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Is a transaxillary breast augmentation more likely to cause loss of nipple sensation?

Q:

Is it true that an axillary incision is more likely to cause nipple sensation loss since the nerve to the nipple runs along this dissection route on the side of the chest wall?

A:

The further you are from the nerve to the nipple, the less chance you have of involving or injuring the nerve. The incision that has the highest chance of numbness to the nipple is thought to be the periareolar incision. This makes sense, as the nerve is traversing to the nipple, and can be in the dissection of putting the implant in. The second most incision is thought to be the inframammary incision, but way less than the periareolar approach. Because the dissection is furthest from the nerve to the nipple (the nerve comes from the back about at the level of a bra and enters into the breast at the level of the tail of spence about 4-5 inches below the incision for the transaxillary incision), it appears that the transaxillary approach has the least chance of having nipple sensation loss. A paper that was in the Aesthetic Surgery Journal in September of 2011, that I authored, had extremely low incidence of loss of nipple sensation. I hope this helps.

Dan Mills, II, MD

A:

Nipple Sensation and Incision Choice in Breast Augmentation:

Dr. Mills is partially right. However, other studies have shown that it is not really the incision that is responsible for loss of nipple sensation, it is the size of the implant and, thus, the size of the dissection. The larger the implant, the more dissection that is necessary to accommodate the breast implant base width; therefore, the more sensation that is lost. This generally does not matter if a reasonable sized implant is used. When measured at a year, more than 90% of women, no matter which incision was used, thought the sensation was enhanced, though everyone had a measurable sensory loss of at least 5%. Many people will have a significant sensory loss initially. However, I have never had anyone complain after several months to a year. I personally do not use the transaxillary incision because of other problems.

R.T. Buchanan, MD

A:

Gina,

Thank you for your question. In my experience the transaxillary breast augmentation incision is the least likely to injure the nerve to the nipple. Dr Buchanan is correct, larger implants create a larger risk of nerve injury regardless of incision location.

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