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Uncovering Predictors of Nipple-Areolar Complex Sensation After Breast Reduction: A Prospective Cohort Study
Makayla Kochheiser
*, Nancy Qin, Clara Choate, Anna M. Vaeth, Lucy Wei, Elias Khayat, David Otterburn
Weill Cornell Medical College, New York, NY
Background: Preservation and recovery of nipple-areolar complex (NAC) sensation is an important consideration in breast reduction surgery. Prior research has shown that the NAC is the slowest region of the breast to recover sensation postoperatively. However, it remains unclear whether specific surgical or patient-related factors influence postoperative NAC sensory outcomes. This study aimed to identify predictors of NAC sensation over time following breast reduction.
Methods: Patients undergoing breast reduction with superomedial or superior pedicle and Wise pattern incisions were prospectively followed. Neurosensory testing of the NAC was performed using a pressure-specified sensory device at baseline, 1 month, 3-6 months, and 9+ months postoperatively. Clinical variables, including age, body mass index (BMI), smoking status, diabetes, pedicle type, and resection weight (grams), were collected. Univariate analysis was conducted using Spearman correlation and t-tests. Variables with p-values less than 0.10 were included in multivariable linear regression models to identify predictors of NAC sensation at each timepoint.
Results: Sensory testing was completed on 40 breasts. Mean patient age was 39.4 years (±13.7), and mean BMI was 28.9 (±4.4). In univariate analysis, higher BMI and greater resection weight were associated with significantly worse NAC sensation at 1 month (p<0.05). At 3-6 months, older age and pedicle type were associated with worse sensation (p<0.05). No variables were associated with sensation at 9+ months. In multivariable regression, resection weight was the only independent predictor of worse sensation at 1 month (β=0.0656, p=0.003). No predictors were significant at later timepoints.
Conclusions: Greater resection weight is independently associated with worse early NAC sensation following breast reduction. However, no factors predicted long-term sensation, suggesting that sensory recovery progresses over time regardless of initial risk factors. These findings may help guide patient counseling by setting expectations for early sensory changes.
Figure 1. Association between resection weight (grams) and nipple-areolar complex (NAC) sensation at 1 month postoperatively. Each point represents an individual breast, where higher scores reflect worse sensation. The blue line indicates the fitted linear regression line, with shaded 95% confidence intervals.
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