Nipple Areolar Complex Sensory Recovery as a Patient-Centered Outcome After Nipple-Sparing Mastectomy

Nipple-sparing mastectomy (NSM) has become increasingly prevalent in breast cancer surgery, offering superior aesthetic outcomes and psychosocial benefits compared to skin-sparing approaches. However, transection of the lateral intercostal sensory nerves during mastectomy results in predictable and often permanent loss of nipple-areolar complex (NAC) sensation, a patient-centered deficit that is systematically underreported and rarely incorporated into standard reconstructive outcome measures. As survivorship improves and patient expectations evolve, sensory recovery has emerged as a meaningful dimension of reconstructive success that existing metrics, including traditional complication-based endpoints and current patient-reported outcome instruments, fail to adequately capture. Nipple neurotization, the surgical reconnection of intercostal sensory nerves to the underside of the NAC at the time of reconstruction, has shown promise in restoring tactile sensation and improving patient satisfaction across both implant-based and autologous reconstructive modalities following NSM, though heterogeneity in technique, follow-up, and outcome measurement limits definitive conclusions. Emerging sutureless nerve coaptation technologies may further reduce the technical barriers that have historically restricted neurotization to microsurgically trained centers. This narrative review synthesizes the current evidence on sensory outcomes after NSM, evaluates neurotization techniques and their patient-reported results across reconstructive modalities, examines novel coaptation technologies in early clinical use, and proposes a framework for integrating sensory recovery as a standard patient-centered outcome following nipple-sparing mastectomy. Gaps in evidence and priorities for future investigation are identified.