A ‘bionic’ breast that restores sensation after reconstructive surgery following cancer is now being trialled in US patients.
The device has been designed to help women who’ve had a mastectomy, as removing the whole breast usually involves removing nerves that supply sensation – meaning it’s no longer sensitive to touch or temperature.
The implantable gadget is small and battery-powered and has a sensor about the size of a 2p coin. It sits under the skin in the middle of the breast near the nipple and is connected to electrodes implanted in the breast. The implant also has a sensor and a processor that can convert the mechanical energy (from touch) into electrical energy so it can be ‘felt’ by the woman.
Some 55,000 women are diagnosed with breast cancer every year in the UK, and nearly 15,000 have a mastectomy. Around 31 per cent of these patients will have a reconstruction (21 per cent immediately, and 10 per cent having a delayed reconstruction).
As well as improving sensation (and the woman’s sex life), it is hoped the device will alleviate the long-term pain that can accompany mastectomy, which affects between a quarter and a half of patients, according to a University of Copenhagen study in 2009.
Women who have a mastectomy ‘don’t want to feel numb – they want some sensation in their breast, they want to feel a hug, want sexual pleasure, to know where their breast is in space’, explains Professor Stacy Lindau, a professor of obstetrics and gynaecology at the University of Chicago and the lead investigator on the Bionic Breast Project.
‘They want to feel the breast belongs to their body’ – the scientific term for this is embodiment, she explains. ‘And when the breast is numb, it’s hard for the brain to perceive that body part as belonging to one’s body.
‘This is a very distressing feeling because when we reconstruct the breast to look like a natural breast, women are aware that others gain pleasure or reassurance from seeing that breast, but they don’t feel the breast belongs to them. And, especially in the sexual context, this can be very, very distressing.’
The ‘bionic’ device has been designed to help women who’ve had a mastectomy, as removing the whole breast usually involves removing nerves that supply sensationÂ
Some 55,000 women are diagnosed with breast cancer every year in the UK, and nearly 15,000 have a mastectomy
Many women – 77 per cent – experienced sexual dysfunction after a mastectomy, research from US-based Drexel University claims.
‘There have been some efforts over the last ten to 20 years to try to restore sensation by recreating nerves through flap procedures [where tissue from the patient’s body is used to form a breast shape] and other technologies, and some women can benefit from these,’ says Professor Lindau.
‘But we’re not getting the outcomes that women want to see and most women are not eligible for these procedures.’
Professor Lindau was inspired to develop an alternative after a patient came to her in distress about her numb breasts, saying she couldn’t have pleasurable sex any more as a result – and asked what she could do about it.
Professor Lindau contacted a neuroscientist at her university, Professor Sliman Bensmaia, who was developing prosthetic limbs that could restore a realistic sense of touch to amputees and patients who were paralysed. Professor Lindau is about to trial the technology in eight women who are undergoing mastectomy and reconstruction with implants.
They will have the electrodes fitted at the first stage of their reconstruction.
The whole device would then be implanted at a later date but, in this first trial, electrodes with leads connected to the nerves will come through the skin so electricity can be delivered to the women externally for a few minutes at a time, twice a week.
As Professor Lindau explains: ‘We don’t expect women will live with that material coming through their skin in the real world – in the long run, the electrical leads will be contained inside the breast.
‘Also, if we are able to restore sensation in these patients, we expect we should be able to achieve similar results for women who don’t have a reconstruction,’ she explains.
The long-term plan is ‘different size sensors for different-sized women’, as the hope is that the device will become part of the reconstructed breast itself.
Commenting on the new technology, Professor Kefah Mokbel – an oncoplastic breast surgeon at the London Breast Institute – says: ‘The ‘bionic breast’ promises to revolutionise breast reconstruction by combining living tissue with advanced technology.
‘While this concept is exciting, it poses a complex challenge.’
This includes ‘ensuring the tissue remains healthy, making the nerve stimulation feel natural – and proving that the device can reliably restore sensation, which will require years of research’.
Professor Mokbel says the small nerves supplying sensation to the breast are often cut during a mastectomy but, ‘in my experience, making an incision around the nipple rather than under the breast can minimise trauma to the key nerves that provide sensation’.
He adds: ‘Nerves can regenerate, and when they are cut close to the nipple they have a shorter distance to grow back and restore feeling compared to incisions made under the breast or on the side.
‘Many surgeons were traditionally trained to prioritise complete tumour removal and preserving the nipple blood supply over nerve preservation. While awareness is growing, adopting nerve-sparing techniques in mastectomy requires specialised training and a shift in standard surgical practice.
‘Advances in nerve-sparing surgery and microsurgical re-innervation may hold the key to better sensation outcomes long before a bio-hybrid breast becomes a reality,’ he says.
