Reshaping Our Understanding of Sensation and Pain Following Breast Reduction Surgery.

[BACKGROUND] This study evaluated the sensory and breast pain outcomes in inferior versus superomedial pedicle breast reduction.

[METHODS] Twenty patients undergoing the inferior pedicle technique were matched to 20 patients undergoing the superomedial pedicle technique based on age, BMI, and resection weight. Patients were evaluated preoperatively and postoperatively at 1, 3, 6, and 12 months. Monofilament testing was performed on the nipple-areola complex (NAC) and surrounding breast. Patient-reported outcomes included nipple and breast sensation (5-point Likert scale), pain intensity (0-10), and the Patient-reported Outcome Measurement Information System Neuropathic Pain Quality scale.

[RESULTS] At the NAC, mean monofilament values and patient-reported sensation were significantly better in the inferior versus the superomedial pedicle group at 1 and 3 months postoperatively ( < 0.05) and comparable at 6 and 12 months ( > 0.05). At 12 months, 72.5% of patients reported complete (5 of 5) nipple sensation (77.5% inferior versus 67.5% superomedial, > 0.05). At the breast, the mean monofilament values and patient-reported sensation were similar between pedicle groups throughout follow-up. At 12 months, 82.5% of the patients reported complete (5 of 5) breast sensation (85.0% inferior versus 80% superomedial, > 0.05). Rates of postoperative breast pain were similar between groups throughout follow-up ( > 0.05). At 12 months, 25% of patients reported breast pain, with neuropathic qualities in 85% of cases.

[CONCLUSIONS] The inferior pedicle may allow for earlier restoration of quantitative and patient-reported NAC sensation, but long-term sensation is comparable between techniques. A quarter of patients reported persistent breast pain regardless of the pedicle type.