Evaluation of Permanent Nipple-Areolar Complex Sensitivity Loss Following Reduction Mammaplasty

Predictors for permanent nipple-areolar complex (NAC) insensitivity after reduction mammaplasty are sparsely defined.

We analyzed factors associated with NAC insensitivity over long-term follow-up.

A retrospective analysis of reduction mammaplasties on 1598 breasts performed by 4 surgeons from March 2015 to February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence.

Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. A total of 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had longer sternal notch to NAC (P < .001) and NAC to IMF (P < .001) measurements, greater weight removed (P < .001), and fat necrosis co-complication (P = .022). Greater weight removed (P = .044) and longer sternal notch to NAC measurements (P = .011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, whereas the inferior pedicle had a decreased rate. There was no significant association between pedicle choices and permanent insensitivity.

Transient loss of NAC sensitivity is associated with pedicle choice, and breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.