Abstract
Objective: To establish normative data for nipple-areola complex (NAC) sensibility examined with Semmes-Weinstein monofilament test (SWMT) and two-point discrimination (TPD) in women with varying breast sizes, including women with gigantomastia. We also aimed to identify clinical variables influencing NAC sensation. Methods: A total of 320 breasts in 160 Caucasian women (mean age 33.6 years, SD 11 years) were examined (including 50 hypertrophic breasts). NACs sensation was examined using Semmes-Weinstein monofilaments (SWM) and the Weber Two-Point Discrimination Test. Results: The nipple appeared to be the most sensitive part of NAC. In normal-sized breasts, sensation thresholds (SWM) correlated with: age, BMI, history of births, breast size and ptosis (for all locations), breastfeeding history (for nipple and upper areola) and areola diameter (for all locations apart from the nipple). Regression analysis showed that age, cup size and suprasternal notch-to-nipple distance are risk factors for diminished NAC sensation. Sensation thresholds in all NAC locations of hypertrophic breasts were significantly higher compared to normal-sized breasts, while TPD tests did not differ between the groups. Conclusions: We provided normative values of NAC sensation (tactile threshold and TPD) for different NAC areas. Our investigation indicated that SWM are useful diagnostic tools when the following factors are considered while examining NAC sensation: location (nipple vs. areola), age, breast size, suprasternal notch-to-nipple distance, history of births and breastfeeding. Hypertrophic breasts presented significantly higher sensation thresholds for all NAC locations. The report may serve as a reference data for further investigations regarding NAC sensation after different breast surgeries.
Highlights
Preservation of the sensitivity of the nipple-areola complex (NAC) remains one of the essential goals in breast surgery
Two-point discrimination did not differ across NAC locations in both groups, so in further analysis concerning two-point discrimination (TPD) we included the mean values from all locations
Our study showed that the nipple presents the lowest sensation threshold of all NAC locations and sensation of the areola depends on its diameter, which may be related to stretching of areolar nerves
Summary
Preservation of the sensitivity of the nipple-areola complex (NAC) remains one of the essential goals in breast surgery. Still, providing standard values of nipple and areola sensibility, which would allow for assessment and comparison of sensitivity level preand post-operatively, continues to pose a challenge to both researchers and clinicians The methodology of such studies includes using Semmes-Weinstein nylon monofilaments (most commonly used) and Pressure-Specified Sensory Devices. Many researchers have reported analyses of NAC sensation after certain surgical procedures, i.e., different techniques of reduction mammaplasties (inferior or medial pedicle techniques or free nipple grafts), gender-affirming mastectomies and NAC-preserving mastectomies [1,2,3,4,5] These studies were often based on pre- and post-procedure analyses or included rather small control groups and did not involve important variables which may influence NAC sensation. To make this assessment as reliable as possible, it seems clinically beneficial to provide ample reference data and to identify factors that influence measurements’ results
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