There is always some concern that the sensation to the nipple may be decreased or lost after breast augmentation. Since the placement of a breast implant and the nerve that supplies the feeling to the nipple are in close proximity, breast augmentation always poses some threat of nerve injury. This is an issue which has been fairly well studied in the plastic surgery literature.
The feeling to the nipple of the female breast is derived mainly from the nerves that come out on the side of the chest wall between the 3rd to the 5th ribs. The nerves travel along the underside of the skin after coming out from between the ribs. In theory, these nerves can be injured by where the implant is placed (how far to the side it goes) and by what type of surgical incision is used. (does the incision location make any difference?)
Nipple and breast skin sensation changes after breast augmentation can cause either an increase or decrease of feeling in the breast area. Changes can vary from extreme sensitivity to no sensation at all. The physiological response to stimuli (sexual and non-sexual) and the ability to breastfeed can be adversely affected by nipple and breast sensation changes after breast augmentation. These nipple and breast sensation changes may be temporary or permanent, depending upon the type of nerve damage or other injury caused during breast augmentation surgery.
There have been a number of studies that have looked at this sensation issue after breast implant surgery. The manufacturers’ statistics show that up to 10% of patients will experience decreased or permanent loss of sensation in the nipple. The lower pole of the breast skin can also experience numbness that can also be permanent in a small number of patients. Simple math would suggest that up to 20% of women will experience permanent changes in feeling after breast augmentation. In my Indianapolis plastic surgery practice, these numbers seem high in my experience particularly those with permanent loss of nipple sensation. It could be that my patients simply don’t tell me or that it is not a big issue for them. Either way, I can only count a handful of patients over the years that have ever mentioned it.
Does the type of incision used affect this nerve injury risk? Recent studies in the past few years have now shown that there is not really any difference in this regard in either the nipple, lower breast crease or through the armpit approach. In particular, a study published in 2006 showed that the periareolar (nipple) incision caused no more nipple numbness than any other type.
No formal studies have ever been done about the correlation between breast implant size and nerve injury. But it seems logical that larger implants, with more lateral position, are at greater risk for sensory nerve injury than smaller ones.
The location of the breast implant, above or below the muscle, may also affect nipple sensation.This seems more likely with subglandular (above the muscle) placement because the dissection of the breast implant pocket is more likely to interfere and damage the outer layers of the skin that are responsible for sensation.
In any case, every patient that undergoes breast augmentation must be aware of the risk of loss of nipple or breast skin feeling. While this risk does not seem to be large, a small number of patients will experience these irreversible nerve injuries and loss of some feeling. In my Indianapolis plastic surgery practice, I have had very few complaints about this problem but that doesn’t mean it does not occur.
Dr. Barry Eppley
Indianapolis, Indiana