Prior studies have looked at breast sensation after breast augmentation and demonstrated that 1. most people end up with sensation close or the same as what they started with and 2. breast implant size affects sensation the most (ie bigger implants cause more sensory change likely due to stretching the skin more).
They looked at the inframammry scar, which we use to lower biofilm (and therefore breast implant illness and capsular contracture risk) as the inframammary incision is the best.
Many surgeons tend to place that incision in the midline of the breast. But these authors suggested that moving it slightly laterally is better. This is a study in the Aesthetic Surgery Journal December 2023, “Sensory Evaluation of the Nipple Areolar Complex Following Primary Breast Augmentation: A Comparison of Incision Approaches.” This looked at 100 women, half of whom had the incision directly in the midline of the inframammary fold and the other half laterally .
They postulate that the central incision disrupts the fifth anterior intercostal nerve artery vein plexus, so that sensation would be better if the incision was moved laterally. Sensitivity testing with Semmees-Weinstein monofilaments at 2 days, 2 weeks, one month, and 6 months.
Findings?
Both groups were similar in age, BMI, comorbidities, and implant volumes. Postoperatively they found that the laterally displaced incision group sensory function remained normal in nipple areola complex areas where in the conventional group all cases had sensory diminution at days 2, 14 and 30.
My thoughts?
My patients have the central incision (? maybe a little laterally) and sensation returns to normal. If this study shows that moving that incision slightly laterally more can ensure normal sensation even more, I think that is great. My goal with the incision is to keep it hidden under the fall of the breast.
Interesting.