Breast Neurotization with Resensation after Mastectomy

In this episode in the MedStar Health DocTalk series, host Debra Schindler talks with Dr. Meghan Milburn, FACS, director of the Breast Center at MedStar Franklin Square Medical Center, about an important and emerging advancement in breast cancer surgery: breast nerve preservation and resensation after mastectomy. 

Dr. Milburn explains why loss of sensation is so common after mastectomy, affecting up to 60–80% of women, and how it can impact far more than physical feeling. Numbness and nerve pain can affect safety, intimacy, emotional wellbeing, and a woman’s sense of connection to her body, even when reconstruction looks cosmetically successful. 

The conversation explores how newer surgical techniques allow surgeons to identify, preserve, and reconnect nerves at the time of mastectomy and reconstruction, helping restore sensation to the breast and nipple over time. Dr. Milburn explains how nerve regeneration works, what patients can realistically expect, and why recovery can take months to years, but with meaningful improvements for many women. 

Listeners will learn:

 ·       Why numbness and neuropathic pain occur after mastectomy

 ·       How breast neurotization and nerve grafting are performed 

·       What recovery and rehabilitation look like, including sensory “retraining” 

·       Who may or may not be a good candidate for these procedures 

·       How restoring sensation can reduce pain, improve quality of life, and help women feel whole again 

Dr. Milburn also shares patient experiences, discusses the emotional and psychological impact of sensation loss, and emphasizes the importance of shared decision-making, asking questions, and considering second opinions. This episode offers hope, education, and empowerment for anyone facing breast cancer surgery, and highlights how advances in surgical care are focusing not just on survival, but on long-term quality of life. 

If you're in the Baltimore area and would like to schedule an appointment to discuss breast neurotization surgery, call 443-777-6500.  Or to make an appointment in the DC region at MedStar Washington Hospital Center, call 202-877-7937. You can also see a specialist for nerve resensation at MedStar Georgetown University Hospital in DC. Call 202-295-0560.   

