Breast sensitivity before and after the L short-scar mammaplasty.

BACKGROUND: Breast sensitivity preservation is among the aims of modern breast surgery. Large-volume resection, extensive undermining, and resections at the breast base have been associated with breast sensitivity alterations. The L short-scar mammaplasty technique is designed to preserve breast sensitivity by resection of tissue in the middle and inferior portions of the breast, but specifically dissection and preservation of the breast lateral neurovascular pedicle. Using this technique, a prospective study was designed for measurement of breast sensitivity quantitatively and subjectively to determine whether different resection volumes of the breast correlate with alteration of sensitivity postoperatively.

METHODS: This study compared the sensitivity of 125 breasts of 64 consecutive patients who underwent mastopexy or breast reduction with the L short-scar mammaplasty technique. Nine points were tested with Semmes-Weinstein monofilaments: the nipple and cardinal points on the areola and skin. The tests were performed by the same examiner 1 day before surgery and then 6 and 12 months after surgery. The breasts were divided into three groups according to the resected volume as follows: group A (≤200 g), group B (201-400 g), and group C (>400 g). The patients also were asked to complete written surveys 12 months postoperatively, and the response rate was 100%.

RESULTS: Before surgery, larger breasts were observed to have less sensitivity in the areola (groups B and C, P<0.001) and skin (group C, P<0.001). After 12 months, no correlation was found between larger resected volumes and less breast sensitivity. The sensitivity of the nipple-areola complex in all the groups reached levels equal to the preoperative measurement within 12 months after surgery. After 6 and 12 months, significant improvement in skin breast sensitivity with resections greater than 200 g (group B, P=0.002; group C, P<0.001) was observed. After 12 months, 66.4% of the patients and 94.4% of the group C patients (average resection, 499 g) reported equal or better nipple-areolar sensitivity compared with preoperative sensibility. No patient reported areas of areola or nipple insensitivity.

CONCLUSION: After the L short-scar mammaplasty, breast sensitivity to pressure in most cases returns to preoperative levels or improves primarily in those with larger breasts. The data of this prospective study contradict the misconception that mammaplasty techniques with resections at the breast base leave the patient with reduced breast sensitivity because the fundamental neural pathways, such as the lateral neurovascular pedicle, are preserved.