Preserving and Restoring Sensation After Nipple Sparing Mastectomy Through Nerve Preservation and Nipple Areolar Complex Neurotization

Preserving the nipple–areolar complex during mastectomy does not ensure that its sensory function is retained. This narrative review evaluates nerve preservation and nipple–areolar complex neurotization, distinguishing objective sensory recovery from patient-reported benefit and surgical safety. A focused PubMed search was performed, supplemented by targeted searches for anatomical, methodological, and reconstructive publications and review of available full texts. The synthesis included clinical series, comparative studies, a small randomized conference report, anatomical investigations, and relevant consensus publications, without quantitative pooling. Early implant-based reconstruction studies reported encouraging recovery of tactile sensibility, but several lacked concurrent controls. Comparative observational evidence suggests potential psychosocial and sexual well-being benefits, although reconstruction type and treatment selection complicate causal interpretation. A six-patient randomized split-chest report did not demonstrate significant sensory differences, emphasizing the preliminary nature of the evidence. Larger matched database research provides reassurance regarding recorded postoperative complications but does not establish sensory efficacy or oncologic equivalence. Assessment methods vary substantially, encompassing pressure thresholds, two-point discrimination, and patient-reported measures. Nerve preservation and neurotization are promising components of functional breast reconstruction, provided that they do not alter the required oncologic resection. Standardized baseline and longitudinal assessment, adequately powered comparative studies, and transparent counseling are needed before the magnitude, durability, and generalizability of benefit can be established.