I'm Scared of Losing Sensation on my Nipple, What Implants Are Too Large? (photo)

I'm 19 years old, I'm 5'5 and I weigh 155. I'm a size AAcup. and I'm going to get my breasts done in less than two months. I'm going to a full C cup.(420cc). My sister just got her breasts done for the second time, she didn't lose sensation the first time (implant under muscle)(320cc) but she did the second time when it was put over (600cc). Ive read that if the implant is too big your at greater risk. Would I be in that category? AA to C (420cc)? If so, I have enough time to back out.

Doctor Answers 10

Loss of sensation

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Loss of sensation in the nipple/areola is fortunately an uncommon occurrence.
In my experience, permanent loss of of sensation may be due to stretching of the sensory nerves by using very large implants causing a stretch injury or pressure on the nerves, extent of dissection which can damage the nerves, and the size of implant. I find that the location of the incision is not usually the reason for loss of sensation.
Choosing a board-certified plastic surgeon is important when considering surgery, as it will lower your chances of complications.

Numb nipple

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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

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Nipple Sensation and Implant Size

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Basing the success of breast augmentation on cup size is not advisable as cup size varies considerably from company to company. Implant selection should be a collaboration between the patient based on her needs/objectives and the surgeon based on his or her expertise and experience.  However, nipple sensation loss can occur with any implant, but the risk increases with the size of implant. Ensure that your surgeon understands your goals/objectives before you proceed with surgery.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Nipple sensation loss after breast augmentation

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Unfortunately, losing sensation in your nipple after breast augmentation is a very real possibility. Fortunately it does not happen often. I do not believe that it is implant size related. I tell my patients that if nipple sensation is the key to your happiness, perhaps breast surgery of any kind is not for you. Many times, patients experience some change in their nipple sensation after breast surgery, but most often this change is only temporary. This can include decreased sensitivity or increased sensitivity.

Antonio Gayoso, MD
Saint Petersburg Plastic Surgeon
4.9 out of 5 stars 33 reviews

Sensation loss and breast augmentation

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There is a small risk of sensation loss with ANY implant, but the risk grows with the size of the implant.  This is from stretching of the nerves and having to make a bigger pocket for a bigger implant.  The changes can be temporary or they can be permanent.  There is no line in the sand of implant size where below the line you are safe and above the line you are at risk.

Nipple sensation after breast surgery

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Our goal is for you to have normal sensation after breast surgery if it was normal before. However, there are some patients who have some change in their sensation afterwards. It is important to chose an implant that fits your body and is not too wide which would put additional stress on the nerves that provide the sensation. The larger the implant you chose, especially in your case with not a lot of skin stretch available, the greater the chance of decreased sensation. The plastic surgeon you chose to take care of you should measure your breast and tissue tightness and then let you size with appropriate implants prior to surgery. This is an important question to discuss with the plastic surgeon you chose to take care of you. I wish you well.

Dr Edwards

Nipple sensation changes

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About 85% of patients have normal sensation at a year with breast surgery.  No one know for sure what the etiology is.  It could be direct injury to the sensory nerves to the nipple, it could also be from stretch.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Nipple Sensation after Breast Augmentation?

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Thank you for the question and picture.

Hopefully, you are aware that loss of nipple/areola sensation can occur even with the use of small implants and under the best of surgical care. If this loss would be “devastating” you should not undergo the procedure.

Unfortunately, there is no predicting what size of implant will increase your risks of loss of sensation.

It may behoove you to really consider the pros/cons of breast  augmentation surgery based on reputable sites ( such as the FDA website)  and not get too much weight to anecdotal ( your sister's) experience.

I hope this helps.

Scared of Losing Sensation on my Nipple, What Implants Are Too Large?

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Respectfully, I think you have a wrong idea of what "complication" (such as loss of nipple sensation) means. By definition, a complication is an unwanted POSSIBLE event which cannot be prevented (bleeding, infection, ugly scar, numb nipple(s) etc). IF choosing one breast implant over another could prevent nipple numbness in breast augmentation MOST Plastic surgeons could avoid this event. But - that is NOT the case. The location of the nerves along the side of the breast makes them susceptible to injury during the implant placement or later by the movement and upward tension from the implant.

As your sister's case clearly demonstrates, there ABSOLUTELY is a correlation between implant volume AND subsequent nipple numbness after all a larger implant requires the creation of a wider pocket (getting the surgeon into these nerves) AND the implants then proceed to stretch the nerves as well.

So WHICH Breast Implant should you have is the wrong first question in my opinion.  You should first ask yourself if you are even willing to trade in nipple sensation (ugly scarring, potential scar around the implants and the need for further implant replacements in the future among others) for larger breasts in the first place. IF your answer is - no way, please stop here.

If the answer is - yes, then you may proceed to which implants would best suit your frame and anatomy.  If you have not seen it, google VECTRA and Canfield. Some Plastic surgeons use digital 3D technology to SHOW YOU what you may look like with every possible breast implant BEFORE you go through surgery. I think you should find who in your area offers this technology. It will get you the answers you seek.

Good Luck.

Peter A. Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

Sensation to nipple CAN be lost with any kind, size, or incision choice.

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Usually nipple sensation is provided courtesy of your 4th lateral intercostal nerve, and sometime branches of the 3rd and 5th. Every patient has one or more of these tiny nerve branches which cannot be specifically singled out for "avoidance" during the surgical creation of your implant pocket. About 5-10% of my patients experience loss of nipple areola sensation on one or both sides.

Since these nerve branches course along the side of the chest wall into the breast, dissection in this area can unavoidably damage a nerve that exists in the location where the pocket must be. Unfortunately, the nerve is not "color-coded" or waving a "save me, save me" flag! Perhaps axillary incisions have a slightly higher tendency to damage this nerve branch, since dissection from the armpit to create a properly-located pocket can be right along the course of the nerve. But any incision approach still is used to create an open pocket for your implants, and CAN damage THE nerve.

Larger implants require a correspondingly larger pocket, and therefore a slightly higher potential for damaging a nerve along the side of the breast theoretically exists. However, I use large implants (500-800cc) in many patients, and I really don't see a "higher" percentage of numb nipple patients in this group. It's much more about your individual anatomy rather than size of implant.

Bottom line: if this is your "favorite nerve" and you can't live without it, then you shouldn't undergo breast augmentation! Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.