Nipple reinnervation in two-stage alloplastic breast reconstruction

Loss of sensation in the nipple-areolar complex (NAC) after mastectomy negatively affects quality of life, body image, and psychological well-being. Although direct nipple reinnervation has been described in immediate implant-based reconstruction, data on expander-based reconstruction is limited.

The aim of this study was to present our experience with nipple neurotization performed during second-stage implant exchange and evaluate its role in improving sensory outcomes in patients undergoing alloplastic breast reconstruction.

A prospective study was conducted by including patients who underwent nipple-sparing mastectomy with neurotization during expander-to-implant exchange between 2021 and 2025. Demographic and clinical data were collected. Each breast was divided into five regions and assessed using the British Medical Research Council (BMRC) scale and Semmes-Weinstein monofilament testing. Evaluations were conducted preoperatively and at 6 and 12 months postoperatively. Outcomes were compared using the Friedman test.

Thirteen patients (18 breasts), with a median age of 42 years, were included. Preoperatively, median NAC sensation was S0, which improved to S1 at 6 months and S3+ at 12 months (p < 0.01). The Semmes-Weinstein thresholds improved from >300 g preoperatively to 10 g at 6 months and 2 g at 12 months (p < 0.01).

Nipple neurotization using intercostal nerves during expander-to-implant exchange is a feasible technique associated with improved sensory outcomes in implant-based breast reconstruction. Further comparative studies are needed to determine its efficacy relative to standard reconstruction.