Breast implants - do they cause loss of sensation?

Generally, there is minimal, partial, and usually temporary loss of nipple sensation following breast augmentation. 

I perform most breast augmentation (both above and below the muscle) through the peri-areolar approach, unless a patient has an existing incision in the inframammary fold below the breast, or unless I am using the cohesive gel textured implants, which generally require an incision larger than the diameter of the areola. 

I find that my patients often report a heightened sensitivity of the nipples following breast augmentation, which I believe is due to the fact that the breast and nipple surface area is increased by the presence of the implant. 

Patients can lose sensitivity regardless of the incision approach, however, and I find that patients who have had multiple breast surgeries are more likely to experience loss of sensitivity of the nipple.

Loss of sensation is not very common.  It can happen when placing implants. 

On the other hand, short term sensory change is quite common.  This may be due to swelling and usually gets better within a few weeks after surgery. 

One theory:  The larger the implant, the more likely it could happen.  This may be due to stretching of the tissues ans subsequently the sensory nerve fibers that go to the nipple.  There is no strong evidence suggesting any one incision is more likely to cause it.

It is not inevitable and in most cases patients will not loss sensation in their nipples.  Most incisions are made away from the nipple, therefore avoiding any reason for loss of sensation. 

Loss of sensation of your breasts can occur with augmentation, but the overall incidence of permanent sensation loss is very low.

Things that can increase the chance of having permanent sensation loss are:

• Large implants 
• Incisions around the nipple

There is always the risk that there may be some loss of sensation with placing breast implants, but this is fortunately a rare occurrence. It is not uncommon for there to be some temporary changes in sensation right after the surgery due to swelling and the stretch from the implant to the nerves, but this usually doesn't last.

There seems to be a difference in incidence of loss of sensation with the incision placement. The closer you are to the nerve to the nipple, the higher the chance of loss of sensation.

The periareolar incision has the highest chance of loss of sensation, with stats being about 15%. The inframamary incision has about a 5% chance of loss of sensation. This is one of the reasons that I like the transaxillary approach, as the chance of loss of sensation is, according to published papers, about a 1% chance. This makes sense, as you are further away from the nerve that goes to the nipple, if you are going in at the armpit, and going under the muscle.

Each surgeon has his own statistics, and you should feel free to ask each one his own stats when you see him. As always, make sure that your surgeon is certified by the American Board of Plastic Surgery. To be a member of the American Society for Aesthetic Plastic Surgery (ASAPS) means that the surgeon does a preponderance of his work in Aesthetic Surgery, so this can be a plus as well.

Loss of sensation of the nipple and areola after breast augmentation is uncommon and is considered a complication of surgery. There should be no change in the sensation of the breast in a well performed breast augmentation. The sensory nerves to the breast can be stretched or cut during the procedure but the nerves are deep and off to the side of the chest, out of harms way with an appropriately chosen implant.

The problem occurs when larger implants or implants that are too large for the breast they are being placed in are used. If the nerves are stretched, the majority will heal uneventfully; cut nerves are less forgiving.

There is a misconception that nipple numbness is more common with the incision below the areola. The incidence of nerve injury is the same regardless of the location of the incision under arm, in the fold or at the areola. Incisional numbness occurs with any incision but this usually resolves completely over time.

Yes, breast implants may cause a change in nipple sensation. Expect to have a temporary change as nerves will be stretched by the implant and swelling from the surgery won't allow the nerves to send signals as they normally did. This will usually last about 3-4 months.

As the swelling goes down and the nerves get used to their new stretched form, they will start to transmit signals better and 'normal' sensation will begin to return. Expect your final amount of sensation to return after a year.

Realize that the surgery itself does carry the risk of nerve injury and the larger the implant size you use, the higher the risk becomes for a decrease in sensation.

Although most girls ask questions and express concerns about breast/nipple sensation during a preoperative consultations, the truth is that rarely it is a problem after surgery.

Although loss of nipple sensation is certainly possible, it does not seem to be a common problem.  What is even more interesting, loss of nipple sensation is not associated with particular incision site, as recent studies showed most loss occured during inframmary incisions.

Therefore, nipple and axillary incisions are not only safe but might be better in preserving nipple sensation.

There are a lot of misconceptions about this, but it is rarely a long-term problem. Many still tell their patients that the areolar margin incision has a higher incidence of sensory loss to the nipple, but more recent studies have disproven that.

One study from Brazil found that larger implants have a higher risk of sensory loss, which makes sense because the dissection required to make a larger space for the implant may get closer to where the nerves are.

The take-home message is that it should not be the basis for deciding on where the incision is made, but something to think about if you are considering a larger size.

Dear Jamie,

There is always a small risk of decreased or lost nipple sensation after breast enhancement. Depending on technique, positioning of implants and size of implants, it varies from 2-5%. Some people quote the numbers a bit higher. In our practice it is 2-3%.

The larger the breast implant is, compared to your chest size, the greater the risk of injuring the nerve leading to the nipple; however, it is not even close to 100%.

Talk to your local plastic surgeon about relation between the size, location and risk of nipple sensation loss.

Loss or decrease in sensation is a possible complication of operating on any breast. Changes in sensation is the second most common patient complaint following breast augmentation (after capsular contracture).

The choice of incision may impact on changes in sensation - some surgeons feel that the inframammary (below the breast) approach increases risk and others feel that the periareolar approach (under the nipple) increases risk; there are many studies in the literature to support both opinions. However, a study published in 2007 out of Brazil found no difference between either incision.

The main risk for sensory changes seems to be the relative size of the implant selected - this means putting a large implant into a small breast appears to increase the risk. The reasons for this are likely due to the increased amount of dissection needed to create the large pocket for the implant (and dissection increases the possibility of injuring the nerves); it is also likely due to the pressure and stretch on the nerves due to the large implant in a smaller breast.

In your case, you would likely only need a small implant to make up the one cup size difference in your breasts, but this would need to be determined in consultation with your plastic surgeon.

Breast implant surgery rarely results in a permanent loss of sensation. However, any surgery on the breast can possibly produce numbness and the only way to be assured that this will not happen is to not have the surgery.

The other factors that increase the risk of sensory loss are the surgical technique and the size of the implant. Large implants stretch the nerves more and are more prone to causing numbness.

If a patient experiences some loss of sensation after surgery, taking B complex vitamins may be helpful. It is possible to recover some or all sensation over many months to a few years post-op.

A few patients experience "hypersensitivity" after surgery which is the opposite of numbness. In these patients, excess sensitivity is present and in my experience is always temporary and resolves with time and massage.

Loss of sensation, while rare, is a known complication of breast augmentation and may be related to several variables--choice of incision, extent of dissection, and size of implant.

To begin, there are three main approaches to Breast Augmentation:

• Below the fold (IMF approach)
• Under the arm (trans-axillary approach)
• Through the areola (periareolar approach)

There is no perfect approach and every incision has its advantages and its disadvantages. The most important thing for you, as a client, is to weigh your options and decide what approach works best for you individually. The periareolar approach is thought to have a slightly increased risk for sensation loss because dissection must pass from the skin and then directly through glandular tissue. In contrast, the other two approaches pass beneath the muscle and generally avoid the nerves altogether.

Another factor which may affect sensation is the extent and manner of tissue dissection. Many surgeons feel that blunt dissection to the lateral aspect of the breast pocket may protect nerves and avoid loss of sensation, although there is very little hard evidence to support this.

The final factor is the degree of augmentation. The more you stretch your tissue, the more potential you have for temporary or even permanent nerve injury.

The good news is that even with all of these potential causes for nerve injury, loss of sensation is actually very uncommon.