The preservation of sensation in the nipple-areola complex is a primary concern for individuals undergoing both reconstructive and cosmetic breast surgeries. Historically, methods to assess breast sensitivity before and after surgical procedures have been limited, often relying on the Semmes-Weinstein monofilament test. This method, while used, is considered somewhat imprecise as it measures the logarithmic force needed to bend filaments of varying thicknesses. Over the past decade, research into normative pressure threshold data for breasts has shown significant variation, differing by more than tenfold across studies. Recent anatomical investigations have provided a clearer understanding of the nipple-areola complex innervation, detailing medial and lateral nerve pathways originating from cutaneous branches of the intercostal nerves. Despite this advanced anatomical knowledge, there has been a gap in quantitative research comparing post-operative sensation in reduction mammaplasty when medial versus laterally innervated pedicles are utilized. This study pioneers the use of computer-assisted neurosensory testing to establish baseline data for normal breast sensation and, importantly, to compare sensory outcomes between the inferior and medial pedicle techniques employed in reduction mammaplasty.
This research encompassed 34 patients, totaling 67 breasts, divided into four distinct groups. Participants underwent breast sensory testing using the Pressure-Specified Sensory Device, a sophisticated computer-assisted force transducer. This device is capable of measuring both static and moving one and two-point discrimination, providing a more precise evaluation of sensation. Measurements were taken at the nipple and across the four quadrants of the areola in each breast. Groups I and II consisted of 17 control subjects who had not undergone breast surgery. Group I included 18 breasts with sizes ranging from 34A to 36C, representing a smaller breast size comparison group. Group II comprised 16 breasts with sizes from 36DD to 46EE, representing a larger breast size comparison group. These groups were recruited from a general plastic surgery clinic. Groups III and IV included 17 patients who had undergone either medial or inferior pedicle reduction mammaplasty between July 1997 and March 1999.
The study revealed significantly lower pressure thresholds in the most sensitive breasts, registering as low as 0.3 g/mm², which starkly contrasts with previous Semmes-Weinstein monofilament studies that reported the lowest recordable pressure threshold to be above 2 g/mm². This highlights the enhanced sensitivity detection capabilities of the computer-assisted neurosensory testing method. Confirming findings from prior studies using Semmes-Weinstein monofilament testing in the unoperated control groups, this study also observed an inverse correlation between sensitivity and breast size. Specifically, the larger breast size comparison group (Group II) exhibited lower sensitivity compared to the smaller breast size comparison group (Group I). Furthermore, consistent with earlier research, nipple sensitivity was found to be superior to areolar sensitivity. The study also noted significant interpatient variability in both static and moving two-point discrimination, even among women of similar age and breast size within each breast size comparison group.
In a direct comparison between patients who underwent medial pedicle reduction mammaplasty and those who underwent inferior pedicle reduction mammaplasty, the study yielded an interesting result. Despite the medial pedicle technique resulting in significantly greater tissue reduction (average 1.7 kg removed compared to 1.1 kg in the inferior pedicle technique), no statistically significant differences were observed in postoperative sensory outcomes within the sample of 17 patients. Moreover, within each surgical group (medial or inferior pedicle), the amount of breast tissue removed did not show a correlation with postoperative sensory outcomes. This suggests that, in this sample size, the surgical technique itself, whether medial or inferior pedicle, may have a more dominant influence on sensory preservation than the extent of tissue reduction.
In conclusion, this study underscores the computer-assisted quantitative neurosensory testing as a highly precise and accurate method for measuring breast sensibility. The application of this advanced technology has revealed a tenfold difference in measurable sensory thresholds in individuals with normal breasts when compared to data obtained using Semmes-Weinstein monofilaments. These advancements in measurement techniques have enabled a more reliable comparison of postoperative sensory outcomes following two commonly practiced reduction mammaplasty techniques. Furthermore, the study provides valuable normative data on breast sensation across different breast sizes, confirming the inverse relationship between breast size and sensitivity and highlighting the superior sensitivity of the nipple compared to the areola. While comparing breast size and sensitivity, this research also demonstrates that, within the context of reduction mammaplasty, the choice between medial and inferior pedicle techniques did not significantly impact sensory outcomes in the studied cohort, despite differences in tissue reduction amounts.
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