Impact of Patient and Operative Factors on Nipple-Areola Complex Sensation After Bilateral Reduction Mammaplasty

Jesse I. Payton, MD; Jasson T. Abraham, MD; Matthew D. Novak, MD; Kendall P. Hammonds, MPH; Andrew Altman, MD


Plast Reconstr Surg Glob Open. 2022;10(6):e4353 

In This Article

Abstract and Introduction


Background: Alteration of nipple-areola complex (NAC) sensation following reduction mammoplasty is commonly reported and may impact patient satisfaction. The goal of this study was to evaluate the patient and procedural factors that influence the rates of subjective NAC sensation change.

Methods: A retrospective review of all patients who underwent primary bilateral reduction mammoplasty between January 2014 and August 2018 at the senior author's institution was performed. The primary outcome measured was subjective NAC sensation via digital stimulation of the NAC with the patient reporting sensation as decreased, unchanged, or increased.

Results: In total, 274 patients met inclusion criteria. NAC sensation was decreased in 19% of breasts, unchanged in 74%, and increased in 7.3%. Patients who underwent vertical pattern, superomedial pedicle reductions were more likely to report a decrease in sensation than those who underwent Wise pattern, inferior pedicle reductions (26% versus 13%; P = 0.0025). Patients with minor complications were more likely to report decreased NAC sensation than those who did not (23% versus 15%; P = 0.0264). The only factor found to be associated with increased sensation was operative time.

Conclusions: Patients were more likely to report decreased sensation if a vertical skin resection, superomedial pedicle was chosen, or if patients experienced a minor complication. The only factor found to correlate with increased NAC sensation was longer operative times.


Reduction mammaplasty is a safe surgical procedure with more than 100,000 women undergoing the intervention annually.[1] Women report a high degree of satisfaction and improvement in neck pain, back pain, shoulder grooving, intertrigo, ease of exercise, and unwanted attention after surgery.[2,3] Significant improvements in anxiety, depression, and body image as measured using the Hospital Anxiety and Depression Scale and the Corporeal Dissatisfaction Subscale of the Eating Disorders Inventory (EDI-2) have also been reported.[4] Despite these significant merits, a risk of reduction mammaplasty is alterations of nipple areolar complex (NAC) sensation, which can potentially impact patient satisfaction.

In a prospective questionnaire of women undergoing reduction mammaplasty, 79% reported NAC sensation as very important to their sexual lives.[5] Despite this, a study of 40 women undergoing reduction mammaplasty showed significant reductions in NAC sensation, but no change in the Female Sexual Function Index scores.[6] This may be due to improved psychosocial and physical symptoms after breast reduction outweighing the negative feelings associated with changes in NAC sensation. Nonetheless, elucidating factors that contribute to changes in NAC sensation may help preserve sensation and contribute to patient satisfaction. The goal of this study was to evaluate the patient and operative factors that influence subjective NAC sensation after reduction mammaplasty.