Reduction Mammaplasty and Sensitivity of the Nipple-Areola Complex

Abstract

W omen requesting reduction mammaplasty are generally more concerned with the improvement of the size and shape of their breasts than with the preservation of mammary sensation. Even after surgery, if not specifically asked, many patients do not mention changes in the sensitivity of the nipple and areola. The improved appearance of the breasts causes a positive change in body image 1-5 and makes the patients feel more sensual, 2,6,7 irrespective of the actual breast sensation. 6 It is therefore not surprising that, in the past, plastic surgeons who described reduction techniques have focused more on breast shape, scar length, and scar position than on preservation of sensation. Esthetic aspects and sensuality were considered more important than nerve supply and sexuality. Only during the last years has attention been directed toward the preservation of the nerves supplying the breast. The influence of surgery on the sensitivity of the nipple-areola complex, and hence on sexuality, is increasingly regarded as a criterion in the evaluation of reduction mammaplasty techniques. 8 -16 Recent studies have significantly added to our knowledge of the normal function and anatomy of the sensory nerves and helped to identify the factors which influence the preservation of sensation during breast reduction surgery.

The Impact of Reduction Mammaplasty on Breast Sensation

“…Another consideration is that the middle-aged patient with hypertrophic breasts has indeed experienced additional long-term but subclinical insult to intercostal nerves perhaps due to the increased weight and increased pull by gravity and resultant traction injury to nerves over several decades of life as theorized in previous reports. 6,15 Although the bulk of the literature on reduction mammaplasty has focused on the best techniques to minimize scarring and improve the shape and contour of the breasts, more recent reports have been designed to address more nuanced outcomes including sensation. 9,15,16 Published reports concerning potential alteration of breast sensitivity after reduction mammaplasty have produced conflicting results regarding the area of the breast that was most sensitive and whether breast size influences sensation.…”

Clinical outcome, quality of life, patients’ satisfaction, and aesthetic results, after reduction mammaplasty

“…Kuzbari and Schlenz [21] concluded that inferior pedicle techniques are preferable when trying to preserve the areola innervation. In their study, most patients treated with an inferior pedicle kept or improved their original sensitivity after 3 weeks, and 3, 6, and 12 months.…”

“…The reduced sensitivity did not seem to affect the normalisation of the quality of life, indicating that patients are happy as long as the breast looks good and weighs less Á that is, ''sensuality over sexuality'' [21]. Table II.…”

“…Even if there is impaired sensitivity, patients are still satisfied with the general result [21]. Patients with macromastia may also have reduced sensitivity preoperatively, which can result in a smaller decline in postoperative sensitivity [23].…”

“…The areola and nipple complex is the most densely innervated part of the breast and receives nerves from two directions, laterally from the lateral branches of the intercostal nerves, and medially from the medial branches of the intercostal nerves. The lateral nerve supply is the dominant one in most patients [21], and should be spared if possible, but the medial branches overlap in most cases [21,22].…”