For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Transcript

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Comprehensive, relevant, and insightful conversations about health and medicine happen here when MedStar Health, DocTalk. These are real conversations with physician experts from around the largest healthcare system in the Maryland, DC region. For many women, the decision to undergo a mastectomy or breast reconstruction brings understandable fear, worries about symmetry, shape, size, scars, where unnatural appearance are normal and commonly expressed. Will I recognize my own body in the mirror? It often happens that the most life-altering change can't see at all. The permanent loss of breast and nipple sensation. Numbness after surgery has long been dismissed as unavoidable, but losing the ability to feel touch, temperature, or even pain can have profound emotional, physical, and intimate consequences. The good news, there is new hope. Surgeons are now using advanced nerve preservation and uritization or resensation to reconnect sensory nerves and restore feeling to reconstructed breasts. I'm happy to welcome Dr. Meghan Milburn, director of the Breast Center at MedStar Franklin Square Medical Center in Baltimore and a leader in this emerging field about how these innovations are transforming recovery and empowering women to feel whole again. I'm your host, Deborah Schindler. Dr. Milburn, thank you so much for being here. Hi, thanks for having me. Pleasure to be here. Explain what breast reconstruction typically involves that would impact nerve sensation. So typically during a mastectomy, most of the sensory nerves to the breast and the nipple are cut and they're transacted for oncologic purposes. With reconstruction, even though we can preserve the nipple and the breast skin and often have the plastic surgeon place an implant or an autologous flap using a patient's own tissue and get a very normal, appearing or aesthetically pleasing appearance to the reconstructed breast, it is not normal as far as sensation. This can be difficult from a psychological and emotional and mental aspect for the patients because they're often facing a hidden loss that they're not aware of, this loss of sensation. And this can really lead to functional impairment. It's a loss of protective sensation, so sunburn, heat, just proprioception, knowing where your body is in space, that can all be lost or diminished, as well as erogenous sensations, but also being able to feel the hug from your child or from your partner as well. So these are all very important. So are we talking about sensation just in the nipple area or the whole breast? So the nipple as well as the remaining breast. And the studies have shown that most patients are left with little to no sensation after mastectomy. And not only do they have diminished sensation or no sensation at times, so numbness, but they can also have pain. And this can be neuropathic pain, this can be burning, tingling, painful zaps. The new procedures that we're doing, or I should say new to breast surgery, it's actually been a well established surgery for nerves that have been transected in other parts of the body, but this decreases the chances of post-mastectomy pain syndrome and also helps restore sensation. So I was very surprised to learn in my research that up to 60 to 80% of women experience long-term numbness after surgery. Does it come back? Some it will. Most patients will regain some sensation. Usually it's more towards the perimeters of the breast. That's because the breast has multiple sites of innervation and also the skin has innervation as well. But what we tell our nipple sparing mastectomy patients, typically the nipple and the areola and the central aspect of the breast will be numb following the surgery. Okay. Explain that nipple sparing surgery. So with a nipple sparing mastectomy, oftentimes I will make a hidden incision underneath the breast, along the bra line, and then I surgically dissect under the skin. There's a plane between the breast tissue and the subcutaneous tissue of the skin all the way around the breast, including under the nipple and the areola, and then remove the breast off the pectoralis muscle, remove all of that. And then I work very closely with plastic surgeons. So the plastic surgeon will come in once I'm finished and do the reconstruction, whether that's an implant or using the patient's own tissue with a free flap to reconstruct. Are the nerves impacted differently based on how the reconstruction is performed? Is a deep flap or the implants going to have a different impact on that nerve sensation? So the nerves are mostly impacted by the mastectomy. So when the breast surgeon performs the mastectomy, oftentimes the lateral intercostal nerves are transected as we dissect through the tissue. And-. What is that? A lateral ... So what that means is these are the nerves coming from between the ribs and the rib muscles off to the sides, and then they go from the edges of the chest wall and the ribs into the breast and then up into the nipple and that provides sensation. So previously during the course of the mastectomy, these nerves are cut. Honestly, I thought that when we were going to talk about breast neuritization or regeneration of the nerves, it was around the nipple. I thought that's where the loss was for sensation where women would feel it or be impacted by most in their life. So it is. It is. And again, when you cut under the nipple and the areola, you're also transecting the other end of the nerves that go to the nipple. So the nerves run from the intercostal muscles at the edge of the chest wall where the ribs are through and around the breast up towards the nipple. But with newer techniques, we're on the lookout for these nerves, especially off to the side. So when I do the procedure, when I do the mastectomy, I am aware of this. And when I get to that area, the anatomic region where the nerves are, I'm very careful and I dissect through looking for the nerves. And once I identify a nerve, sometimes it could be more than one, I preserve that as much as possible and then I transect it. We try to get as much length of that nerve as possible to save for the microvascular plastic surgeon to come in and do the nerve grafting. So this is very important for me to preserve