About 70% of patients lose breast sensation after mastectomy, and most will not get it back on their own.
Dr. Andrea Moreira is chief of plastic surgery at UPMC Magee-Womens Hospital, director of the UPMC Breast Reconstruction Service Line, and associate professor of plastic surgery at the University of Pittsburgh School of Medicine. She spoke in the panel ‘Are you feeling nerve-us?’ at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS). The meeting was held October 15 to 18, 2026, in Houston, Texas. She reviewed how surgeons can restore breast and nipple sensation and where the evidence falls short.
Dr. Moreira calls sensation the missing outcome of breast reconstruction. A reconstructed breast can look right and still feel numb, and some patients develop chronic pain. For flap reconstruction, there is already a way forward: connecting a nerve in the flap to a nerve in the chest improves sensory recovery. For implant-based reconstruction, the path is harder and the evidence is early.
Restoring Nipple Sensation With Implants Starts With Finding Enough Nerve
With implants, the challenge centers on the nipple-areolar complex (NAC). After mastectomy, the NAC may have no nerve left to connect to. The nearest usable nerves sit on the chest wall, near the lateral edge of the pectoralis muscle, and the space between them and the nipple may need a nerve graft or transfer to bridge.
Her answer begins during the mastectomy. She preserves every nerve that can be saved, then looks for enough length to reach the nipple without tension. Without a usable nerve, an intercostal nerve segment can be moved into place.
‘One thing I want to mention is that length of the nerve matters,’ she said. That is also why she suggests starting with smaller breasts. ‘Choose patients who are small breasted because it's a little bit easier.’ In a smaller breast, the nipple sits closer to the chest-wall nerves, so the gap is shorter.
She distilled the approach into 4 steps: save the nerves at mastectomy, reconnect the NAC, size the graft to the implant, and measure sensation before and after surgery.
Sensory Recovery Continues Long After Breast Reconstruction Surgery
Reconnecting a nerve is only part of recovery, so she proposed a year-long rehabilitation protocol. It starts before surgery with education and baseline testing, moves from imagined and gentle touch in the first weeks to active re-education from week 4, and continues as a home program through the first year.
She closed with what remains unknown. Only one randomized trial has studied implant neurotization, with 6 months of follow-up, and most other reports are short case series. Sensory testing is not standardized, so studies cannot be pooled. Surgeons do not yet know which patients benefit most, how radiation changes the picture, or whether the added cost is justified. Even the rehabilitation protocol she proposed remains unproven in the breast.
Abbreviation: NAC, nipple-areolar complex.