Will My Nipples Have Feeling After a Mastectomy and Breast Reconstruction?

For many women facing a mastectomy, the possibility of losing their nipple may come as a surprise. For some patients, a procedure that saves the nipple and areola, known as a nipple-sparing mastectomy, may be an option.  If a nipple-sparing approach isn’t possible, or if the patient prefers to remove the nipple-areola, nipple reconstruction can be performed. Whether the nipple is preserved or reconstructed, nipple sensation will most likely never be the same.

The best approach to maximizing the remaining sensation after a mastectomy is to preserve the sensory nerves that supply feeling to the breast.  Patients must understand that even if the breast surgeon takes the greatest care to preserve these nerves, sometimes the anatomy of the breast tissue is not favorable and does not allow it.  The location of the breast cancer (if it involves the outer part of the breast) can also prevent sparing important nerves.

What is Nipple-Sparing Mastectomy?

A nipple-sparing mastectomy is a surgical technique that preserves the entire breast skin envelope and nipple-areola. Only the underlying breast tissue is removed. When combined with immediate breast reconstruction in appropriate candidates, nipple-sparing mastectomy provides superior cosmetic results without compromising cancer treatment. It can also improve the return of sensation in some patients.

Does Sensation Return After Nipple Reconstruction?

Not everyone is a candidate for nipple-sparing mastectomy.  There are also those who do not wish to save their nipples.  In either circumstance, nipple reconstruction can be performed.  There are a variety of nipple reconstruction techniques.  At PRMA, we perform what we call the “bow-tie” method.  The procedure gets its name from the bow-tie shaped incision used to create the new nipple.

Nipple reconstruction is typically paired with 3D areola tattooing to achieve the most natural-appearing results.  Although many reconstructed nipples look quite similarly to a native nipple, they will not react to stimuli and change size like a natural nipple.  Reconstructed nipples will not respond to temperature or touch.  They may regain some sensation following surgery, but usually very little.  Reconstructed nipples do not provide erogenous (sexual) sensation.

Can Sensory Nerve Reconstruction Improve the Return of Nipple Sensation?

Sensory nerve reconstruction is a major game changer for the field of breast reconstruction!  Using microsurgery, the PRMA surgeons reconnect sensory nerves in the chest that were cut during the mastectomy.  This can be performed with or without a nerve graft depending on the patient’s anatomy and type of reconstruction procedure.  While we have been performing sensory nerve reconstruction for many years at PRMA, the procedure has yet to gain widespread adoption, partly because of the expertise required, and few plastic surgeons currently offer it.

Does the Type of Breast Reconstruction Procedure Performed Impact Future Nipple Sensation?

There are a variety of breast reconstruction options that range from using breast implants to your own natural tissue (called autologous, or “flap” reconstruction).  Both types of procedures can provide great cosmetic results.  For patients concerned about nipple sensation following a mastectomy and reconstruction, flap options offer a better chance of some feeling returning.  This is because, unlike implants, tissue flaps contain nerves that can be connected to the cut nerves in the chest, and naturally contain multiple nerve endings within the tissue.  Implants are man-made devices that do not contain any nerves.  For this reason, breasts reconstructed with tissue flaps may regain some feeling even without a nerve reconstruction.  However, studies show that the feeling that returns is significantly better when a nerve reconstruction is performed.

Implant patients may also experience return of feeling, but this is usually minimal unless a nerve reconstruction (with a nerve graft) is performed.

Realistic Expectations

Regardless of the type of mastectomy or reconstruction performed, patients should have honest conversations with their surgeons when it comes to the degree of nipple sensation they should expect long-term.  Preserving nerves, if at all possible, is crucial.  Patients must be aware that if feeling does come back, it usually won’t return overnight.  Nerves that are reconstructed regenerate at a rate of 1mm a day.  For this reason, patients will not experience their final level of sensation for up to 2 years following their reconstruction.

Author: Dr. Minas Chrysopoulo and Courtney Floyd