Breast Augmentation and Sensory Outcomes: A Systematic Review of Surgical Techniques and Their Impact on Nipple-Areola Complex and Breast-Skin Sensibility

Background Breast augmentation is among the most frequently performed aesthetic procedures worldwide, offering high satisfaction levels but carrying potential sensory consequences that may affect function and quality of life. Preservation of nipple-areola complex and breast-skin sensation remains a key concern, given its significance for sexual and psychological functions. This systematic review aims to synthesize evidence regarding sensory outcomes following primary cosmetic breast augmentation. Methods Following the PRISMA 2020 guidelines, a comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Web of Science, was conducted for studies published from 2000 to September 2026. Eligible studies included prospective or retrospective clinical investigations evaluating postoperative nipple-areola complex or breast-skin sensibility following primary breast augmentation, using objective measures (e.g., Semmes-Weinstein monofilaments, biothesiometry) or patient-reported outcomes. Non-English articles, reconstructive procedures, and secondary augmentations were excluded. Data were synthesized qualitatively due to the heterogeneity in study designs and outcome measures. Results Twenty-six studies involving 9190 patients were included. Across studies, most sensory alterations were transient, with recovery typically occurring within six to twelve months. Periareolar incisions showed higher rates of early nipple-areola complex hypoesthesia, while inframammary and submuscular or subfascial placements were associated with fewer and milder changes. Implant volume demonstrated a limited but plausible mechanical effect, with larger devices exerting greater tension on superficial sensory branches. Discordance between objective and subjective assessments was noted, reflecting the nipple's unique innervation pattern dominated by deep smooth-muscle fibers rather than superficial mechanoreceptors. Conclusion Postoperative sensory alterations after breast augmentation are generally mild and reversible. Surgical planning that prioritizes incision placement, pocket selection, and implant dimensions within the anatomical limits of the skin envelope can minimize neural disruption. Future studies should use standardized sensory testing and patient-centered outcome measures to refine evidence-based strategies that preserve both aesthetic and functional integrity.