How is Nipple Sensitivity After Breast Reduction?

Breast reduction is a surgery where patients have typically thought about the procedure for years prior to coming into the office.  The vast majority of patients want to be able to exercise and wear clothes without their breast limiting those activities. .  However, patients often do worry about sensitivity of their nipples after breast reduction surgery.  It is import to remember that many patients have decreased nipple sensitivity when they have very large breasts.  This comes from the fact that the nerves have been stretched over a period of years. 
It is impossible to predict if patients will lose sensitivity in their nipples after breast reduction, but the majority of patients return to their baseline in terms of sensitivity several months after surgery.

Patients typically go through a several phases in terms of sensitivity after their breast reduction surgery.  Patients can lose sensitivity initially after their surgery as the nerves are stretched and moved by the reduction and re-arragement of the breast tissue.  However, the majority of the breast reduction techniques are designed to protect the glandular tissue below the nipple areolar complex.   Protecting this glandular tissue below the nipple areolar complex does two things, one it protects the blood suppler to the nipple and areola, it also protects some of the nerves going to the nipple areolar complex.  The nipple sensation typically starts to return over the next couple months, but can vary greatly from patient to patient. 

Patients can also experience a period of hypersensitivity after their breast reduction.  This hypersensitivity is typically the period when the nerves are “waking” back up and are sensitive to any type of contact.  During this period of hypersensitivity, it is important to massage the breasts as this will help the nerves return to baseline.  The nerves need to adjust to being touched again.  Wearing a soft, sports bra typically helps until the sensitivity returns to baseline, however massaging the nipple areolar complex is key to helping calm down the hypersensitivity of the area.  It is important to touch them or the hypersensitivity can linger for a period of time. 

Some initial nerve sensation changes initially are normal in breast reduction surgery; however, the majority of patients return to their baseline in terms of sensitivity several months after their surgery.


It is important to discuss this risk with your Board-Certified Plastic Surgeon.  They can help guide you through the process and further discuss the risks of losing sensation after your breast reduction surgery. 

In rare circumstances, for extraordinarily
large or bulky breasts, i.e. gigantomastia, for technical reasons, the nipples are completely removed and reattached as “free grafts”. The sensory
nerves are all cut, and even though a certain amount of sensation returns after
healing, it will never be normal and erotic sensation if present prior to
surgery (many of these patients preoperatively do not have this due to stretch
of their nerves) is lost completely. The milk ducts are interrupted in this
operation, so nursing would be impossible. You will be amply informed in
advance if your #breasts are in this category. This may be one of the
exceptions where the inverted “T” or Anchor technique is utilized.I prefer to use a minimal
incision surgery with a “#vertical” or “#lollipopBreastReduction scar technique.
This method has been used in Europe and South America for more than 30 years
but is performed by a small number of Plastic Surgeons in this country.The trend toward using this much better
procedure is growing as younger plastic surgeons learn this technique in their
residency programs.The benefits
include: approximately fifty percent less scarring, a narrower breast, better
forward projection and shape, longer lasting improvement, shorter surgery time
and less complications. In general, we have stopped using the older traditional
“anchor” or inverted “T” incisions as these provide inferior results.

Without your photos and an exam it is difficult to give you an accurate answer. Free Nipple Graft is only required in reduction of massively enlarged breasts and a J cup size would qualify for this. It results in inability to breast feed, loss of sensation, loss of nipple projection, incomplete take of the nipple/areolar graft and other complications can occur with this procedure. In my practice this is a very unusual as even very large breasts can be reduced with other techniques. On the other hand this is a technique that should be considered when it is expected that there is not sufficient blood supply for the nipple and areola survival in extreme cases. One option your surgeon can try is to see if the nipple/areola has a sufficient blood supply at the time of surgery. If not then he can go ahead with the free graft technique.

