Bigger implants may decrease nipple sensation

San Diego — Breast augmentation negatively impacts nipple sensation in proportion to the size of the implants, according to a recent study published in Plastic and Reconstructive Surgery.

"Patients should be counseled that the selection of larger implants results in a diminution of sensation within the nipple-areola complex," says Mark Mofid, M.D., the study's lead investigator, a plastic surgeon in private practice in La Jolla, Calif., and a volunteer clinical faculty member at the University of California, San Diego.

Dr. Mofid tells Cosmetic Surgery Times that since erogenous sensation is a cortical transfer function, there is no conclusive evidence that large implant sizes will categorically impair the ability to achieve arousal through stimulation of the nipple-areola complex.

Study findings, implications

An additional and important finding of the study published by Dr. Mofid was that the technique used for the performance of breast augmentation surgery, whether by the inframammary or periareolar technique, had no impact on sensory outcomes.

In an earlier study by Dr. Mofid published in 2002 in Plastic and Reconstructive Surgery, he found women with naturally larger breasts had decreased nipple sensation compared to their counterparts with smaller breasts. A total of 34 women were studied and underwent breast sensory testing using the Pressure-Specified Sensory Device, a highly accurate computer-assisted quantitative technique for measuring sensitivity.

"We know that women with large breasts have poor sensitivity," Dr. Mofid says. "We suspect that two separate processes are occurring. One is that nerve traction injury results from the stretching of nerve fibers that extend from the chest wall to the nipple. The second is that innervation density decreases. Since the number of sensory receptors stay the same but the surface area increases proportionately with larger implant size, the density of sensory receptors for a given surface area decreases with increasing breast volumes."

While the subject of breast sensation following reduction mammaplasty has been explored, there has been scant research on the effect of breast sensation following breast augmentation, Dr. Mofid notes.

In the most recent study, published in early May, Dr. Mofid studied 20 women who underwent primary augmentation mammaplasty by either the periareolar or inframammary approach. The average duration between surgery and sensory evaluation was 1.12 years. No women in the study had morbidities affecting sensation or a history of other breast surgery.

A total of nine women were size-matched, non-operated controls, who ranged in age from 19 to 38 and had breast sizes between 34A and 36C. Of the 20 study participants who underwent breast augmentation, 13 patients (26 breasts) underwent surgery using the periareolar incisional approach and seven patients (14 breasts) were augmented using the inframammary incisional approach. The preoperative range of breast sizes for the 20 subjects was 32B to 36C. The average implant size used was 375 cc with a range of 315 to 700 cc.

Augmentation itself relevant

The Pressure-Specified Sensory Device was employed for sensory testing, comparing moving and static sensory thresholds at the upper and lower areola and nipple.

A total of five readings were recorded for each site of the nipple-areola complex. Statistically significant differences were found between the 20 subjects who underwent breast augmentation compared to controls. Cutaneous pressure threshold values were found to be 10 times higher in women who underwent augmentation mammaplasty compared to non-operated controls with matched breast sizes.

The study also sought to establish if using either the periareolar incisional approach or the inframammary incisional approach made a difference in sensory outcome, according to Dr. Mofid.