The Assessment of Nipple Areola Complex Sensation with Semmes-Weinstein Monofilaments—Normative Values and Its Covariates

Kasielska‐Trojan, Anna; Szulia, Agata; Zawadzki, Tomasz; Antoszewski, Bogusław

doi:10.3390/diagnostics11112145

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…Higher age, larger breasts, previous pregnancies and breastfeeding, and higher body mass index (BMI) negatively influence breast sensation. Contrary to common assumptions, the NAC appears less sensitive than surrounding breast skin ( 31 , 32 ).…”

Section: Resultscontrasting

confidence: 65%

Sensory recovery and the role of innervated flaps in autologous breast reconstruction—a narrative review

Bubberman,

Van Rooij,

Van der Hulst

et al. 2023

Gland Surg

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Background and Objective Continuing (micro)surgical developments result in satisfactory aesthetic outcomes after autologous breast reconstruction. However, sensation recovers poorly and remains a source of dissatisfaction and potential harm. Sensory nerve coaptation is a promising technique to improve sensation in the reconstructed breast. Methods In this literature review an overview of current knowledge about sensory recovery in autologous breast reconstruction and the role of innervated flaps is presented. A thorough PubMed search was conducted, using the terms “autologous breast reconstruction”, “innervated” and “sensation”. Key Content and Findings The breast skin is predominantly innervated by the second until sixth intercostal nerve. Some nerves can occasionally be spared during mastectomy, especially during nipple-sparing mastectomy, but transection of sensory nerves is inevitable and leads to impaired sensation. Besides unpleasant, this is unanticipated by patients and negatively influences quality of life. Coaptation between the third anterior intercostal nerve and a sensory nerve from the donor site improves sensory recovery. The donor site and nerve vary, depending on the flap type chosen. The sensory nerves from the commonly used abdominal DIEP flap originate from the 7th until 12th thoracic spinal nerves. Non-abdominal flaps, including the back, buttocks, or thigh area, can also be accompanied with a sensory nerve. Nerve coaptation can be performed directly, or by using grafts or conduits to obtain tensionless repair if necessary. It can be utilized in both immediate as well as delayed autologous breast reconstruction. No adverse outcomes of nerve coaptation have been described. And, most importantly: improved sensory recovery improves patient satisfaction and quality of life. Conclusions Restoring sensation is, besides restoring aesthetic appearance, an important goal in breast reconstruction. Current evidence unambiguously demonstrates superiority of innervated flaps compared to non-innervated flaps. Sensory recovery initiates earlier and it approaches normal sensation more closely in innervated flaps, without associated risks or extensive increase in operating time. This improves patient satisfaction and quality of life. It is, therefore, a valuable addition to autologous breast reconstruction. These findings encourage implementation of sensory nerve coaptation in standard clinical care.

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Section: Resultscontrasting

confidence: 65%

Sensory recovery and the role of innervated flaps in autologous breast reconstruction—a narrative review

Bubberman,

Van Rooij,

Van der Hulst

et al. 2023

Gland Surg

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“…All these methods have been developed to improve the variables which add to the "perfect breast" such as: breast shape, footprint, and nipple-areolar complex (NAC) sensation and projection for both better aesthetic and functional results. [4][5][6][7][8][9][11][12][13][14]. Furthermore, it seems to be important to verify the available surgical techniques in the aspect of the possibility to achieve "clinically" symmetric breasts.…”

Section: Introductionmentioning

confidence: 99%

Is Preoperative Asymmetry a Predictor of Postoperative Asymmetry in Patients Undergoing Breast Reduction?

Zawadzki

Antoszewski

Kasielska‐Trojan

2023

IJERPH

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Plastic surgeons aim to achieve symmetry in breast surgeries, which is the main determinant of chest aesthetics. The aim of this study was to verify if preoperative breast asymmetry is a predictor of postoperative asymmetry in women undergoing breast reduction. In this prospective study, we enrolled 71 women (the mean age 37 years, SD 10 years) with breast hypertrophy who underwent reduction mammaplasty. We collected clinical data including age, height, weight, weight of the resected tissues, and performed pre and postoperative photographic documentation. The following measurements of both breasts were analyzed: volumes (vol), nipple–sternal notch distance (A-sn), difference between nipples’ levels (A-A’), nipple–midline distance (A-ml), difference between inframammary folds levels (IF-IF’), distance between inframammary fold and nipple (IF-A), distance between inframammary fold apex and midline (IF-ml). All measurements were performed preoperatively and 6 months after the surgery and asymmetries of all variables were calculated (asy-vol, A-A’, asyA-sn, asyA-ml, IF-IF’, asyIF-A, asyIF-ml). Postoperative asymmetry of breast volumes and nipples position was not associated with any of the analyzed clinical variables. Postoperative asymmetry of nipples’ level was associated with preoperative asymmetry of IF-ml; however, logistic regression did not detect any preoperative measurement influencing postoperative volume and nipples’ level asymmetry. Moreover, we found that preoperative asyIF-ml increased the risk of postoperative volume asymmetry, which is above the average (52 cc) (OR = 2.04). Postoperative breast asymmetry after breast reduction is not related neither to preoperative asymmetries nor clinical variables; however, asymmetry of inframammary fold apex to the midline may be the factor affecting postoperative volumetric asymmetry.

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“…These values seem high for a nonoperated, healthy breast, especially when comparing them to other studies measuring sensation in the healthy breast. Bijkerk et al 8 used the 20-piece kit of the Semmes-Weinstein monofilaments to measure breast sensation and found values ranging from 2.36 to 3.22, translating to pressures between 0.02 and 0.16 g. Tairych et al 9 used the same monofilaments to analyze breast sensation in women with various breast sizes, and Kasielska-Trojan et al 10 specifically evaluated the nipple-areolar complex. All these studies found comparable results regarding the nonoperated breast.…”

mentioning

confidence: 99%

Letter to the Editor per Lu Wang et al.

van Rooij,

Tuinder

2024

Ann Plast Surg

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The Assessment of Nipple Areola Complex Sensation with Semmes-Weinstein Monofilaments—Normative Values and Its Covariates

Cited by 6 publications

References 28 publications

Sensory recovery and the role of innervated flaps in autologous breast reconstruction—a narrative review

Sensory recovery and the role of innervated flaps in autologous breast reconstruction—a narrative review

Is Preoperative Asymmetry a Predictor of Postoperative Asymmetry in Patients Undergoing Breast Reduction?

Letter to the Editor per Lu Wang et al.

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