the nerves, finish the mastectomy, remove all of the breast tissue. And then when the plastic surgeon comes in, he is able to take, or she is able to take the nerve stump that's there and take a graft and sew the nerve graft to the nerve and then attach the other side of the graft to the back of the nipple. And then over time, as the patient's nerve actually regenerates and the nipple, and this is what's going to provide re-sensation to the breast. Will it feel normal for the woman? Because I know that I have had nerves cut either on my hand, for example, and I can touch an area of my thumb and it is not-. Normal.... where the cut was. It's different. It's a different sensation. So I've wondered about that after the breast is cut and then you reestablish these nerves, is it going to be like it was before? Probably not. And we are certainly not promising that this is Back to the way you were before, but we know that nerves grow about a millimeter a day or an inch a month. And over time, with the nerve preservation and the resensation, it should significantly improve sensation to the breast. Whereas before, or without this procedure, most of the chest and the breast is numb. Some of the studies are showing that about 75% of women had excellent sensation at 12 months after the procedure to very light touch. And this is extremely important. None of the patients in these studies have experienced neuropathic pain or neuromas within the study period, and that's not the case in patients who don't have the procedure. I also want to emphasize that because nerves grow a millimeter a day, this is a longer process. So from the studies, at a minimum, patients should begin to notice some improvement in sensation at about the six month mark. And we know from studies with breast resensation, as well as other studies looking at nerves in other part of the body, it's that six month to 12 month window where you see the most gains in improvement in sensation. But breast cancer patients are also seeing continued gains, although smaller amount up to 24 months, so two years. It is a slow process, but it's very exciting where previously patients had numbness and they may have some return of more peripheral sensation, but still pretty significant numbness throughout the breast, as well as pain. Can you explain the difference between numbness and nerve pain after surgery? So numbness is really lack of sensation, diminished light touch versus the tingling is more of paresthesias. That's that tingling feeling when your foot or your arm falls asleep. That's all nerve pain. And for some people, there can also be a burning quality as well, or even a sharp, very significant neuropathic pain. I guess they come back, how many weeks after a mastectomy? So usually I see patients postoperatively one to two weeks after surgery, and then oftentimes we see them at three or six months, and then about every six months, continuing on just to monitor them for their cancer journey and survivorship. Oftentimes, the plastic surgeons will see them more frequently. They are doing testing and follow up in the office and monitoring that as well. There's some little filaments or light touch that you can do just to monitor the different quadrants of the breast, as well as the nipple and the areola. One of the other important things to know is that patients really need to take an active role in this process. So just like so many other injuries and challenges, whether it's stroke rehab or just rehabbing your knee patients really benefit by doing rehabilitation and maintaining those cortical pathways from the breast to the brain. We recommend they do this one to two times a day as much as possible, and that really helps train the brain and map everything out and really maintain those current cortical connections. What is that a cortical connection or a cortical pathway and how do women help with that? So what that is, is that's just your brain's knowledge of what the breasts feel like, whether it's to light touch or vibration or heat or cold. And so even if the breasts are numb, by continuing to stimulate that area with ice, a Q-tip, even a small brush for vibration, you're still using the nerves that are there, trying to get some signals through and making sure you don't lose the pathways and the memory that is in the brain. So similar to stroke rehab as well. So you're literally trying to feel the sensation in your breast to exercise those nerves? Exactly. Yeah. It's all about exercise. That's a huge component of my practice is really encouraging patients in their prehabilitation, the rehabilitation, exercise. We know it's crucial to breast cancer survival, decreasing recurrence, also helping decrease the risk of breast cancer. And then it also makes such an improvement in their functional outcomes, no matter what type of breast cancer surgery they've had, whether it's lumpectomy with radiation or mastectomy, a lot of times you get scar tissue. So I strongly encourage my patients to do their exercises, their stretches, as well as strength training and cardio. All of that is extremely helpful for them to heal on their cancer journey. Let me understand, you go in, the patient goes in for her scheduled mastectomy, the reconstruction is done right after, and then the nerve regeneration surgery is performed all in the same day. Right. So we like to think of it as one stop shopping. So we work very closely as a team, the breast surgeons, as well as the plastic surgeons, and we all work in conjunction. So as I'm doing the mastectomy, I'm looking for and preserving the nerves. Once the cancer operation is finished, I am essentially tag teaming with the plastic surgeon. So then the plastic surgeon can come in, do the reconstruction. And during the course of the reconstruction, he is also doing the nerve reconstruction as well. Nerve resensitizing in the breast is relatively new. So what I'm understanding then is before a few years ago maybe a woman would get a mastectomy and was there any effort at that time to preserve that nerve or- So typically- I mentioned before, it was just thought of as an unavoidable. Right. So typically, no. Okay. Typically with the mastectomies, it was just a part of the surgery and it was explained to patients that they would have some numbness. I think many patients are unprepared