PRESERVING AND RESTORING SENSATION AFTER NIPPLE SPARING MASTECTOMY THROUGH NERVE PRESERVATION AND NIPPLE AREOLAR COMPLEX NEUROTIZATION
DOI:
https://doi.org/10.31435/ijitss.4(52).2026.6779Keywords:
Nipple-Sparing Mastectomy, Neurotization, Intercostal Nerves, Breast Sensation, Breast Reconstruction, Patient-Reported OutcomesAbstract
Preserving the nipple–areolar complex during mastectomy does not ensure that its sensory function is retained. This narrative review evaluates nerve preservation and nipple–areolar complex neurotization, distinguishing objective sensory recovery from patient-reported benefit and surgical safety. A focused PubMed search was performed, supplemented by targeted searches for anatomical, methodological, and reconstructive publications and review of available full texts. The synthesis included clinical series, comparative studies, a small randomized conference report, anatomical investigations, and relevant consensus publications, without quantitative pooling. Early implant-based reconstruction studies reported encouraging recovery of tactile sensibility, but several lacked concurrent controls. Comparative observational evidence suggests potential psychosocial and sexual well-being benefits, although reconstruction type and treatment selection complicate causal interpretation. A six-patient randomized split-chest report did not demonstrate significant sensory differences, emphasizing the preliminary nature of the evidence. Larger matched database research provides reassurance regarding recorded postoperative complications but does not establish sensory efficacy or oncologic equivalence. Assessment methods vary substantially, encompassing pressure thresholds, two-point discrimination, and patient-reported measures. Nerve preservation and neurotization are promising components of functional breast reconstruction, provided that they do not alter the required oncologic resection. Standardized baseline and longitudinal assessment, adequately powered comparative studies, and transparent counseling are needed before the magnitude, durability, and generalizability of benefit can be established.
References
Dossett, L. A., Lowe, J., Sun, W., Lee, M. C., Smith, P. D., Jacobsen, P. B., & Laronga, C. (2016). Prospective evaluation of skin and nipple-areola sensation and patient satisfaction after nipple-sparing mastectomy. Journal of Surgical Oncology, 114(1), 11–16. https://doi.org/10.1002/jso.24264
Tsangaris, E., Klassen, A. F., Kaur, M. N., Voineskos, S., Bordeleau, L., Zhong, T., Broyles, J., & Pusic, A. L. (2021). Development and psychometric validation of the BREAST-Q sensation module for women undergoing post-mastectomy breast reconstruction. Annals of Surgical Oncology, 28(12), 7842–7853. https://doi.org/10.1245/s10434-021-10094-y
Peled, A. W., & Peled, Z. M. (2019). Nerve preservation and allografting for sensory innervation following immediate implant breast reconstruction. Plastic and Reconstructive Surgery – Global Open, 7(7), e2332. https://doi.org/10.1097/GOX.0000000000002332
Jaspars, J. J., Posma, A. N., van Immerseel, A. A., & Gittenberger-de Groot, A. C. (1997). The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. British Journal of Plastic Surgery, 50(4), 249–259. https://doi.org/10.1016/s0007-1226(97)91155-3
Knackstedt, R., Gatherwright, J., Cakmakoglu, C., Djohan, M., & Djohan, R. (2019). Predictable location of breast sensory nerves for breast reinnervation. Plastic and Reconstructive Surgery, 143(2), 393–396. https://doi.org/10.1097/PRS.0000000000005199