Hello! Thank you for your question!  With that large of a breast reduction that it sounds like you will have, it is not uncommon to have some changes in your sensation.  Consideration for a free nipple graft should be discussed.   Breast procedures such as the
breast augmentation and breast lift/reduction certainly result in a more
shapely,
perky, and fuller appearance of your breasts. With any breast procedure
there is a risk, albeit very small, of change in
sensation to the area. The reported rate of sensation changes
(decreased, loss, or increased) is ~7% for lift/reductions and much
smaller for breast augmentation. In my experience, this rate is
reportedly much lower, but is higher when tissue is excised or the
amount of lift that is needed, so the breast reduction procedure has a
slightly greater risk. It can take up to a year for full sensation to return.It is one risk of such a procedure, and
one that you must consider, amongst others, as with any surgical
procedure. You should consult with a plastic surgeon well-trained in
breast procedures who will examine and discuss with you the various
risks and benefits of the procedure(s) and assist you in deciding if
such a procedure will be the right decision for you.

         The breast reduction
technique that you describe is utilized for extremely large breasts with severe
breast sag. This procedure involves totally removing the nipple areola
complexes and replacing them as free skin grafts. Unfortunately when this
procedure is utilized the nerves are divided and the nipple no longer has
sensation.

 

         Traditional breast
reduction techniques leave the nipple areola complexes attached to the
underlying breast tissue. In women with significant breast sag, this can put
the blood supply to the nipple areola at risk and potentially cause tissue
loss.

 

         If you’re concerned
about nipple sensation, it’s important to discuss this issue with your plastic
surgeon. Depending on your anatomy, tolerance for risk and aesthetic goals,
your surgeon may have some latitude regarding the choice of breast reduction
technique used. Another approach may be possible that preserves nipple areola
sensation and ultimately meets your aesthetic goals. 

After a routine breast reduction nerve sensation returns to normal but is sometimes delayed.  If your breasts are extremely large then a nipple amputation must be performed and the nipple areolar complex will have to be reattached to the reduced breast at the correct location as a free nipple graft.  These usually heal well but the sensory nerves are cut so there will be no sensation. However, patients have reported that they have some nipple erection with sympathetic stimuli.

If you are planning to have a free nipple graft with your breast reduction, then you may lose your sensation.  However, not all breast reductions require the complete removal of your nipple (free nipple graft).  The technique used will often times determine the chances of losing nipple sensation, which generally is in the 10% range. If your breasts are extremely large and your surgeon is concerned about the blood supply to the nipple/areola then a free nipple graft offers the best chance at preserving the nipple, but not necessarily it's sensation.

If you are unsure about this issue, please ask your surgeon to review the technique again with you so you have a better understanding of the surgical plan.

Best wishes,

Dr.Bruno

Thank you for the question.

Some patients require “free nipple grafting” when undergoing breast reduction surgery. These patients generally have very large breasts and a long distance from the sternal notch to the current nipple areola position.  Patients who require nipple/ areola grafting  will not have any sensation after surgery.  These patients are generally pleased with the results of the surgery nevertheless given the relief of symptoms ( at least partial)  after the breast reduction surgery.

Most patients undergoing breast reduction surgery however do not require free nipple grafting;  the majority of these patients will have normal sensation of the nipple/areola after surgery.

Best wishes.

If you are having a free nipple graft, you will have numb nipples because the nerves are completely severed.  They also will not react to cold or stimulation.  Even with your measurements, I wouldn't jump straight to a free nipple graft procedure. I would do an inferior pedicle technique and see how the blood supply looks during surgery.  At least that way, I would know we've given you every chance to keep your nipples intact.

Patients today have many excellent choices in breast reduction surgery. The amount of nipple sensation after surgery depends on the surgical technique that was used. In our practice we almost never remove the nipple from the underlying tissue. This is so that we can preserve the structures of the nipple and the sensitivity. If you are going to receive a surgery where the nipple is completely removed and then placed as a free nipple graft onto the new breast, you will lose almost all sensation to the nipple. After your healing process, you may have minimal sensation to touch in this area.

Be sure that you're working with a board-certified plastic surgeon who has a great deal of experience with breast reduction techniques. Ask your surgeon of the multiple techniques that may be used for your surgery in which technique may prevent removing the nipple in the first place.