for this aspect. And again, like so many things, I think until you truly experienced it, you don't understand it. We know that women often feel depressed or have anxiety about their body's response to touch. There's a lot of grief that goes into with a breast cancer diagnosis as well as subsequent treatments. And oftentimes women report that they feel like their body is no longer their own and have a disconnect with their breast, even though when they look in the mirror, they have an excellent cosmetic outcome, but it's that sensation and the loss of touch and feeling, as well as the potential for pain that really impacts them. It has to be a huge psychological and emotional adjustment for sure to lose that sensation. Can women who have had the mastectomy before nerve preservation was being considered come back and have that surgery still years later? So that's a great question, and this is something that is under investigation. The chances of finding the nerve oftentimes and having a functional outcome are low. I know some plastic surgeons are willing to try it, especially if the patient has to go back for additional surgery for reconstruction. Oftentimes there's some additional surgeries where there is some adjustment to the reconstructed breast. Some plastic surgeons feel that if they're in the OR, they will attempt to take a look and see if there's any nerve that is still able to be preserved and then reconstructed. But generally, no. The nerves have already been transected and they're either difficult to identify or they're just too short. Again, because the nerves grow slowly, but there's only a certain length that they can grow. Generally, it's about five to seven centimeters that we use as the graft, something much longer than that. And when you say graft, that means you're getting that piece of nerve from somewhere else? Correct. Correct. Where do you take that from? So you can use the body's own nerves that you can harvest. Again, you're then treating a new area of numbness when you're taking the nerve. Oftentimes, if the patient is having autologous reconstruction with their own tissue, such as a deep flap where they're taking skin and subcutaneous fat from the tummy and using that to reconstruct the breast, sometimes the plastic surgeon can find a nerve in there and use that as the reconstruction, or there are commercially available nerve grafts. Artificial nerve grafts or maybe cadaver parts? Cadaveric nerve grafts. And that has been one of the issues in the last couple of years where just trying to get insurance reimbursement for these cadaveric grafts and for the procedure itself, that's certainly been a stumbling block for more surgeons and more institutions to offer this. Let's say money isn't an option. It could work. It could actually be effective. That is the standard. That's what we typically. Use for these. Yeah. We use the. Ketavert block.That's pretty amazing. Oh. It is. It really speaks to the importance of us having sensation in our breasts, doesn't it? It. Does. Just like any other part of the body, it's not just erogenous, it's just not the need for sensation, but it's protective. It decreases the risk of pain and it's functional. How long does it take to regenerate the nerves? How long is that portion of the surgery? So that portion of the surgery really depends. It adds about 15 to 30 minutes to my portion of the case, so not too, too much longer. And then if we have a great nerve, the plastic surgeon is very happy with. You can do that pretty quickly, again, 15 to 30 minutes at most. If we're using a cataveric graft, it's two small sutures to connect the nerve with the nerve graft, and then it's attached to the backside of the nipple. So not too, too long. Some people have beautiful nerves and absolutely perfect. Other people have very tiny, small, kind of wimpy nerves that if we see that, then we want to look for some additional nerves, see if there's a little bit better candidate in order to do this. And there's some women that for whatever reason, whether it's anatomy or just the location of the cancer or we just can't find it. Even if we plan to do it, there's some women where it's unsuccessful. It sounds like you're talking about it's just one nerve that you're working on per breast. Is there-. Generally, it's just one. Again, depending on the anatomy and whether the patient is having an implant or an autologous flap, sometimes the plastic surgeon will reconnect more than one, but the goal is to do one per side. And that would be enough? It seems like there's a lot of nerves in your breasts. Yeah. Yeah. So again, it's not perfect, but it's very exciting. Yeah. It's improved. It is significantly. What kind of feedback do you get from your patients? If someone's listening to this now and they're considering or facing a mastectomy or reconstructive surgery, or even implants, maybe they didn't have breast cancer and they have implants put in. Does that affect your nerves? So that's a great question. I think if someone is having a breast augmentation, depending on where the implant is placed, there is a possible risk of nerve injury and decreased nipple sensation or nipple numbness. It really depends on the surgeon and the anatomy of the patient. Everyone's different. So someone having a reduction, for example, wouldn't necessarily need a nerve preservation procedure and then a nerve regeneration procedure. So usually not for that. Usually with the breast reductions, oftentimes patients will have numbness along the bottom of the breast, sometimes to the nipple, but much of that is generally preserved. If they've had that and then down the line they go on to have a masttectomy, usually we can still preserve the nerves because they're lateral. They're off to the side, at the side of the chest wall. Maybe you can share a patient experience who's had this procedure and share with us what the feedback's been. Sure. So one of the most surprising feedback that I heard from a patient was that at about six months she felt like her breasts were a part of her. And she said prior to this with the mastectomy and the reconstruction, with the numbness and the changes, she just didn't feel or mentally feel like these were her breasts. But she said at about six months or so, she started noticing some sensation and feeling and really felt