Hemal, K., Boyd, C. J., Sorenson, T. J., Lu, S., Miller, B., Karp, N. S., & Choi, M. (2026). Breast neurotization in implant-based breast reconstruction: Results of a split-chest, prospective, randomized controlled trial [Conference abstract]. Aesthetic Surgery Journal Open Forum, 8(Suppl. 1), ojag138.020. https://doi.org/10.1093/asjof/ojag138.020
Gardetto, A., Hörmann, R., Pfitscher, K., Konschake, M., & Stofferin, H. (2024). Anatomical mapping of the 4th intercostal nerve's lateral cutaneous branch in both sexes: implications for advanced breast reconstruction. Surgical and Radiologic Anatomy, 46(12), 2019–2026. https://doi.org/10.1007/s00276-024-03507-6
Gfrerer, L., Sager, J. E., Ford, O. A., Carty, M. J., Verdial, F. C., Gadd, M. A., Specht, M. C., Winograd, J. M., & Valerio, I. L. (2022). Targeted nipple areola complex reinnervation: technical considerations and surgical efficiency in implant-based breast reconstruction. Plastic and Reconstructive Surgery – Global Open, 10(7), e4420. https://doi.org/10.1097/GOX.0000000000004420
Coopey, S., Keleher, A., Daniele, K., Peled, A. W., Gomez, J., Julian, T., & Moreira, A. A. (2024). Careful where you cut: strategies for successful nerve-preserving mastectomy. Plastic and Reconstructive Surgery – Global Open, 12(5), e5817. https://doi.org/10.1097/GOX.0000000000005817
Djohan, R., Scomacao, I., Knackstedt, R., Cakmakoglu, C., & Grobmyer, S. R. (2020). Neurotization of the nipple-areola complex during implant-based reconstruction: evaluation of early sensation recovery. Plastic and Reconstructive Surgery, 146(2), 250–254. https://doi.org/10.1097/PRS.0000000000006976
Peled, A. W., von Eyben, R., & Peled, Z. M. (2023). Sensory outcomes after neurotization in nipple-sparing mastectomy and implant-based breast reconstruction. Plastic and Reconstructive Surgery – Global Open, 11(12), e5437. https://doi.org/10.1097/GOX.0000000000005437
Guido, G., Peled, Z. M., & Peled, A. W. (2025). Degree and timing of sensory return following nipple-areolar complex neurotization during nipple-sparing mastectomy. Annals of Plastic Surgery, 94(5S Suppl 3), S452–S456. https://doi.org/10.1097/SAP.0000000000004282
Zhang, C., Moroni, E. A., & Moreira, A. A. (2025). One size does not fit all: prediction of nerve length in implant-based nipple-areola complex neurotization. Journal of Reconstructive Microsurgery, 41(7), 566–574. https://doi.org/10.1055/a-2460-4589
Soares Domingues Polita, B., Lapinš, J., Ģīlis, A., Grucki, M., Irmejs, A., Gardovskis, J., & Maksimenko, J. (2024). Evaluation of breast skin/nipple-areolar complex sensation and quality of life after nipple-sparing mastectomy followed by reconstruction. Medicina, 60(10), 1655. https://doi.org/10.3390/medicina60101655
Telich-Tarriba, J. E., Rivera Del Río-Hernández, A., Martínez-Schulte, A., Barlandas-Quintana, E., & Garza-Arriaga, D. (2026). Nipple reinnervation in two-stage alloplastic breast reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 122, 242–250. https://doi.org/10.1016/j.bjps.2026.09.010
Tevlin, R., Brazio, P., Tran, N., & Nguyen, D. (2021). Immediate targeted nipple-areolar complex re-innervation: improving outcomes in immediate autologous breast reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(7), 1503–1507. https://doi.org/10.1016/j.bjps.2020.11.021
Bubberman, J. M., Brandts, L., van Kuijk, S. M. J., van der Hulst, R. R. W. J., & Tuinder, S. M. H. (2024). The efficacy of sensory nerve coaptation in DIEP flap breast reconstruction - preliminary results of a double-blind randomized controlled trial. The Breast, 74, 103691. https://doi.org/10.1016/j.breast.2024.103691
