How to Get Nipple Sensation Back After Breast Reduction

Abstract

Introduction:
Since its inception, reduction mammaplasty has matured considerably. Primary evolution in clinical research and exercise has focused on preserving tissue viability. Surgery involves preserving not only tissue viability but also part and sensation. The nipple serves as the sensate unit of measurement of the breast and is a valuable part of women’s psychological and sexual wellness, making preservation of nipple sensation of utmost of import. Studies regarding primary innervation to the nipple are few and oft contradictory. Nosotros advise an unsafe zone in which dissection during reduction mammoplasty ought to be avoided to preserve nipple sensation.
Methods:
Circumareolar dissection of 22 cadaveric breasts was performed. Primary nerve branches to the nipple-areola complex were identified and dissected to their origin.
Results:
Three to five branches of the 4th intercostal nerve primarily innervated the nipple on eighteen of 22 breast dissections. Ii breasts received innervation from the third intercostal nervus and ii from the fifth intercostal nerve. In half of the specimens, accessory innervation from the third and fifth intercostal nerves provided medial branches to the nipple.
Conclusions:
The fourth intercostal nerve provides the major innervation to the nipple-areola complex. Fugitive dissection in inferolateral quadrant “unsafe zone” of the breast during reduction mammaplasty and other breast surgical procedures can reliably spare nipple sensation and maximize patient outcomes.

Keywords:

nipple innervation, reduction mammaplasty, nipple, breast reconstruction, nipple-areola complex

Since its inception, reduction mammaplasty has matured considerably. Main evolution in clinical research and exercise has focused on developing techniques to preserve tissue viability and chest parenchyma, peel, and nipple tissue. Previously, women with macromastia were more concerned with chest size and shape over mammary sensation. Presumably, the improved aesthetic outcome resulted in an enhanced torso image and helped patients feel more than sensual. All the same, surgery today involves preserving not only tissue viability but also function in terms of sensation. The nipple serves every bit a sensate unit of measurement in erectile function and plays a big function in the concrete intimacy of women. Nipple sensation has shown to be a valuable part of women’s psychological and sexual health. While preservation of nipple sensation is of utmost importance, the literature regarding main innervation of the nipple is scant and contradictory.^1
–
5
The authors review the current literature of nipple innervation and perform anatomical studies to identify a safe zone for reduction mammaplasty to preserve nipple awareness.

METHODS

Xi dissections were performed on 22 cadaver breasts at the Academy of Louisville Fresh Tissue Lab. 4 cadavers (8 breasts) had macromastia as determined by the investigator’s judgment. Circumareolar subcutaneous autopsy was performed to identify the nerves from the chest wall to the nipple using 2.5× loupe magnification. In one case the trajectory of the fretfulness to the nipple was identified, the nerves were dissected back to their origin of penetration of the breast fascia.

RESULTS

Anatomical results identified 3 to 5 branches of the fourth intercostal nerve to primarily innervate the nipple on 18 of 22 breast dissections. Two breasts received innervation from the third intercostal nervus and ii from the 5th intercostal nerve. In half of the specimens, accessory innervation from the 3rd and fifth intercostal fretfulness provided medial branches to the nipple (Table 1
and
Fig 1). On the left side, the nerve travels toward the nipple at the 4 o’clock position while it enters at the 8 o’clock position on the right side. The nerve pierces the chest fascia above the fifth rib 3 cm lateral to the border of the pectoralis major muscle and travels through the gland in an inferolateral position toward the nipple (Figs 2
and
​
3). Breast size did not modify the form of the intercostal nerves to the nipple-areola complex (NAC).

