Methods for Preserving Nipple Sensation During Breast Surgery

The loss of nipple sensation is among the common concerns women express when considering cosmetic breast surgery. Having diminished sensation following surgery can be very disappointing to women, but modern surgical techniques can help to minimize the risk of nipple sensation loss.

The Anatomy of Nipple Sensation
All sensation is based upon nerve connectivity, and in particular, a certain set of nerves called the fourth intercostal nerve branch provides sensation to the nipple. These nerves extend from the chest wall to the nipple and if any of them are severed or damaged - or if their blood supply is cut off - the result may be diminished nipple sensation.

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Surgeons must use careful techniques in order to avoid damaging this nerve branch and to promote proper healing and nipple sensitivity. Depending on the specific type of breast surgery being performed, some methods are better at preserving nerves than others. The following are a few cases in which permanent sensation loss may occur, along with techniques surgeons can use to help preserve feeling.

With Breast Augmentation
With breast augmentation, the nerves below the nipple are not typically cut, but can be damaged or stretched when the surgeon maneuvers the implant inside the breast. This is particularly true in cases where larger breast implants are used. While there is some debate about incision location and implant placement affecting post-operative nipple sensitivity, the strongest evidence supports the size of the implant as being the major determining factor in sensation loss.

Essentially, the larger the implant placed in the breast pocket, the more pressure that the implant puts on the nerves and tissue within that pocket. If there is a large implant and a smaller breast pocket, the risk is even greater.

There has also been evidence that placing breast implants under the pectoral muscles preserves sensation more than sub-glandular placement. This may be because, when the implant is under the muscle, it places less pressure on the fourth intercostal nerve branch. Choosing a moderately sized implant and placing the implant below the muscle may help reduce the risk of sensation loss.

With Breast Reduction
Unlike breast augmentation, breast reduction carries significantly more risk for decreased nipple sensation. This is because the nerves may need to be cut in order to sufficiently remove enough breast tissue. In more extreme cases, a plastic surgeon may need to remove the nipple entirely to reposition it. Called a free nipple graft, this method allows the surgeon to remove more tissue, but it severs the blood supply and nerves, almost guaranteeing loss of nipple sensation.

The more common pedicle method of breast reduction in Seattle is a much better way to preserve nipple sensation. Instead of completely severing the nipple from the nerves and surrounding tissue, the surgeon will leave the nipple attached to a section of tissue called a "pedicle" that contains the milk ducts, nerves, and blood supply. Because the nerves remain intact, it is far less likely that patients will permanently and fully lose sensation.

With Breast Lift
Breast lifts are often very similar to breast reduction, in that the nipple may need to be moved, increasing the chances of nerve damage and stretching. Some surgeries will sever the nerves, requiring months of healing for the nerves to (hopefully) regenerate and sensation to return. Typically, the more dramatic the lift and the more the nipple needs to be moved, the greater the patient's chances of losing nipple sensation. However, in many cases, the surgeon can use a similar technique to the pedicle method to maintain the nerve connection to the nipple when performing the breast lift.

What You Can Do
All breast surgeries usually result in temporary sensation loss, since incisions can damage surface nerves. However, these nerves typically grow back, returning sensation over a period of about 3 to 6 months on average.

In general, if you are concerned about nipple sensation when considering breast surgery, discuss your options with your plastic surgeon. He or she can advise you about certain methods that may be right for you.

Methods for Preserving Nipple Sensation During Breast Surgery

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