Breast sensation after superior pedicle versus inferior pedicle mammaplasty: anatomical and histological evaluation

Despite contradictory information about the course and distribution of the nerves supplying the breast, surgical techniques using an inferior pedicle have been recommended over those using a superior pedicle for preserving th e nipple-areolar sensation after surgery. This anatomical study was designe d to quantify the nerve branches preserved in inferior and superior pedicle s after reduction mammaplasty performed on cadavers. Reduction mammaplasty was done on four fresh cadavers (within 48 h of death) using a superior ped icle on the right and an inferior pedicle on the left in a standard way. Th e pedicle was cut at its base and then fixed in formalin. The base was divi ded in biopsy specimens and embedded in paraffin. The nerves were quantifie d and located in each pedicle with haematoxylin-eosin stain and light-micro scopic evaluation. Histological evaluation of the pedicles showed the prese nce of a variable number of nerves (between one and seven) within two super ior pedicles and three inferior pedicles. The nerves were located in fibrou s tissue and accompanied by vessels in most cases. The nerves were always f ound superficially and were most likely to be located in the central part o f the pedicle. Our results showed that including the nerves within the pedi cle is technically uncertain regardless of the mammaplasty technique used. The final recovery of sensation in the breast after mammaplasty seems to re sult from the regeneration of severed cutaneous nerve branches or the remai ning cutaneous innervation rather than the preserved adjacent cutaneous bra nches. (C) 2001 The British Association of Plastic Surgeons.