I'm going to need a full areola incision with the called cookie cutter, is that going to kill the nerves and lose sensitivity?

The incision itself around the nipple does not increase risk for loss of sensation, but the breast augmentation is what puts the nipple at risk.  Patients do often have a change in nipple sensation right after surgery for a couple months (either hypersensitive (too sensitive) or hyposensitive (loss of sensation)), but this goes away in the large majority of patients.

In my experience, nipple/areola repositioning in a breast lift does not usually result in loss of nipple sensation if the incision and dissection are limited to superficial levels just under the skin.  When a periareolar incision is used for an augmentation, the surgeon usually dissects through or along the lower border of the breast to create an implant pocket behind the pectoralis muscle.  It is the disturbance of sensory nerves during the pocket dissection that can lead to sensory changes.  Also, in a breast reduction, when deeper tissue is removed, then nerves can be damaged or interrupted.  If you are just having nipple lifting without any deep dissection around the areola, and if your implant pocket is already there, then I would not expect you to have any significant sensory loss, but it is always possible.  Generally, I would say that your original surgeon is the most knowledgeable about what dissection was done, and how the nerves may have been altered, and he or she would be the best to do additional surgery in that area.

A periareolar lift should not affect nipple sensation as the nerve are deeper than this area.However, this is always a risk with any surgerybest of luck!Dr Schwartz

You state that you lost sensation from your previous breast surgery performed through the areola incision.  That incision for access for the implant placement has a higher risk of nipple sensory changes/loss.  However making the incision all the way around the areola does not really increase those risks because that is a skin procedure. It is the cutting through the breast tissue that increases your risks, so creating the access for the implant, not the nipple lift is what increases your risks of sensory loss.  So in short, it would be about the same amount of risk as your last surgery.  I hope that this helps!

Hello tefyrodriguez7. There's no evidence that incisions around the areola increased the risks of loos of nipple sensation when compared to other incisions. Larger breast implants can increase the risks of permanent loss of nipple sensation. The bigger your go the bigger the risks. Talk to your PS about this issue for more information. Best, Dr. ALDO.

The sensation to the areola and nipple is from the deeper tissues.  It is unlikely that a circumareola lift will cause decreased sensation.

If I understand that you already have an incision / scar in the upper areola (between 9:00-3:00) from your initial surgery, there is a possibility that a 'crescent' lift might give enough elevation when you place a larger implant.  If the decision is to proceed with the 'donut' type lift with a scar all around the areola, I would expect a slight change in sensation just after the procedure but things usually settle back to normal within a few weeks.JJO

As long as the incision in ONLY for skin excision and not into deeper tissue than sensation should not be impaired. But there are always cases that there is some decreased sensitivity... 

Thank you for the question.  No, the circumareolar incision will not necessarily cause loss of sensation. The previous surgery also does not necessarily put you at increased risk for loss of sensation. Generally speaking, it is stretch or injury to the intercostal nerves (that approach the nipple/areolar complexes from the sides)  that may cause change/loss of sensation. Best wishes for an outcome that you will be very pleased with.

Usually the circumareolar incision itself does not significantly alter sensation unless extensive breast tissue rearrangement is done at same time.  Good luck.  Donald R Nunn MD Atlanta Plastic Surgeon