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Plastic Surgery of the Breast: Keeping the Nipple Sensitive.

Riccio CA, Zeiderman MR, Chowdhry S, Brooks RM, Kelishadi SS, Tutela JP, Choo J, Yonick DV, Wilhelmi BJ - Eplasty (2015)

Bottom Line: In half of the specimens, accessory innervation from the third and fifth intercostal nerves provided medial branches to the nipple.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky.

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.

No MeSH data available.


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.
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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.

Mentions: Anatomical results identified 3 to 5 branches of the fourth intercostal nerve to primarily innervate 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 (Table 1 and Fig 1). On the left side, the nerve travels toward the nipple at the 4 o'clock position while it enters at the 8 o'clock position on the right side. The nerve pierces the chest fascia above the fifth rib 3 cm lateral to the border of the pectoralis major muscle and travels through the gland in an inferolateral position toward the nipple (Figs 2 and 3). Breast size did not alter the course of the intercostal nerves to the nipple-areola complex (NAC).


Plastic Surgery of the Breast: Keeping the Nipple Sensitive.

Riccio CA, Zeiderman MR, Chowdhry S, Brooks RM, Kelishadi SS, Tutela JP, Choo J, Yonick DV, Wilhelmi BJ - Eplasty (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492192&req=5

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.
Mentions: Anatomical results identified 3 to 5 branches of the fourth intercostal nerve to primarily innervate 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 (Table 1 and Fig 1). On the left side, the nerve travels toward the nipple at the 4 o'clock position while it enters at the 8 o'clock position on the right side. The nerve pierces the chest fascia above the fifth rib 3 cm lateral to the border of the pectoralis major muscle and travels through the gland in an inferolateral position toward the nipple (Figs 2 and 3). Breast size did not alter the course of the intercostal nerves to the nipple-areola complex (NAC).

Bottom Line: In half of the specimens, accessory innervation from the third and fifth intercostal nerves provided medial branches to the nipple.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, Ky.

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.

No MeSH data available.