurotization at 59.0 (p\u2009=\u20090.01).<\/jats:p><jats:p>\n          Conclusion\u2003Access to neurotization differed significantly by patient health insurance and by ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life for patients who come from disadvantaged communities. Our institution's process for preauthorization is outlined to enhance likelihood of insurance approval for neurotization.<\/jats:p>","DOI":"10.1055\/a-2404-1924","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T23:49:45Z","timestamp":1724802585000},"page":"398-404","source":"Crossref","is-referenced-by-count":0,"title":["Accessibility of Neurotization in Deep Inferior Epigastric Perforator Flap Reconstruction: Inequities and Implications for Preauthorization"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4996-2141","authenticated-orcid":false,"given":"Rachel E.","family":"Schafer","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph D.","family":"Quick","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeleine M.","family":"Blazel","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Shukla","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon S.","family":"Wu","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffi","family":"Gurunian","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Cleveland Clinic, Abu Dhabi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah N.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Risal","family":"Djohan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1111\/tbj.13420","article-title":"Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy","volume":"25","author":"R Knackstedt","year":"2019","journal-title":"Breast J"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"e976","DOI":"10.1097\/PR9.0000000000000976","article-title":"Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery","volume":"6","author":"K M Flowers","year":"2021","journal-title":"Pain Rep"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1097\/PRS.0000000000004108","article-title":"Sifting through the evidence: a comprehensive review and analysis of neurotization in breast reconstruction","volume":"141","author":"J M Weissler","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref4","first-page":"594","article-title":"Importance of breast sensation after mastectomy: evidence from three sources","volume":"4","author":"S T Lindau","year":"2023","journal-title":"Womens Health Rep (New Rochelle)"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.1016\/j.bjps.2022.06.034","article-title":"Long-term breast and nipple sensation after nipple-sparing mastectomy with implant reconstruction: relevance to physical, psychosocial, and sexual well-being","volume":"75","author":"J B Hammond","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s10549-017-4547-3","article-title":"Sensation of the autologous reconstructed breast improves quality of life: a pilot study","volume":"167","author":"A JM Cornelissen","year":"2018","journal-title":"Breast Cancer Res Treat"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/PRS.0b013e3181ccdaa4","article-title":"Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study","volume":"125","author":"R Djohan","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s40271-021-00565-5","article-title":"Patient-reported outcome measures used for assessing breast sensation after mastectomy: not fit for purpose","volume":"15","author":"H P Smeele","year":"2022","journal-title":"Patient"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"e1033","DOI":"10.1097\/GOX.0000000000001033","article-title":"Thermal injury to reconstructed breasts from commonly used warming devices: a risk for reconstructive failure","volume":"4","author":"H R Faulkner","year":"2016","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/02844310701694381","article-title":"Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction","volume":"42","author":"T T Tindholdt","year":"2008","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/00006534-199702000-00013","article-title":"The spontaneous return of sensibility in breasts reconstructed with autologous tissues","volume":"99","author":"W W Shaw","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/PRS.0000000000005199","article-title":"Predictable location of breast sensory nerves for breast reinnervation","volume":"143","author":"R Knackstedt","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1016\/j.bjps.2022.06.006","article-title":"Neurotization in innervated breast reconstruction: a systematic review of techniques and outcomes","volume":"75","author":"E Shiah","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/jso.25223","article-title":"Sensory restoration of breast reconstruction - the search for the ideal approach continues","volume":"118","author":"A Zhou","year":"2018","journal-title":"J Surg Oncol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"9654741","DOI":"10.1155\/2022\/9654741","article-title":"Preserving nipple sensitivity after breast cancer surgery: a systematic review and meta-analysis","volume":"2022","author":"V Harish","year":"2022","journal-title":"Breast J"},{"issue":"07","key":"ref16","doi-asserted-by":"crossref","first-page":"e2332","DOI":"10.1097\/GOX.0000000000002332","article-title":"Nerve preservation and allografting for sensory innervation following immediate implant breast reconstruction","volume":"7","author":"A W Peled","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/PRS.0000000000009773","article-title":"Sensory restoration in abdominally based free flaps for breast reconstruction using nerve allograft","volume":"151","author":"R Djohan","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.bjps.2020.11.019","article-title":"Determining the precise anatomic location of the sensory nerves to the abdominal wall: optimizing autologous innervation of abdominally based free flaps","volume":"74","author":"C Cakmakoglu","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.1097\/GOX.0000000000000008","article-title":"Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve","volume":"1","author":"A J Spiegel","year":"2013","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"12","key":"ref20","doi-asserted-by":"crossref","first-page":"e5437","DOI":"10.1097\/GOX.0000000000005437","article-title":"Sensory outcomes after neurotization in nipple-sparing mastectomy and implant-based breast reconstruction","volume":"11","author":"A W Peled","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"103691","DOI":"10.1016\/j.breast.2024.103691","article-title":"The efficacy of sensory nerve coaptation in DIEP flap breast reconstruction - preliminary results of a double-blind randomized controlled trial","volume":"74","author":"J M Bubberman","year":"2024","journal-title":"Breast"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"1e","DOI":"10.1097\/PRS.0000000000006315","article-title":"Impact of insurance payer on type of breast reconstruction performed","volume":"145","author":"F Chouairi","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1016\/j.whi.2014.03.001","article-title":"Health insurance coverage and racial disparities in breast reconstruction after mastectomy","volume":"24","author":"T P Shippee","year":"2014","journal-title":"Womens Health Issues"},{"issue":"10","key":"ref24","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1245\/s10434-017-5933-0","article-title":"Socioeconomic factors associated with post-mastectomy immediate reconstruction in a contemporary cohort of breast cancer survivors","volume":"24","author":"J R Schumacher","year":"2017","journal-title":"Ann Surg Oncol"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"203e","DOI":"10.1097\/PRS.0000000000002343","article-title":"Distance to a plastic surgeon and type of insurance plan are independently predictive of postmastectomy breast reconstruction","volume":"138","author":"M C Roughton","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"e4818","DOI":"10.1097\/GOX.0000000000004818","article-title":"The insurance landscape for implant- and autologous-based breast reconstruction in the United States","volume":"11","author":"L C Boyd","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"26","key":"ref27","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible - the neighborhood atlas","volume":"378","author":"A JH Kind","year":"2018","journal-title":"N Engl J Med"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1007\/s00266-022-02833-7","article-title":"Neurotization does not prolong operative time in free flap breast reconstruction","volume":"46","author":"T Y Xia","year":"2022","journal-title":"Aesthetic Plast Surg"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/01.GOX.0000992032.11028.df","article-title":"Charting outcomes: the correlation between area of deprivation index and disparities in breast reconstruction","volume":"11","author":"H Huang","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2404-1924.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T22:33:50Z","timestamp":1747089230000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2404-1924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,27]]},"references-count":29,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,5,12]]},"published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2404-1924","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"type":"print","value":"0743-684X"},{"type":"electronic","value":"1098-8947"}],"subject":[],"published-other":{"date-parts":[[2024,8,27]]},"published":{"date-parts":[[2024,8,27]]}}}