like then they became a part of her body. And that was amazing to hear because again, you know all of the nerves are regenerating, not just the ones that were reconnecting, but a lot of the smaller branches of the nerves under the skin and from the muscle, everything is regenerating and growing and waking up and it was so amazing to hear that. And. Just see how we'd helped her. Right. Until you told me that story when I read that women felt very detached from their breasts after a reconstruction or mastectomy, I thought it was more of an emotional detachment that they were experiencing, but it sounds like it's more like when your foot is asleep and you're walking on it and you don't feel your foot. I think it's a combination and I think the two go hand in hand. It's that emotional and psychological aspect as well as the feeling. The. Numbness, the absence of sensation. I'm trying to imagine what that is like and appreciate the ability to restore that. Do you find it to be more successful than not? So. I think it's early. Again, we have been limited with being able to do these procedures with the insurance reimbursement, which is one of the reasons why I think at many places it hasn't taken off. But again, it's two years before you're really going to see the full impact. And some patients are even reporting, I've heard from other surgeons that their patients are saying even four or five years later, they're still continuing to have some improvement, which I think gives a lot of hope for this. Do you forewarn women who are facing a surgery or scheduled for a surgery that the numbness and the loss of sensation is going to follow? Always. And that's something I had always counseled women list of risks and possible complications when we're talking about the surgery. But I don't think I was aware about how impactful this was, especially with the emotional aspect and really the functional aspect as well with this. And just being in practice and seeing patients come back doing well, I also think that oftentimes patients are not telling us this and whether that's side effects from chemotherapy or menopausal or sexual symptoms related to their treatment, I think oftentimes patients are not going to volunteer that information. It's really up to us as clinicians to ask them very specific questions. And that's one thing that I've learned over the years. And I'm happy to say that as part of survivorship, being focused on the quality of life is just as important as treating the cancer itself. And the NCCN guidelines have a lot of guidance on how to manage a slew of side effects of treatment, and this is just one more tool in our toolbox to help with that. And when you have those conversations with your patients, are you suggesting that this nerve preservation might be necessary or is necessary and that there are steps to take to restore that sensation and I guess get them to opt in or do they ask for it? So I've only had one patient recently who's asked for it, but I think-. Everybody else, you're telling them that this could happen and we would like to do this surgery? It could. We're starting to. I mean, I think too, women are so educated now. There's a lot of information in support groups and social media groups. I think the word is going to get out there with the potential benefits for this procedure. Now that I'm here at MedStar, I've talked to my partner and the plastic surgeon as well, and everyone is on the same page where we really feel like this should be the default that offering- Routine. Routine. Routine, that it should be just a part of all of the nipple sparing masttectomies and potentially even some of the skin sparing mastectomies as well. I think that's important to mention, and especially since women don't know this could happen or might happen, or apparently will happen, that they will lose sensation in their breasts, that it just becomes a normal part of the reconstructive process. What should women ask for? So I think it's most important to talk to your surgeon and the rest of your team, your medical oncologist, and talk to them about your cancer, the recommended treatment plans, and then just ask questions because most patients have choices for their treatment. And there are many different routes or pathways that we can take to get you to the same endpoint. For example, many women are candidates for lumpectomies followed by radiation or a masttectomy and generally survival is exactly the same, but it's really about talking about what's recommended, individualizing the treatment plan for each specific patient, their cancer, but also their anatomy, their lifestyle, what's important to them as far as quality of life. And these are the things that I really enjoy talking to my patients about and working together as a team. I mean, it's all about shared decision making. Who wouldn't be someone that you would suggest we try this with? What patients might ask for would you say,"You're not a good candidate for this? " I'm sorry. That's a great question. There's certainly anatomic limitations to the nerve grafts. But you wouldn't know that until you're in there, right? Well, for women that are having implant-based reconstructions, we know the nerve has to go up and around and over the implant to get from that nerve stump by the ribs to the nipple. It's just a matter of distance. So if someone wanted a very large implant, the nerve would not be able to transverse that far, so they would not be good candidates. You would know that in advance. Now, what about the women whose nipples could not be spared, they're reconstructed or tattooed? I've even seen that there are surgeries to create a perky nipple. Sure, sure. Could they get their sensations installed? Yeah. Yeah. And those are incredible. The 3D nipple tattoos are game changers. I mean, they're so realistic. I think they bring a lot of closure and completeness to the reconstruction. And again, it's all about that emotional aspect and wellbeing. We have also talked about performing this procedure in the skinsbury mastectomies where the nipple and the areola are removed, but if we can still preserve the nerve and have the plastic surgeon use the nerve graft, that can still provide significant sensation to the remaining chest. Again, it's not always about the nipple itself, it's bringing sensation back