Which type of breast augmentation incision is least likely to cause loss of sensation of the nipples?

There is not a perfect answer for this. There are surgeons like my self who will claim that the incision will not necessarily affect nipple sensation, as it is the surgery itself. This is some what controversial and to be absolutely certain to not lose nipple sensation then you should not have the surgery.

The risk of sensation loss is very low but it is not zero for either approach, inframammary or periareolar incision.

Good luck.

Probably none of the incisions directly affect nipple sensation directly. The nerves to the nipple come more from above and to the side of the nipple, then below where the incision is made when choosing that type of approach. Which incision is the best approach is an entirely different question. Nipple sensation loss is most commonly completely reversible with time, and that numbness is probably just the pressure of the implant on the nerves in the breast, similar to when you sit on your leg funny and your foot goes to sleep. However, there is a tiny nerve coming up the side of the chest into the breast and that supplies much (but not all) of the sensation to the nipple. If during the course of making the pocket that nerve is injured, numbness of the nipple may result. Usually temporary, but in a minority of cases it can be permanent reduction, or even absence of sensation in the nipple. I have seen it take up to one year, sometimes more, to regain nipple sensation, although usually it takes less time.If you absolutely cannot be without nipple sensation, don't have an augmentation. If you are the rare, unlucky minority who experiences permanent loss of nipple sensation, you will not be happy.

It does not make sense to put scar tissue on a breast. Armpit incision is a wonderful scar-free option for breast augmentation. Silicone implants can absolutely be inserted through the arm-pit, don't let anyone tell you that is not an option. There are few reasons for an incision under the breast or through the nipple. The scarring under the armpit is minimal, look at the attached video. Don't let doctors not comfortable with the approach talk you out of it. Transaxillary is the standard in Asia and the UK and the results are completely natural. Patients are so happy not having to deal with any types of incision or scarring on the breast. 

It is my impression from my reading that while the periareolar incision sounds as if it would have a greater risk of comprimising nipple sensation, recent reports have linked the risl of losing sensation to the relative size of the implant.

Thank you for your post. In general, most women who have a disturbance in nipple sensation, whether it be less (hypo-sensation), or in some cases too much (hyper-sensation), the sensation goes back to normal with 3-6 months. Occasionally, it can take 1 - 2 years to be normal. Extremely rare, the sensation never goes back to normal. This is extremely rare in augmentation alone, more common in lift or reduction but less with a smaller lift like a crescent lift. Signs that sensation is coming back are needle type sensation at the nipple, itchiness at the nipple, or 'zingers' to the nipple. The number of women that lose sensation is much lower than 10%, closer to 1% in a simple augmentation. In some cases the same occurs with contraction where some women have no contraction and some women have a constant contraction of the nipples. Unfortunately there is no surgical correction for this. Massaging the area can help sensation normalize faster if it is going to normalize, but will not help if the nerve does not recover. In women with hyper-sensitive nipples, this will go away with time in most cases. Usually 3 months or so. In the interim, I have them wear nipple covers or 'pasties' to protect them from rubbing. It is unlikely that down-sizing the implant will cause regaining sensation. Down-sizing the implant may cause saggy breasts, however, and may necessitate a breast lift. Physical therapy with de-sensitivity techniques can help with this issue. The Peri-areolar incision is associated with increased risk of nipple numbness due to the fact that the nerve is in close proximity.Best Wishes,Pablo Prichard, MD