Breast sensitivity after vertical mammaplasty.
Breast sensation after reduction mammaplasty is a major concern for surgeons and patients. The sensitivity of 80 breasts that were reduced using Lejour's technique (a superior dermoglandular pedicle with resection at the lower quadrants) was assessed in a prospective study. Ten points were selected on each breast for this study, including the nipple, four points on the areola, and five points on the breast skin. The measurements were performed preoperatively and at 3, 6, and 12 months postoperatively. Pressure thresholds were measured with 20 Semmes-Weinstein monofilaments, temperature sensitivity with hot and cold metal probes, vibratory thresholds with the Biotesiometer, and static and moving two-point discrimination tests with a Disk-Criminator. To assess the influence of breast ptosis and hypertrophy on sensitivity, the population was divided into two groups. In group I (19 patients), the sternal notch-to-nipple distance was less than 29 cm, and less than 500 g of tissue per breast was removed. In group II (21 patients), the sternal notch-to-nipple distance was more than 29 cm, and more than 500 g of tissue was resected. The sensitivity on the nipple and areola was significantly decreased at 3 and 6 months postoperatively for all modalities. At 1 year, sensitivity recovered, and no breast or nipple-areola complex was insensitive. Pressure sensitivity was not significantly different from the preoperative measurement in any area of the breast or in either group of patients, except for superior breast skin, for which sensitivity was improved in group II (p = 0.0004). Temperature sensitivity in group I was not different preoperatively and postoperatively, but in group II, a significant decrease was observed in sensitivity for the nipple and areola (p = 0.01 and 0.004, respectively). Vibratory sensitivity was significantly decreased on the nipple, the areola, and the inferior breast skin (p = 0.01, 0.01, and 0.001, respectively) in group II but not in group I. In conclusion, ptotic or moderately hypertrophied breasts that were reduced using Lejour's technique recovered their preoperative level of sensitivity after an initial postoperative decline. However, in large breasts, although pressure sensitivity recovered after 1 year, temperature and vibration sensitivity remained diminished on the nipple-areola complex.
Department of Plastic Surgery, C. H. U. Brugmann, Free University of Brussels, Belgium. muriel.greuse@chu-brugmann.be
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Hamdi
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DeMey
D000293:Adolescent; D000328:Adult; D001941:Breast Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006984:Hypertrophy; D006987:Hypesthesia / Q000175:diagnosis* / Q000503:physiopathology; D016462:Mammaplasty / Q000379:methods*; D008465:Mechanoreceptors / Q000503:physiopathology; D008875:Middle Aged; D009558:Nipples / Q000294:innervation / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012684:Sensory Thresholds / Q000502:physiology; D012867:Skin / Q000294:innervation; D013697:Thermosensing / Q000502:physiology