Somato-somatic theory of referred pain elucidates observations of referred sensations during micropigmentation of nipple-areolar complex in a cohort study on patients undergoing pedicled latissimus dorsi flap breast reconstruction

• Published in: Annales de chirurgie plastique et esthétique 2022-06, Vol.67 (3), p.140-147
• Main Authors: Ma, Y., Khan, M.A.A., Javed, A.A., Mohan, A., Bhatti, D., Khalil, N., Rayatt, S.
• Format: Article
• Language: English
• Subjects: Central sensitization; Convergence-projection theory; Micropigmentation; Neuroplasticity; Nipple and areolar restoration; Nipple sensation
• ISSN: 0294-1260; 1768-319X
• DOI: 10.1016/j.anplas.2022.03.004

Micropigmentation of the nipple-areolar complex is the final aesthetic step in autologous breast reconstruction. The mechanism of referred pain observed in patients during micropigmentation after a non-neurotonized pedicled latissimus dorsi flap breast reconstruction is poorly understood. Patients undergoing micropigmentation for nipple-areolar restoration at our breast unit were included in this study. Baseline sensitivity of both breasts was recorded using a questionnaire and non-invasive Semmes–Weinstein monofilament testing. Patients experiencing local and regional referred symptoms, while undergoing micropigmentation, were identified and their clinical data were collected and analysed. Three months postoperatively, the patients completed a questionnaire pertaining to their satisfaction and future analgesic preference. Thirty (17.8%) patients experienced referred sensations during micropigmentation. Their symptoms ranged from “ache” (6.7%), “discomfort” (13.3%) to “deep pain” (13.3%) and were either local and/or referred to ipsilateral axilla, upper limb and back. The majority were pleased with postoperative outcomes [shape (30, 100%), size (28, 93.3%), colour match (22, 73.3%)] and a small number were not satisfied with the shape (2, 6.7%,) position (1, 3.3%) and appearance of the tattoo (1, 3.3%). Micropigmentation is a safe procedure with good patient satisfaction and low rates of complications; however, patients may experience significant local or referred symptoms. This observation can be explained by the proposed “somato-somatic” theory of referred pain and ascertains the need for use of oral and/or local anaesthetic as well as improved counselling in these patients.