During my transition and increased use of the inframammary incision in breast augmentation, along with an increased incision length required for proper placement of the Style 410 implant, I have noticed with increasing frequency sensory nerves located in the lower pole of the breast.
These nerves are often located near the center of the incision and need to be sacrificed in order to insert the implant. They most consistently penetrate through the pectoralis muscle fascia and then course toward the nipple and dive into the breast parenchyma in the lower pole of the breast (Fig. 1). Occasionally, if they are more medially or laterally located in relation to the incision, they may be spared, although they may possibly be stretched or traumatized during implant insertion. I had not found any prior specific references to these nerves, although they were recently mentioned in Vanderbilt's reported work1 and prior work by Sarhadi et al.2 Not seeing any prior specific references or titles, I typically name them after the resident who happens to be working with me at the time in the operating room.
I may be at risk of being guilty of Steve Kroll's warning of “experience–series–time after time.” (For those who have not heard this, Steve warned me one day to be careful of some presentations, even at national meetings. A presenter when reporting his “experience” may mean one case. When he says, “My series,” it may be two cases, and three cases may be what he finds “time after time after time”!)
However, in the last 10 patients in whom I have identified these nerve branches, and have been able to preserve them, these patients have either maintained sensation postoperatively or quickly regained sensation over the lower pole of the breast within 3 weeks. Patients in whom the nerve was identified and had to be sacrificed took up to 6 months to regain sensation, although half regained sensation within 3 months. No patients had any accompanying nipple/areola numbness, with the numbness limited to the lower pole of the breast only. Interestingly, in one of our nurses who underwent a Style 410 breast augmentation, it was possible to spare the nerve on the right side but not the one on the left. It was about 2 mm in diameter. She maintained sensation on the preserved side but took 5 months to regain lower pole sensation on the left, where the nerve had to be divided for implant insertion.
I am in the process of studying this more closely, but I was wondering whether this specific nerve or recovery phenomenon has been previously published and I missed it, whether any other surgeons have identified this nerve in the course of their inframammary dissections, whether anyone has ever seen a neuroma in situ or any complications resulting from the sparing of this nerve or knows of any reason why it should not be salvaged if possible, and finally whether any surgeons have identified any patients with long-term numbness similar to that seen in the infraumbilical area following abdominoplasty.
The author is an Allergan consultant, is involved in both Mentor and Allergan Silicone implant silicone core and adjunct trials, and is an investigator in the core and continued access Style 410 cohesive silicone implant trials.
Bradley P. Bengtson, M.D.
220 Lyon, NW, Suite 700
Grand Rapids, Mich. 49503
1. Okwueze MI, Spear ME, Zwyghuizen AM, et al. Effect of augmentation mammaplasty on breast sensation. Plast Reconstr Surg.
2. 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.
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