title: Nipple-Sparing Mastectomy Improves Long-Term Nipple But Not Skin Sensation After Breast Reconstruction: Quantification of Long-Term Sensation in Nipple Sparing Versus Non-nipple Sparing Mastectomy.
abstract: BACKGROUND
  Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non-nipple-sparing mastectomy.
  
  
  METHODS
  Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included. Breast measurements were taken in 4 quadrants (upper/lower lateral, upper/lower medial) and nipple. Averaged skin cutaneous thresholds [(UL+LL+UM+LM)/4] and nipple sensation between NSM and NNSM were compared as the primary outcome measure. A generalized estimating equations model was used; univariate and multivariate variable analyses were done when appropriate.
  
  
  RESULTS
  Forty-four patients (74 breasts) were examined (53 NNSM vs 21 NSM). The groups were further subdivided into autologous versus implant-based reconstruction. Averaged cutaneous skin thresholds for quadrants were better for the NSM, 51.8(±24.5) g/mm versus NNSM, 56.5(±25.7) g/mm, although this difference was not statistically significant. However, NSM breasts measured higher nipple or nipple area sensitivity, 44.5(±30.8) g/mm versus NNSM, 83.8(±27.4) g/mm (P < 0.001). In a multivariate regression analysis, a predictor of decreased sensation was the number of revision surgeries, especially after third revision.
  
  
  CONCLUSIONS
  Breast sensation is decreased after reconstruction in both NSM and NNSM, but nipple sensation or nipple area is better preserved in NSM breasts. Number of revision surgeries (>3) was a predictor of decreased sensation.
authors.affiliation: From the *Department of Plastic Surgery, Johns Hopkins University School of Medicine; and †Biostatistics Consulting Center, Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Rodriguez-Unda
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Bello
authors.forename: Emily M
authors.initials: EM
authors.lastname: Clarke-Pearson
authors.forename: Abanti
authors.initials: A
authors.lastname: Sanyal
authors.forename: Carisa M
authors.initials: CM
authors.lastname: Cooney
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009558:Nipples / Q000502:physiology*; D012677:Sensation; D012879:Skin Physiological Phenomena