Nipple-Areola Complex sensation after nipple sparing mastectomy

Abstract

BACKGROUNDNipple-areola complex (NAC) is a signature of the breast. Preservation of the NAC has a positive impact on patients' satisfaction with cosmetic results and feeling of mutilation. 1 Nowadays, there are still no reconstruction techniques quite as satisfying as the real NAC. Nipplesparing mastectomy (NSM) is developed to optimize es-thetic outcomes. However, the oncologic safety and the postoperative viability of the NAC are important concerns. Welling and Jensen 2 postulated that the origin and progression of ductal carcinoma in the breast are from terminal duct lobular unit, and pathological study found only 9% of terminal duct lobular unit at the base of the nipple from mastectomy specimens. 3 According to the aforementioned data, preservation of NAC can still be performed if there is no evidence of cancer cell at the base of the nipple. NSM is also an option for patients requiring riskreduction mastectomy and has a role in treating breast cancer in selected patients. 4 Several studies reported an occult NAC involvement on mastectomy specimens varying from 0% to 58%. These results are due to the differences in the inclusion criteria and the pathological assessment method between stud- From the Breast and

Preserving Nipple Sensitivity after Breast Cancer Surgery: A Systematic Review and Meta-Analysis

“…Te NAC is innervated by a plexus under the areola formed by variations of the second, third, fourth, and ffth intercostal nerves [43]. Tese nerves course through the gland to the posterior surface, increasing the likelihood of injury during resection of retroareolar tissue and making the preservation of the anterior branches more important [8,16]. Te frst report of sensory repair in autologous breast reconstruction used the anterior ramus of the lateral branch of the fourth intercostal nerve, which emerges at the midaxillary line after traveling through the serratus anterior muscle and later reports used the third anterior intercostal nerve, most likely due to the decreased likelihood of injury [12,44,45].…”

“…Study characteristics are described in Table1. Of 28 total included studies, twelve (n = 578 patients) used objective measures to evaluate sensitivity, such as monoflament testing which included SWM or von Frey hairs [7][8][9][10][15][16][17][18][19][20][21][22]. Areas of the NAC tested with these flaments are displayed in Figure 2.…”

“…Other studies reported sensitivity outcomes using the pinprick sensation test, two-point discrimination test, and pressure-specifed sensory devices. Chirappapha et al used the pinprick sensation test and found that 70% (n � 7) of patients followed for a year experienced partial sensation recovery [16]. Te NAC two-point discrimination test and the pressure-specifed sensory device were used by Peled and Djohan, respectively, both of which also performed neurotization and are discussed later in this section.…”

Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy

“…19,30 The procedure itself offers a high level of AS, 31,32 but has downsides, including decreased or absent sensation, local complication such as nipple necrosis, and unnatural reconstruction of the breast. 33,34 With more women surviving breast cancer, it is important for patients to fully understand the positive and negative aspects of the procedure before electing it.…”

“…Although studies have found NSM to be superior to traditional and skin-sparing mastectomies, 40,41 the hypesthetic and dysesthesic consequences of NSM have been well described. 33,34 Earlier study has also delineated a patient-perceived expectation gap for women undergoing NSM. 34,42 As such, these risk outcomes should be described to patients preoperatively.…”