QUANTITATION OF SENSIBILITY IN GIGANTOMASTIA AND ALTERATION FOLLOWING REDUCTION MAMMAPLASTY

A vibrometer and Semmes-Weinstein monofilaments were used to delineate the sensory threshold for quickly and slowly adapting fibers in 13 women with gigantomastia (bra size D or greater) as compared with small-breasted women (bra size A or B). It was found that the mean thresholds for gigantomastia patients were significantly higher (i.e., they were less sensitive) for vibration (p < 0.001) and pressure (p < 0.02). After amputation and free nipple grafting (six patients) or a McKissock-type breast reduction (four patients), six patients had improved sensation, two patients were less sensitive, one patient was unchanged, and one patient was lost to follow-up. These results suggest (1) that preoperatively, there is a chronic traction injury to the fourth, fifth, and sixth intercostal nerves in women with gigantomastia (this is corrected after breast reduction, and sensation improves), (2) that breast reduction surgery itself divides some intercostal nerve fibers, the number dependent on the extent and type of skin and glandular resection (this decreases sensation), and (3) that postoperatively, reinnervation from intercostal and supraclavicular nerves occurs (this improves sensation with time). The postoperative sensory outcome of the breast depends on a combination of these factors; the majority of our patients with gigantomastia have improved sensation after breast reduction.