How to Get Nipple Sensation Back After Breast Reduction

How to Get Nipple Sensation Back After Breast Reduction

  • Journal List
  • Eplasty
  • v.xv; 2015
  • PMC4492192

Eplasty.
2015; 15: e28.

Published online 2015 Jul 2.

Plastic Surgery of the Breast: Keeping the Nipple Sensitive

Charles A. Riccio, MS,
Matthew R. Zeiderman, BA,
Saeed Chowdhry, Physician,
Ronald M. Brooks, Doctor,
Shahrooz S. Kelishadi, MD,
John Paul Tutela, Medico,
Joshua Choo, Md,
David 5. Yonick, MD,
and Bradon J. Wilhelmi, Doctor
corresponding author


Charles A. Riccio

Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky

Matthew R. Zeiderman

Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky

Saeed Chowdhry

Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky

Ronald M. Brooks

Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky

Shahrooz South. Kelishadi

Partition of Plastic and Reconstructive Surgery, University of Louisville Schoolhouse of Medicine, Louisville, Ky

John Paul Tutela

Partition of Plastic and Reconstructive Surgery, Academy of Louisville School of Medicine, Louisville, Ky

Joshua Choo

Division of Plastic and Reconstructive Surgery, University of Louisville Schoolhouse of Medicine, Louisville, Ky

David V. Yonick

Sectionalization of Plastic and Reconstructive Surgery, University of Louisville Schoolhouse of Medicine, Louisville, Ky

Bradon J. Wilhelmi

Division of Plastic and Reconstructive Surgery, University of Louisville Schoolhouse of Medicine, Louisville, Ky

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.

Read:   How to Get Revenge With a Phone Number

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).


An external file that holds a picture, illustration, etc.
Object name is eplasty15e28_fig1.jpg

Inductive view of intercostal nerve innervation to the nipple. The red dashed lines demarcate the inferolateral breast quadrant to be avoided during surgical dissection and then as to preserve nipple sensation.


An external file that holds a picture, illustration, etc.
Object name is eplasty15e28_fig2.jpg

Cross-sectional illustration of intercostal nerve innervation to the nipple.


An external file that holds a picture, illustration, etc.
Object name is eplasty15e28_fig3.jpg

Photographs from cadaveric dissection, highlighting the class of the 4th intercostal nerve in the inferolateral quadrant.


Table i

Primary and accessory innervation of the nipple
*

Specimen Side ICN Accompaniment ICN No. of branches
1 50 four 3 three
2 Fifty 4 5 three
3 R 4 5 5
four R 5 v 5
5 L 4 3 iv
6 R iv 3 4
7 R 3 four 4
8 Fifty four 5 iii
9 Fifty iv 5 5
10 R 4 3 3
xi L four 3 4
12 R four 3 three
13 L 3 v v
14 R 4 5 5
15 Fifty 4 3 4
16 R 4 3 five
17 R five 4 three
18 L 4 5 5
nineteen R 4 iv iv
20 L 4 3 five
21 50 4 3 four
22 R 4 five 3

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. Wisenine
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

Read:   How to Get Sticky Residue Off Bathing Suit

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

ane.
Schlenz I, Kuzbari R, Gruber H, Holle J. The sensitivity of the nipple-areola complex: an anatomic written report.

Plast Reconstr Surg.
2000;105(3):905–9.

[PubMed]
[Google Scholar]

Read:   How to Make Get Back Whip

2.
Sarhadi NS, Shaw-Dunn J, Soutar DS. Nerve supply of the breast with special reference to the nipple and areola: Sir Astley Cooper revisited.

Clin Anat.
1997;10:283–8.

[PubMed]
[Google Scholar]

three.
Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nervus supply of the chest, including the nipple and areola.

Br J Plast Surg.
1996;49(3):156–64.

[PubMed]
[Google Scholar]

4.
Jaspars JJ, Posma AN, van Immerseel AA, Gittenberger-de Groot Ac. The cutaneous innervation of the female person chest and nipple-areola complex: implications for surgery.

Br J Plast Surg.
1997;fifty(four):249–59.

[PubMed]
[Google Scholar]

5.
Craig RD, Sykes PA. Nipple sensitivity post-obit reduction mammaplasty.

Br J Plast Surg.
1970;23(2):165–72.

[PubMed]
[Google Scholar]

seven.
Thorek 1000. Possibilities in the reconstruction of the man form 1922.

Aesthetic Plast Surg.
1989;13(1):55–8.

