Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul 2:15:e28.
eCollection 2015.

Plastic Surgery of the Breast: Keeping the Nipple Sensitive

Charles A Riccio  1 , Matthew R Zeiderman  1 , Saeed Chowdhry  1 , Ronald M Brooks  1 , Shahrooz S Kelishadi  1 , John Paul Tutela  1 , Joshua Choo  1 , David V Yonick  1 , Bradon J Wilhelmi  1
Affiliations

Plastic Surgery of the Breast: Keeping the Nipple Sensitive

Charles A Riccio et al. Eplasty. .

Abstract

Introduction: Since its inception, reduction mammaplasty has matured considerably. Primary evolution in clinical research and practice has focused on preserving tissue viability. Surgery involves preserving not only tissue viability but also function and sensation. The nipple serves as the sensate unit of the breast and is a valuable part of women's psychological and sexual health, making preservation of nipple sensation of utmost important. Studies regarding primary innervation to the nipple are few and often contradictory. We propose an unsafe zone in which dissection during reduction mammoplasty ought to be avoided to preserve nipple sensation.

Methods: Circumareolar dissection of 22 cadaveric breasts was performed. Primary nerve branches to the nipple-areola complex were identified and dissected to their origin.

Results: Three to 5 branches of the fourth intercostal nerve primarily innervated the nipple on 18 of 22 breast dissections. Two breasts received innervation from the third intercostal nerve and 2 from the fifth intercostal nerve. In half of the specimens, accessory innervation from the third and fifth intercostal nerves provided medial branches to the nipple.

Conclusions: The fourth intercostal nerve provides the major innervation to the nipple-areola complex. Avoiding dissection in inferolateral quadrant "unsafe zone" of the breast during reduction mammaplasty and other breast surgical procedures can reliably spare nipple sensation and maximize patient outcomes.

Keywords: breast reconstruction; nipple; nipple innervation; nipple-areola complex; reduction mammaplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Anterior view of intercostal nerve innervation to the nipple. The red dashed lines demarcate the inferolateral breast quadrant to be avoided during surgical dissection so as to preserve nipple sensation.
Figure 2
Figure 2
Cross-sectional illustration of intercostal nerve innervation to the nipple.
Figure 3
Figure 3
Photographs from cadaveric dissection, highlighting the course of the fourth intercostal nerve in the inferolateral quadrant.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Schlenz I, Kuzbari R, Gruber H, Holle J. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000;105(3):905–9. - PubMed
    1. Sarhadi NS, Shaw-Dunn J, Soutar DS. Nerve supply of the breast with special reference to the nipple and areola: Sir Astley Cooper revisited. Clin Anat. 1997;10:283–8. - PubMed
    1. Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49(3):156–64. - PubMed
    1. Jaspars JJ, Posma AN, van Immerseel AA, Gittenberger-de Groot AC. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg. 1997;50(4):249–59. - PubMed
    1. Craig RD, Sykes PA. Nipple sensitivity following reduction mammaplasty. Br J Plast Surg. 1970;23(2):165–72. - PubMed

LinkOut - more resources