QUANTITATION OF SENSIBILITY IN GIGANTOMASTIA AND ALTERATION FOLLOWINGREDUCTION MAMMAPLASTY

A vibrometer and Semmes-Weinstein monofilaments were used to delineate the sensory threshold for quickly and slowly adapting fibers in 13 wo men with gigantomastia (bra size D or greater) as compared with small- breasted women (bra size A or B). It was found that the mean threshold s for gigantomastia patients were significantly higher (i.e., they wer e less sensitive) for vibration (p < 0.001) and pressure (p < 0.02). A fter amputation and free nipple grafting (six patients) or a McKissock -type breast reduction (four patients), six patients had improved sens ation, two patients were less sensitive, one patient was unchanged, an d one patient was lost to follow-up. These results suggest (1) that pr eoperatively, there is a chronic traction injury to the fourth, fifth, and sixth intercostal nerves in women with gigantomastia (this is cor rected after breast reduction, and sensation improves), (2) that breas t reduction surgery itself divides some intercostal nerve fibers, the number dependent on the extent and type of skin and glandular resectio n (this decreases sensation), and (3) that postoperatively, reinnervat ion from intercostal and supraclavicular nerves occurs (this improves sensation with time). The postoperative sensory outcome of the breast depends on a combination of these factors; the majority of our patient s with gigantomastia have improved sensation after breast reduction.