[PubMed]
[Google Scholar]

8.
Schwarzman E, Goldan South, Wilflingseder P. The archetype reprint. Die Technik der Mammaplastik [The technique of mammaplasty]

Plast Reconstr Surg.
1977;59(ane):107–12.

[PubMed]
[Google Scholar]

9.
Wise RJ. A preliminary report on a method of planning the mammaplasty.

Plast Reconstr Surg (1946)
1956;17(v):367–75.

[PubMed]
[Google Scholar]

10.
Harris HI. Advantages of the Biesenberger technic for mammaplasty of hypertrophied pendulous breasts.

J Int Coll Surg.
1953;19(two):170–4.

[PubMed]
[Google Scholar]

xi.
McKissock PK. Reduction mammaplasty with a vertical dermal flap.

Plast Reconstr Surg.
1972;49(iii):245–52.

[PubMed]
[Google Scholar]

12.
Robbins TH. A reduction mammaplasty with the areola-nipple based on an inferior dermal pedicle.

Plast Reconstr Surg.
1977;59(1):64–7.

[PubMed]
[Google Scholar]

xiii.
Courtiss EH, Goldwyn RM. Reduction mammaplasty by the inferior pedicle technique. An alternative to free nipple and areola grafting for severe macromastia or farthermost ptosis.

Plast Reconstr Surg.
1977;59(4):500–seven.

[PubMed]
[Google Scholar]

fourteen.
Courtiss EH. Reduction mammaplasty by suction alone.

Plast Reconstr Surg.
1993;92(7):1276–84.

discussion 1285-9. [PubMed]
[Google Scholar]

xv.
Arie G. Una nueva tecnica de mastoplastia.

Rev Iber Latino Am CirPlast.
1957;iii:28.

[Google Scholar]

16.
Lassus C. An “all-flavour” mammoplasty.

Aesthetic Plast Surg.
1986;x(ane):9–15.

[PubMed]
[Google Scholar]

17.
Lassus C. Breast reduction: development of a technique—a single vertical scar.

Aesthetic Plast Surg.
1987;11(ii):107–12.

[PubMed]
[Google Scholar]

18.
Lejour One thousand, Abboud Thou, Declety A, Kertesz P. [Reduction of mammaplasty scars: from a short inframammary scar to a vertical scar]

Ann Chir Plast Esthet.
1990;35(5):369–79.

[PubMed]
[Google Scholar]

19.
Lassus C. A technique for breast reduction.

Int Surg.
1970;53(1):69–72.

[PubMed]
[Google Scholar]

20.
Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve.

Plast Reconstr Surg.
1999;104(3):748–59.

give-and-take 760-3. [PubMed]
[Google Scholar]

21.
Hofmann AK, Wuestner-Hofmann MC, Bassetto F, Scarpa C, Mazzoleni F. Chest reduction: modified “Lejour technique” in 500 large breasts.

Plast Reconstr Surg.
2007;120:1095–104.

give-and-take 1105-7. [PubMed]
[Google Scholar]

22.
Terzis JK, Vincent MP, Wilkins LM, Rutledge G, Deane LM. Breast sensibility: a neurophysiological appraisal in the normal breast.

Ann Plast Surg.
1987;19(4):318–22.

[PubMed]
[Google Scholar]

23.
Slezak South, Dellon AL. Quantitation of sensibility in gigantomastia and alteration following reduction mammaplasty.

Plast Reconstr Surg.
1993;91(7):1265–9.

[PubMed]
[Google Scholar]

24.
Gonzalez F, Dark-brown FE, Gold ME, Walton RL, Shafer B. Preoperative and postoperative nipple-areola sensibility in patients undergoing reduction mammaplasty.

Plast Reconstr Surg.
1993;92(five):809–14.

discussion 815-8. [PubMed]
[Google Scholar]

25.
Temple CL, Hurst LN. Reduction mammaplasty improves breast sensibility.

Plast Reconstr Surg.
1999;104(one):72–6.

[PubMed]
[Google Scholar]

26.
Schlenz I, Rigel Southward, Schemper M, Kuzbari R. Alteration of nipple and areola sensitivity by reduction mammaplasty: a prospective comparison of 5 techniques.

Plast Reconstr Surg.
2005;115:743–51.

word 752-4. [PubMed]
[Google Scholar]


Articles from
Eplasty
are provided hither courtesy of
HMP Global


How to Get Nipple Sensation Back After Breast Reduction

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492192/