What is breast neurotization?

Microsurgical sensory nerve coaptation during breast reconstruction — **Sensory microsurgery:** delicate nerve coaptation during reconstruction. Illustrative image.

Intercostal sensory nerve and nerve graft to the nipple areola complex — **Breast neurotization:** an intercostal sensory branch is connected to a target beneath the areola, directly or through a nerve graft.

Mastectomy can interrupt sensory branches to the breast skin and nipple. Even when skin and nipple are anatomically preserved, sensation may be markedly reduced or absent. Neurotization attempts to preserve or reconstruct a neural pathway as part of the oncologic and reconstructive operation.

The primary goal is protective and touch sensation; this is distinct from treatment of neuropathic pain after breast surgery.

How sensation is reconstructed

Suitable lateral intercostal sensory branches are identified when oncologically safe.
Useful nerve length is preserved without compromising resection.
A sensory target is identified beneath the areola or in the reconstructive tissue.
Direct coaptation is used when possible; a nerve autograft or processed allograft may bridge a gap.
Microsurgical nerve work is completed before implant-based or autologous reconstruction is finalized.

Oncologic safety always takes priority, and a suitable donor and target are not present in every operation.

Who and when

Most evidence concerns neurotization performed with nipple-sparing mastectomy and immediate reconstruction. It has also been described in autologous reconstruction and delayed settings, but evidence for late sensory reconstruction is more limited.

Suitability depends on the oncologic plan, reconstructive method, radiotherapy, previous operations, tissue quality and individual anatomy.

Recovery and follow-up

Nerve growth is slow. Sensation may evolve over many months and continue beyond a year. Protective, touch and erogenous sensation do not necessarily recover equally, and pre-mastectomy sensation cannot be promised.

Follow-up may use sensory maps, Semmes–Weinstein monofilaments, pressure thresholds, moving and static touch, temperature testing and patient-reported sensation.

What research shows

A 2023 prospective study evaluated 47 women and 79 breasts after nipple-sparing mastectomy, implant reconstruction and neurotization. At six months, more than 80% achieved average sensory scores categorized by the investigators as good to excellent.

There was no control group, mean follow-up was 9.2 months and the selected cohort did not receive radiotherapy. The results are encouraging but cannot establish an individual result; controlled studies and longer follow-up are still needed.

Risks and limitations

Specific risks include absent, partial or unpleasant sensory recovery, neuroma, neuropathic pain, injury to a preservable nerve and donor-site complications if an autograft is used. Graft type and length are individualized.

Nipple areola complex neurotization during reconstruction — **Nipple–areola neurotization:** identification and coaptation of a sensory target during breast reconstruction.

References

Peled AW, Peled ZM. Nerve Preservation and Allografting for Sensory Innervation Following Immediate Implant Breast Reconstruction. PRS Global Open. 2019;7(7):e2332. doi:10.1097/GOX.0000000000002332
Peled AW, von Eyben R, Peled ZM. Sensory Outcomes after Neurotization in Nipple-sparing Mastectomy and Implant-based Breast Reconstruction. PRS Global Open. 2023;11(12):e5437. doi:10.1097/GOX.0000000000005437
Chang TN, Lu JCY, Sung CW, et al. Elongation of intercostal nerve cutaneous branches for breast and nipple neurotization. British Journal of Surgery. 2024;111:znae005. doi:10.1093/bjs/znae005
Fung E, Yu BZ, Montalmant KE, et al. The current landscape of sensory neurotization in implant breast reconstruction. Annals of Breast Surgery. 2025;9:17. doi:10.21037/abs-25-7

Breast and Nipple Sensation Restoration