I am looking for a breast reduction and want to reduce the chances of losing nipple sensation

Even though no plastic surgeon should ever guarantee that you'll maintain nipple sensitivity following breast reduction surgery, the fact is that it's a fairly rare complication. As you can see from RealSelf's "worth it" ratings, more than 95% of breast reduction patients are happy with their outcomes. I recommend that you discuss your concerns when you consult with plastic surgeons you might select.

Hello,Thank you for your question.Breast reduction surgery enjoys the highest patient satisfaction rate in all of plastic surgery. Up to 97% of breast reduction patients report improvement in preoperative symptoms and over 90% of patients report being extremely satisfied with their outcomes.Despite this extraordinarily high patient satisfaction rate, breast reduction surgery does carry its own set of risks and known complications. The most common untoward effect of beast reduction surgery is altered nipple sensation postoperatively. Up to 25% of patients report decreased sensation, changes in sensation, and occasionally increased sensation. Wound healing problems, particularly with the anchor or inverted-T breast reduction pattern are encountered in up to 20% of patients. Thankfully, almost all wounds following a breast reduction can be treated in the clinic and rarely require a return trip to the operating room. Partial or complete loss of the nipple-areolar complex occurs in 4-7% of patients undergoing breast reduction and is more common in smokers and those with a very large preoperative breast volume or length. Unsightly scarring occurs in up to 4% of patients and is more common in patients with dark skin, smokers, and those undergoing the anchor or inverted-T breast reduction technique.The ability to breast-feed is a common concern amongst women considering a breast reduction. While studies differ in their findings, it is generally accepted that most (at least 75%) if not nearly all women will have the ability to breast feed following a breast reduction, but the majority of women may need to supplement feedings with formula. The exception, however, is that women who have undergone a free nipple grafting breast reduction will be unable to breast feed as the connection between their nipple and milk ducts has been severed. Fortunately, women electing for a free nipple grafting breast reduction are usually past childbearing age and are not concerned about their inability to breast-feed.Additional considerations following a breast reduction include the possibility of postoperative breast asymmetry, bleeding, infection, insufficient reduction, over-reduction, and change in breast shape over time. We examine all of patients within one to two days after surgery so that in the rare chance there is a complication, it can be diagnosed and addressed appropriately.

Most surgeons perform the procedure described in the illustration commonly referred to as a Wise pattern technique.  Along with this technique, the superomedial pedicle for the nipple/areola has the best chance of sparing sensory innervation to the nipple.  You should not need to travel too far to find surgeons that will perform this procedure for you.  

Dear jessrealreal,Finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. 
You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You have raised a very important question.  No surgeon can guarantee that you won’t experience loss of nipple sensation after breast reduction surgery.  You can decrease the risk by using a fully qualified and experienced plastic surgeon with extensive experience in breast reduction surgery.

It is often a trade-off for a well-supported, well-shaped breast that will resist "bottoming out".  My experience for the first 15 years of my practice convinced me that the traditional Wise pattern or anchor scar led to unpredictable results in all dimensions including sensibility of the tissues. For the past 20 years I have been impressed with the superior pedicle technique I learned from Madelaine LeJour in Belgium. This has been modified by Dr Hall-Findlay to utilize a more medial pedicle for the nipple and areola to better preserve nipple areola sensibility. Her technique was designed to facilitate breast reduction for the demands of the Canadian health system and has stood the test of time. This vertical pattern eliminates the infra-mammary scar and in my experience reduces the risk of bottoming out. Some practical advice:  so much depends upon the amount of elevation the nipple and areola will require and the amount of tissue that will need to be removed to provide adequate relief for you.  If the distance is about an inch and the amount to be removed about a cup I would be more hopeful for preservation.  Ig the elevation of the nipple is going to be closer to 5 inches and tissue removal 2 cups or more you are far more likely to lose that sensation in my experience. Sometimes a compromise can be made, but that may run counter to the requirements of third party insurance carriers who likely will demand parameters of weight fall within the Schnur scale which your surgeon should explain to you.  Tough decisions but you are doing your homework so you will be well prepared for the outcome. Note of caution:  there are still surgeons out there who re-apply the nipple as a free graft.  There would be little to no chance of having normal sensibility under those circumstances.

and no one can guarantee that they can preserve yours following a reduction.  And if someone says they can, get it in writing and know what happens if you do lose it.  The techniques all surgeons are taught try to preserve sensation but if variations in technique are needed due to anatomical issues, loss of sensation is a real possibility.  So stay close to home and hope for the best... and make sure your motivations are true so that you are still happy if you do lose sensation.

Although, no plastic surgeon can guarantee that a breast reduction procedure will not result is some loss of nipple sensation, you are correct that techniques which attempt to preserve the 4th lateral intercostal nerve and the medial 3rd and forth intercostal nerves can minimize the risk of decreased nipple sensation.   Our practice routinely performs breast reduction in which these techniques are utilized to preserve this innervation, and the majority of patients state that their nipple sensation is largely intact following the procedure.  Best wishes, Dr. Lepore.