The risk of losing sensation to the nipple area is a big concern for many patients who are having breast surgery, whether it is a reduction, implants or a lift. For some patients, this concern can be so great, even with a very low incidence, to make them reconsider having the procedure.
The principle nerve to the nipple area exits the spinal cord in the back from the area of the forth thoracic vertebrae and wraps around the chest to the side of the breast where it generally stays deep in the breast tissue until it turns and becomes more superficial in the area of the nipple and the surrounding areola where it has several branches.
With most breast lifts, the dissection during surgery generally stays relatively superficial so that the breast tissue over the nerve protects it from injury. It is more vulnerable in and around the nipple area which is one reason why many surgeons try to avoid an incision around the edge of the areola during breast implant surgery. With a breast lift, the surgeon is not generally tunneling deep into the breast tissue where the nerve is generally hiding.
During a breast reduction, a considerable amount of breast tissue is removed from all layers of the breasts, particularly on the side of the breast where the nerve is most vulnerable. That is why a breast reduction surgery has the highest incidence of numbness to the nipples compared to breast lifts and breast augmentation surgery.
The risk of permanent numbness to the nipple and areola, based on national studies, is around 35% with a breast reduction compared to a breast lift, where it is less than 10%. Although the skin incisions are similar with both procedures, with a reduction, actual breast tissue is removed in order to make the breasts smaller, As a result, the risk of injury to the nerves to the nipple area is higher.
Many patients who have very large breasts or severe sagging (ptosis) comment that they have very little sensation to the nipple area to begin with. This may be because of significant stretching on these nerves with breast growth or drooping. It is interesting that in some of these cases, patients will report that they have more sensation after surgery than they had before their procedure.
Partial numbness after breast surgery is usually temporary and generally goes away after a few months but it can take up to two years for complete recovery. This is especially true of the skin on the lower pole of the breasts below the nipples where significant numbness is the norm after breast lifts and reductions and is not uncommon with breast implant surgeries. This area almost always returns to normal sensation after several months; however, certain patients will have some permanent loss of sensation to that area.
Occasionally after a breast procedure, patients will experience an extra or hypersensitivity to the nipple area, which can be bothersome. This is believed to be secondary to a minor injury to the nerve to the nipple and is generally temporary but can take several months to resolve.