nous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic

Background:
The body of literature documenting normative breast sensation and postoperative changes in sensation after reduction mammaplasty has grown considerably over the last several years. Despite this, only two studies have ever been published on the subject of postaugmentation mammaplasty sensory outcomes. The purpose of this study was to precisely measure sensory thresholds at the nipple-areola complex in women who have undergone augmentation mammaplasty by either the inframammary or periareolar approach.

Methods:
Twenty women underwent primary augmentation mammaplasty by either the periareolar or inframammary approach at an average follow-up of 1.12 years. Sensory testing was performed using the Pressure-Specified Sensory Device by comparing moving and static sensory thresholds at the upper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.

Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.

Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)

The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9

The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic s

pper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.

Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.

Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)

The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9

The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic

in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)

The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9

The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic

pproaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9

The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic

nous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic surgeons to discourage the periareolar approach of implant placement in women who voice concerns about the loss of sensitivity, because of the risk of transection of nerve fibers leading directly to the nipple-areola complex. Although other techniques of performing augmentation mammaplasty, such as the transumbilical and the endoscopically assisted transaxillary techniques, have gained popularity over the last several years, the vast majority of breast augmentations today are performed via either the inframammary approach or the periareolar approach. Unlike the two previous studies on the subject of sensory changes associated with augmentation mammaplasty,7,10 we utilized the Pressure- Specified Sensory Device (Sensory Management Services, Baltimore, Md.). Previous studies have employed modalities such as light touch, pain perception to electrical currents, vibratory stimulus, and Semmes-Weinstein nylon monofilaments. Relative to the technologically advanced sensory testing modalities available today, the techniques used in the two previous studies on this subject are considered unreliable and inaccurate.11 Thus, the purpose of this study was to quantify the sensation of the nipple-areola complex following breast augmentation using the Pressure-Specified Sensory Device and to compare the inframammary and periareolar approaches with respect to sensory outcomes.

PATIENTS AND METHODS
A total of 29 women were included in this study; nine of them were nonoperative controls (group 1), 13 had undergone breast augmentation through an inframammary approach (group 2), and seven had undergone augmentation via a periareolar approach (group 3). All women agreed to a 1-hour sensory examination that was performed in the presence of a female chaperone. No financial or other compensation was provided for enrollment in the study. The breast sensory testing protocol was accepted by our institutional review board, and all study subjects gave informed consent for sensory testing to be performed. No woman enrolled in this study reported a history of diabetes mellitus, thyroid disorders, collagen vascular disease, alcoholism, pernicious anemia, known neurological impairment, or history of previous breast surgery. Sensory evaluation was performed in all 29 women (58 breasts) by one examiner using the sensory device. Women were seated in a reclining chair with one breast exposed for testing and the other draped with a sheet. Women were asked to close their eyes so that the computer screen or the breast being tested could not be seen.

A button linked to the computer was placed in the hand opposite to the breast being tested and the women were instructed to press the button to indicate perception of the test stimulus. The nipple and upper and lower halves of the areola were selected as testing sites. At each test site, five readings were recorded. The highest and lowest values were discarded to eliminate outliers, and the mean of the remaining three was reported as the pressure threshold in grams per square millimeter. One-point static and moving pressure perception threshold was measured within a continuous range of 0.1 g/mm2 to 100 g/mm2. Data were entered into an Excel spreadsheet (Microsoft Corp., Redmond, Wash.). Statistical analyses