For top surgery, is it common to lose tactile sensation from surrounding areas of the actual operated location?

Question

What does the numbness mean?Is it permanent since it didn't come back after 2yrs? The majority of the numbness is located in the surrounding areas of 1 dog ear so it goes up to my armpit almost& a bit over the nipple. I can understand the numbness on the pec but not the area (above dog ear) being like this since it wasn't even operated on. Strangely, there is different types of pain despite having no sensation to touch.

Krishna Vyas, MD, PhD, MHS · Answer

I specialize in gender-affirming top surgery and "targeted nipple reinnervation" and sensory preservation/restoration.
It is common to experience numbness or altered sensation in the surrounding areas after top surgery, especially around the incisions or areas where the tissue was manipulated. The loss of sensation can extend beyond the directly operated area, such as up to the armpit or above the nipple, even if those areas were not directly operated on. This is due to nerve disruption during surgery, as nerves from the chest and back are affected when the breast tissue is removed or repositioned. While loss of sensation is normal, it usually recovers over time. 
However, if the numbness persists for a prolonged period&mdash;such as two years&mdash;there is a chance it may be permanent. Nerve regeneration tends to occur most significantly within the first 6-24 months post-surgery. After that, the nerves may not fully regenerate, and the sensation in those areas could remain altered or absent. Despite numbness, it's still possible to experience pain in the affected areas, as some nerves might convey pain sensations even if touch or pressure sensations are lost. If you are experiencing unusual pain, consulting your surgeon is recommended to explore potential treatment options.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Jed H. Horowitz, MD, FACS · Answer

Any surgery of the breast can lead to reduced nipple sensation. Reduced sensation is usually temporary, but may take months to resolve. In unusual cases, some permanent loss of sensation may occur. #pain #numbness

Ross Blagg, MD · Answer

Hello,At 2 years out, the numbness is likely permanent. When breast tissue is removed, this does involve some removal of breast tissue toward the axilla (arm pit area) and so that could contribute to what you are experiencing. Often, massage with vitamin E oil or other creams will help relieve odd pains and can sometimes improve sensation as well. All the best in your recovery,Dr. BlaggAustin, TX

Anthony J. Wilson, MD · Answer

Thank you for your question. Unfortunately since it has been this long sensation is unlikely to return. Likely a nerve was accidently injured. This is a common complication in mastectomies with numbness extending to the inner arm. There are some medications that can help with any type of nerve pain, such as neuron tin, and you can discuss these with your PS. Best of luck!

Brian Arslanian, MD · Answer

Thanks for the question, and sorry to hear about your loss of sensation. Unfortunately, any surgery will involve cutting small nerve endings to the overlying tissues. As long as they are not the major nerves, these will typically grow back over time. They may not grow back to 100% normal, but usually enough to not cause a problem. However, this is not always the case, and nobody really knows why some people gain back almost perfect sensation, and some people end up with your situation. Typically, if its been 2 years, you may gradually get some more sensation, but chances are that what you have now is what you will have. I usually tell patients, and usually see from experience, that nerve regeneration will usually make its greatest leaps and bounds in the first 6-24 months. After that, the residual status is usually permanent. I will keep my fingers crossed that I am wrong and that you continue to recover. Good Luck"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Sheldon Lincenberg, MD · Answer

Elevation of the skin away from the underlying tissue often results in severing of the fine nerve endings which innervate the scan in transmit sensation to the brain. It is actually more amazing that most of the time these nerves reconnect with the skin and restore sensation. Temporary numbness is universal and permanent numbness of skin after surgery is still a common and yet unsolved dilemma for all surgeons.

Steven Turkeltaub, MD · Answer

It is common to either have reduced sensation or areas of loss of sensation following FTM breast surgery. By 2 years, if you still have areas of numbness, they are likely to remain that way for the most part.Steven Turkeltaub, MD

Emese Kalnoki, MD · Answer

Numbness after any surgery is a known complication. FTM Top surgery involves the removal of breast tissue with movement of the nipple and areola.  The nerves that provide sensation to the chest skin come from the back.  Therefore, after this type of surgery, there can be numbness that can be found in the axilla (the armpit) as well as on the chest.  If the incision goes into the armpit, areas of numbness can be found on the upper arm as well.  That being said, a lot of the feeling returns after about 1 year.  After two years, the likelihood is a little lower.  
Nerves come in different varieties.  There are some that only convey pain sensations and others that carry touch or pressure sensations.  So, if you are numb to pressure or touch, it does not necessarily mean you will have no pain sensations.  Occasionally, vigorous massage may stimulate some of the nerves to grow.  If there is one area that you can pinpoint that is causing pain or burning, you may have a neuroma.  This can be treated in a number of ways.  I would recommend you seeing your plastic surgeon if this is the case.  Good luck!

For top surgery, is it common to lose tactile sensation from surrounding areas of the actual operated location?

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