Nipple Areolar Complex (NAC) Neurotization After Nipple‐Sparing Mastectomy (NSM) in Implant‐Based Breast Reconstruction: A Systematic Review of the Literature

Background Nipple‐sparing mastectomy (NSM) with implant‐based breast reconstruction (IBBR) preserves the nipple‐areolar complex (NAC) with superior aesthetic results but results in loss of nipple sensation. Nipple neurotization has emerged as a technique to restore the sensory function, yet outcomes remain variable across studies. This systematic review synthesizes the available evidence on nipple neurotization in IBBR, focusing on sensory recovery, patient satisfaction, and surgical techniques. Methods A systematic review was conducted following PRISMA guidelines. PubMed, Ovid EMBASE, and Cochrane Library were searched through April 1, 2025, for studies evaluating nipple neurotization in IBBR. Eligible studies included randomized controlled trials, cohort studies, and case series reporting surgical technique, sensory, and/or patient satisfaction outcomes. Data extraction included study characteristics, surgical techniques, sensory outcomes, and patient‐reported satisfaction. Risk of bias was assessed using standardized tools. Results Six studies met inclusion criteria, comprising 212 patients and 257 neurotized breasts. Sensory recovery was assessed using monofilament testing and patient‐reported outcomes. Studies demonstrated overall improvement of NAC sensory outcomes and high patient satisfaction after neurotization. However, variability in neurotization methods, follow‐up duration, and specific measured sensory outcomes limited direct comparisons. Conclusion Nipple neurotization in IBBR shows promise in enhancing sensory recovery and patient satisfaction after NSM, but heterogeneity in surgical techniques and outcome measures, as well as poor study designs, limits definitive conclusions. Standardized protocols and randomized studies with long‐term patient follow‐up are needed to establish best practices and optimize neurotization outcomes.