DISCUSSION

Breast-reduction surgery has evolved considerably through the centuries. Prior to the late 1800s, breast amputation was the process performed to eliminate excessively large breasts. Theodore Galliard-Thomas was the kickoff to advocate preservation of some part of the glandular tissue in the 1880s.⁶
The mid-1920s brought the techniques of Lexar and Kraske to transpose the nipple after creating subcutaneous flaps.⁶
Thorek⁷
was the first to perform a complimentary nipple graft for excessive macromastia. Schwarzman et al⁸
in the 1960s adult the concept of de-epithelialization to maintain the nipple complex on a dermal plexus. Wise^nine
congenital upon Biesenberger’south process of separating the skin from the gland and transposing the nipple by developing resection patterns to aid in safer more reliable reductions.¹⁰
The vertical bipedicle dermal reduction was popularized afterward by McKissock.¹¹
Inferior pedicle techniques were developed by Robbins¹²
and Courtiss and Goldwyn.¹³
Courtiss¹⁴
later described using liposuction alone every bit a reduction method. The vertical reduction was after popularized past Arie, Lassus, Lejour, and Hall-Findlay.^xv
–
21
Chief goals of these procedures through the years accept been tissue viability, shape, contour, and scar aesthetics.

Notwithstanding, many advocate that nipple awareness is paramount to patient satisfaction as well. Equally the nipple is possibly the near sensitive area of the breast, it serves a significant role in a woman’s sexual life. Erectile office and sensation are oft necessary for both the woman herself and her partner. Consequently, loss of these functions has a detrimental impact on procedure outcome and patient satisfaction.^22
–
26

Previous studies have demonstrated that the bulk of women experience that nipple-areola sensitivity as an important part of their sexual life, and of those women who underwent chest surgery and lost nipple sensation, the bulk of women were significantly bothered by the result.²⁶

In general, patients undergoing breast-reduction surgery demonstrate loftier satisfaction due to the comeback in cervix, shoulder, and dorsum pain. Still, loss of awareness to the nipple results in a poorer result. Anatomical assay of the innervation of the NAC possibly helps guide the surgeon in avoiding damage to the fretfulness of the nipple. Our anatomical study demonstrated the innervation of the nipple to come laterally from 3 to 5 branches off of the fourth intercostal nervus. In addition, in some specimens, intercostal fretfulness 3 and 5 provided accessory innervation. These findings were consequent in both normal and hypertrophied breast specimens. Breast size did not alter the trajectory of the nervus to the NAC. Our results demonstrate that the distortion of breast tissue observed in obese patients and patients with macromastia does non alter the anatomical course of innervation to the NAC. Furthermore, the stretching of breast tissue observed with aging as a result of loss of support past the suspensory ligaments was non observed to modify anatomical course of the intercostal nerves to the nipple. The fourth intercostal nerve pierces the fascia of the fifth rib just lateral to the edge of the pectoralis major musculus. The nerve travels to the NAC through the inferolateral position of NAC. Previous studies have demonstrated the lateral branch of quaternary intercostal nerve to be the most reliable innervation to the NAC.^1
–
v
Other studies also demonstrated accessory innervation of the nipple to come from both anterior and lateral branches of the second through 6th intercostal fretfulness.
^ane
,
3
However, not all innervation to the NAC tin exist reliably salvaged during reduction mammoplasty.

Lessons learned in the anatomy laboratory demonstrate that the plastic surgeon ought to avoid excessive resection and dissection in the inferolateral areas of the breast then as to preserve the innervation of the NAC. Breast size does not announced to change the course of the intercostal nerves through the breast parenchyma. Consequently, we suggest that the findings of this anatomical study can exist extrapolated for guidance of breast surgery in patients with either normal or hypertrophied breast tissue. Avoidance of the inferolateral quadrant “unsafe zone” during reduction mammoplasty and other breast surgical procedures can prevent damage to the quaternary intercostal nervus and accompaniment innervation by the 3rd and 5th intercostal nerves. Such technique will reliably maintain the primary innervation of the nipple and maximize patient satisfaction.

Frequently, the plastic surgeon must individualize therapy to the patient. A fixed procedure does non always use to every clinical scenario. Adhering to principles of techniques and knowledge of anatomy frequently serves every bit a foundation for the reconstructive surgeon when planning procedures. This report can assist the novice and experienced surgeons in obtaining quality outcomes in terms of not only aesthetics only also part.

CONCLUSION

Preserving nipple sensation is a valuable goal in breast surgery. Many women value nipple sensation as a meaning component of sexuality and quality of life. The innervation of the nipple is anticipated based on anatomical findings. An unsafe zone tin can reliably be avoided in the inferolateral area of the breast. Clinical application of these findings demonstrates the possibility to reliably maintain the nipple every bit an aesthetic and sensate unit.

REFERENCES