to the reconstructed breast and the chest. And then also very important for function as well as helping decrease the chances of neuroma formation or neuropathic pain. Okay. So what I'm hearing is that you can probably restore some breast sensation, but maybe not to the tattooed nipple. Right, right. Okay. We're early on. We are. We are. This is early. And again, the tattooed nipple is not a nipple, but it's still skin. So if we can get that nerve graft as close as possible, right behind the tattooed nipple, we would be providing sensation to that skin and the anterior aspect of the breast. Can restoring sensation improve the psychological wellbeing and sexual health for women? I think it does. Do you get feedback about that from your patients? So a lot of it is anxiety and depression and grief, disconnect with their body and resentment, anger that women often experience as they go through treatment and have the side effects and the changes to their body. And oftentimes there's a change in relationship Such that many women are caregivers and now they're the ones having to be taken care of. So that certainly changes the dynamic. Many of my patients are young or in their 40s or 50s and they're in the midst of everything. They're raising kids, they're busy at work. Oftentimes they're taking care of aging parents. And now they have been just punched in the gut with this diagnosis and treatment and all of the time and financial impacts of a cancer diagnosis and treatment plus the side effects. They don't feel well. And then often there are lasting side effects. And whether that's peripheral neuropathy, numbness in the breast, menopausal symptoms, hot flashes, night sweats, vaginal atrophy, decreased or no libido, this significantly affects a woman from where she was. And yes, I mean, I think anything that then helps restore wholeness and improves psychological and emotional wellbeing is so crucial. It helps with their relationship with their partner as well as their self-esteem and. Sense of self. What is it most important for women to know about breast neurotization or nipple resensation? What's the takeaway? Because we don't want people to have any misconceptions about what is available and what is not, right? But we want to give them hope. I want to give them hope. Right. And I think that is the most important takeaway from this is that there is hope. Breast cancer is devastating, but there is so much positive news, especially the last couple of years. And going forward, we've come a long way just from a breast surgical and oncologic perspective in that for a long time, reconstruction was minimal or not offered. For the last couple of decades, we know that nipple sparing mastectomies are safe from a cancer standpoint and we've been offering that. We're also decreasing the lymph node surgery as much as possible to help decrease the risk of lymphedema and also doing some things before and after surgery to help treat that or minimize the risk. Same thing with chemotherapy. We're really focused on more targeted systemic therapies. We have improved radiation planning techniques where we spare healthy tissue. And again, less invasive surgery with a focus on obviously cancer treatment is number one priority, but we know that the cosmetic outcome and the functional outcome are such a key component of that as well. I think it's important for patients to ask their surgeons about what types of procedures they do, what they recommend, and then consider getting a second opinion. I encourage all of my patients to get a second opinion with a breast cancer diagnosis, just because it is often overwhelming. And I want to make sure that they feel comfortable with their treatment team. I never, never hold it against anyone if they want to get a second opinion. We tout that all the time, getting a second opinion. You mentioned neuromas. And I wanted to ask about that because neuromas have been described to me as a bundle of angry nerves that want to regenerate, but have nowhere to go because they've been cut. And I know about that because of our hand surgeons. Do women experience that in the breast after surgery? And can you treat that? Absolutely. And that's why it is so important to start identifying and preserving these nerves, because that can happen. Nerves have a function. They want to grow, they want to do their job. And when you cut the nerves during the course of a cancer operation, you're exactly right. You wind up with an angry ball of nerves that don't have a true sensation function, so they're causing pain. Even if we're not doing nerve grafting, one of the things that I can do during the course of the mastectomy is I can identify the nerve, transect it, and then I can tuck it into the muscle and keep it happy there. And that decreases the risk of neuroma formation and pain. They'll still have numbness since we're not doing nerve grafting, but it can significantly decrease the risk of pain from that nerve. We're not truly doing anything new in the breast that hasn't been done elsewhere in the body, whether it's on the hands or the extremities of the face. Nerve grafting is not new. That is well established. What is newer is doing that in the breast and showing that there's a need for it, that it improves sensation, it improves pain outcomes, and really making this a seamless operation. That's what's new. Protective sensation is a big component of this, but it's also just the intimacy in hugging someone and feeling that. Restoring sensation isn't cosmetic. It's about restoring identity and normalcy, intimacy, safety, and long-term emotional wellbeing. I'm certain this will become standard of care with enough time because there's so many benefits. Thank you for sharing your expertise with us here on MedStar Health Doc Talk. Thank you so much for having me. My pleasure. If you're in the Baltimore area and would like to schedule an appointment to discuss breast neurotization surgery, call 443-777-6500. Thank you. Thank you. Sure. Or to make an appointment in the DC region at MedStar Washington Hospital Center, call 202-877-7937. You can also see a specialist for nerve resensation at MedStar Georgetown University Hospital in DC. Call 202-295-0560. To comment on this podcast or recommend a topic for another episode of Doc Talk, send an email to doctalk@medstar.net.