In a recent study describing sensory changes post subfascial breast augmentation, Melbourne, Australia-based plastic surgeon Tim Brown, MChir, FRCS, FRCS (Plast), reports that based on his study of 162 consecutive patients, only 4% had sensory loss at the nipple-areolar complexes three months post-op, but more than 16% had diminished sensitivity in the lower outer breast quadrant.
The author assessed sensory changes using a Semmes Weinstein monofilament test prior to surgery and at two, six and 12 weeks postoperatively.
At 12 weeks, 92.5% of the women regained preoperative levels of sensation in all breast areas, except for the lower-outer quadrants — the most common area of diminished sensitivity and an issue related to the use of inframammary crease incisions. Sensory deficits were more likely among younger patients and patients with high BMIs and measurably thicker soft tissue envelopes. The calculated volume changes produced by implants in the series were from 12.1% to 102.7%, with no association between volume increase and sensory issues, according to the study.
Seattle, Wash., plastic surgeon Richard A. Baxter, M.D., tells Cosmetic Surgery Times that he found the study interesting, given he published the first article on the subfascial technique in North America, in the September-October 2005 Aesthetic Surgery Journal.
“The study confirms that the subfascial plane is equivalent to the submuscular plane in terms of risk of sensory change, which makes anatomic sense,” Dr. Baxter says. “I have not systematically measured sensory changes but my sense is that my results are in line with this report. I would have expected some correlation to larger implant sizes, but it is reassuring that this was not found. There does seem to be improvement with time when it does occur.”
C. Andrew Salzberg, M.D., system chief of plastic surgery at Mount Sinai and associate professor of plastic surgery, Icahn School of Medicine Mount Sinai Health System, says temporary sensory change from breast augmentation, regardless of approach, is common and should be disclosed as part of the consultation with breast augmentation patients.
“…it’s common sense that for the first few weeks or month, there may be a change in sensation,” Dr. Salzberg says. “But I do have some major issues with this study.”
Disagreements Among Doctors
Dr. Salzberg says that Dr. Brown’s description of the sensation changes as “objective” does not seem accurate.
“When I ask you if you feel something, that’s more a subjective response. What you say may not be the same as what some other person says. So, it’s not very objective,” Dr. Salzberg says.
Another issue: The entire paper was about the subfascial plane, which is an uncommon breast augmentation approach among U.S. surgeons, Dr. Salzberg says.
Most breast augmentations in this country are either [subpectoral or subglandular],” he says.
William P. Adams, Jr., M.D., associate clinical professor of plastic surgery at UT Southwestern Medical Center, University Park, Texas, says the sensory issues noted in Dr. Brown’s study are not a perceived issue with breast augmentation patients.
“The biggest issue for sensory issues post procedure is not the incision or pocket plane, but using tissue-based planning and an implant that ‘fits’ the breast,” Dr. Adams says.
Nevertheless, Dr. Salzberg says, there are positive points from Dr. Brown’s work for U.S. plastic surgeons. It highlights the issue of sensory changes, which serves as a reminder to surgeons that they should talk about the risk with breast augmentation patients. And Dr. Salzberg agrees that the 12-week mark is probably a good indicator of when those sensory changes should diminish.
“The article also refers to the inframammary incision, which is an incision underneath the breast in the fold. That’s where the nerves on the side are coming out. The area can be injured not just by stretching but also by either cutting the nerve directly (and that’s where you can get more permanent changes) or when surgeons use electrocautery… to cauterize the blood vessels. That can also temporarily injure the nerves and make it even longer, so patients might feel numb in certain areas for months to years,” Dr. Salzberg says.
There are things that surgeons can do and recommend that help avoid and treat sensory changes, according to these experts.
“… I would say that it is worth taking the time to elevate the fascia laterally even with subpectoral placement,” Dr. Baxter says.
Dr. Salzberg recommends that patients experiencing sensory changes should touch their breasts. The stimulation, he says, will help bring back normal sensation.
Note: We attempted to reach Dr. Brown to comment on his study but he was unable to respond.