For many women potential loss of nipple areolar sensation is one of their major concerns when considering breast augmentation.  Sensation in this area is critically important for a large number of women during sexual activity and thus any potential compromise of sensation in and around the nipple as a result of any breast surgical procedure needs to be carefully discussed during preoperative consultations.

Sensation to the nipple areolar complex usually comes from multiple nerve sources.  In most patients the major nerve providing sensation to this area is a branch of nerve traveling with the 4th thoracic rib.  This nerve comes off the rib on the lateral side of the breast then travels up inside the breast tissue mound to reach the nipple areolar area.  Other nerve branches travel from the more medial sternal and superior breast area to the nipple areolar region and supply additional sensation in varying amounts from patient to patient.

During breast augmentation the location of these nerves is well known to the surgeon and every effort is made to avoid injury.  Breast augmentation does require the careful development of either a subglandular or submuscular pocket for placement of the breast implant.  The larger implant that is chosen the more dissection that is required.

Some patients are concerned that choosing an infraareolar access incision may increase their chances for alteration of nipple areolar sensation.  This approach usually involves making an incision below the areolar and then tunneling away from the nipple to the lower edge of the breast to make the necessary pocket.  The infraareolar technique usually does not present any substantial increase for sensation loss.

Long term loss of nipple areolar sensation associated with breast augmentation should not be routinely expected but some degree of temporary sensory changes such as “tingling” can occur due to tissue stretch or swelling.  These temporary changes usually clear nicely over the first several weeks postoperatively.  I always explore the subject of possible sensory change with every prospective breast surgery patient.  Although the incidence of post operative sensory loss is small, every patient needs to thoroughly explore this subject with her surgeon during preoperative consultation.

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