Chang, T. N., Lu, J. C., Sung, C. W., Illias, A. M., Cheong, D. C., Kao, S. W., Kuo, W. L., Pindur, L., Chen, L. W., Lin, J. A., Chuang, D. C., & Huang, J. J. (2024). Elongation of intercostal nerve cutaneous branches for breast and nipple neurotization during breast reconstruction after mastectomy for breast cancer: case-control study. British Journal of Surgery, 111(2), znae005. https://doi.org/10.1093/bjs/znae005
Shyu, S., Chang, T. N., Lu, J. C., Chen, C. F., Cheong, D. C., Kao, S. W., Kuo, W. L., & Huang, J. J. (2025). Breast neurotization along with breast reconstruction after nipple sparing mastectomy enhances quality of life and reduces denervation symptoms in patient-reported outcome: a prospective cohort study. International Journal of Surgery, 111(5), 3235–3247. https://doi.org/10.1097/JS9.0000000000002331
Boyd, C. J., Hemal, K., Sorenson, T. J., Amro, C., Lu, S., Miller, B., Karp, N. S., & Choi, M. (2025). Assessing perioperative complications and cost of nipple-areolar complex neurotization in immediate implant-based breast reconstruction following nipple-sparing mastectomy: a matched-paired comparison. Annals of Plastic Surgery, 94(4S Suppl 2), S118–S120. https://doi.org/10.1097/SAP.0000000000004177
Chaudhry, A. S., Rabin, D. A., Kelley, E., Kozlowski, K., Tian, W., Adam, T. H., Ko, J. H., Teven, C. M., Ellis, M. F., & Galiano, R. D. (2026). Safety of breast neurotization using nerve allografts in implant-based breast reconstruction: a nationwide propensity-score-matched analysis. Annals of Plastic Surgery, 97(2), 135–141. https://doi.org/10.1097/SAP.0000000000004779
Sorenson, T. J., Boyd, C. J., Park, J. J., Hemal, K., Amro, C., Vernice, N., Lakatta, A., Cohen, O., Karp, N., & Choi, M. (2025). Nipple areolar complex (NAC) neurotization after nipple-sparing mastectomy (NSM) in implant-based breast reconstruction: a systematic review of the literature. The Breast Journal, 2025, 2362697. https://doi.org/10.1155/tbj/2362697
Harish, V., Haffner, Z. K., Bekeny, J. C., Sayyed, A. A., Song, D. H., & Fan, K. L. (2022). Preserving nipple sensitivity after breast cancer surgery: a systematic review and meta-analysis. The Breast Journal, 2022, 9654741. https://doi.org/10.1155/2022/9654741
Weber, W. P., Haug, M., Kurzeder, C., Bjelic-Radisic, V., Koller, R., Reitsamer, R., Fitzal, F., Biazus, J., Brenelli, F., Urban, C., Paulinelli, R. R., Blohmer, J. U., Heil, J., Hoffmann, J., Matrai, Z., Catanuto, G., Galimberti, V., Gentilini, O., Barry, M., … Gnant, M. (2018). Oncoplastic breast consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Research and Treatment, 172(3), 523–537. https://doi.org/10.1007/s10549-018-4937-1
Weber, W. P., Shaw, J., Pusic, A., Wyld, L., Morrow, M., King, T., Mátrai, Z., Heil, J., Fitzal, F., Potter, S., Rubio, I. T., Cardoso, M. J., Gentilini, O. D., Galimberti, V., Sacchini, V., Rutgers, E. J. T., Benson, J., Allweis, T. M., Haug, M., … de Boniface, J. (2022). Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. The Breast, 63, 123–139. https://doi.org/10.1016/j.breast.2022.03.008
Faulkner, H. R., Colwell, A. S., Liao, E. C., Winograd, J. M., & Austen, W. G. (2016). Thermal injury to reconstructed breasts from commonly used warming devices: a risk for reconstructive failure. Plastic and Reconstructive Surgery – Global Open, 4(10), e1033. https://doi.org/10.1097/GOX.0000000000001033
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Copyright (c) 2026 Julia Szczepanowska-Sujka, Mateusz Szczepanik, Laura Starobrat, Katarzyna Stępniak, Kamil Syga, Patryk Remiasz, Michał Szczepanowski, Julia Lewtak, Dawid Staniak, Małgorzata Zgodzińska-Staniak
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