Evaluation of Nipple and Areola Sensation in Different Pedicles of Breast Reduction: A Controlled Trial

Aboul Nasr L A, Plast Reconstr Surg Glob Open, 2025. PMID: 40606808

Key Takeaways

• Inferior-pedicle reductions demonstrated better nipple-areola complex (NAC) sensation at 3 months, but differences equalized by 6–12 months.

• All pedicles regained baseline sensation within a year.

Background

Preserving NAC sensibility is central to patient satisfaction after breast reduction. Pedicle choice influences nerve integrity, yet data comparing techniques are limited.

Objective

To compare postoperative NAC sensation after superomedial, medial, and inferior pedicle breast reductions.

Methods

• Design: Prospective randomized controlled trial, single tertiary center, 2022 – 2024.

• Participants: 45 women (90 breasts) randomized 1 : 1 : 1 to superomedial, medial, or inferior pedicle reductions; median age 36–43 y; BMI ≤ 40 kg/m².

• Exclusion Criteria: Prior breast surgery, sensory-altering comorbidities, BMI > 40, NAC complications.

• Intervention: Standardized reduction mammaplasty performed by one surgical team.

• Endpoints: 1-point discrimination (Semmes-Weinstein monofilaments), crude touch, temperature, pain (needle), and 2-point discrimination measured at 3, 6, 12 months.

• Statistics: χ² and Kruskal-Wallis tests; α = 0.05; intention-to-treat analysis.

Results

• Primary outcome (1-point discrimination): No significant inter-group differences at any time-point.

• Early (3 mo) sensory tests

  • Temperature: inferior > superomedial & medial (P = 0.0002).

  • Crude touch: inferior > superomedial (P = 0.004).

  • Pain: inferior > others (P = 0.004).

  • 2-point discrimination: inferior > others (P = 0.0002).

• Late: By 6 months, > 93 % of breasts in all groups recovered pain/temperature/crude touch; by 12 months, no inter-group differences across tests.

• Complications: Minor NAC necrosis/dehiscence in 8 %–17 % per group; no flap loss.

Conclusion

All three pedicles provide safe reduction mammaplasty with full sensory recovery by one year; the inferior pedicle offers earlier return of NAC sensation.

Strengths & Limitations

• Strengths: RCT design with equal groups; multifaceted sensory testing; standardized surgical team.

• Limitations: Small sample (n = 45); single center; 12-month follow-up; subjective sensory measures; non-blinded assessors.

Clinical Relevance

Surgeons can counsel patients that early numbness is common but typically resolves within a year, regardless of pedicle. Choosing an inferior pedicle may speed early sensory return without compromising long-term outcomes.