Comparing Nipple and Areola Sensory Outcomes and Nerve-Related Complications Using Different Incision Types in Breast Augmentation: A Scoping Review.

[BACKGROUND] Changes in nipple-areola complex sensation are a major concern after breast augmentation. Multiple incision options exist such as inframammary, periareolar, transareolar, transaxillary, and transumbilical, but their sensory impact remains unclear. This scoping review synthesizes evidence on incision type, nipple-areola outcomes, and nerve-related complications.

[METHODS] Following PRISMA-ScR, PubMed, Embase, Scopus, Cochrane, and Google Scholar were searched to July 2025. Eligible studies reported sensory outcomes by incision type. Both subjective and objective measures were included.

[RESULTS] Thirty-seven studies were included, encompassing over 13,000 patients across primary clinical cohorts, with several large meta-analyses contributing additional pooled data. Most studies evaluated inframammary and periareolar incisions. Persistent nipple sensory change was generally low (<5%) but varied with incision and methodology. Large cohorts showed periareolar incisions had ~3× higher risk of hypoesthesia and pain than inframammary. Prospective studies often found no difference, though inframammary incisions could impair lower-pole sensation. Lateralized inframammary incisions preserved nipple-areola complex sensitivity, unlike central cuts. Transareolar incisions caused mild objective hyposensitivity but high subjective satisfaction. Transaxillary data were limited but anatomically suggest higher risk. Transumbilical consistently showed no nipple-areola complex changes. Heterogeneity in outcome definitions, testing tools, and follow-up limited comparisons.

[CONCLUSIONS] Incision type influences nipple sensation but is modified by technique and implant plane. Periareolar incisions show higher risk in large cohorts, while lateralized inframammary access may be protective. Transumbilical avoids breast sensory risk but is device limited. Evidence for transaxillary and perinipple approaches is sparse. Standardized, objective testing is needed to guide counseling and surgical planning.

[LEVEL OF EVIDENCE V] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.