Sensory outcomes after targeted nipple-areola complex reinnervation: A systematic review and meta-analysis.
| Publication Type | Review |
| Authors | Gundlach C, Rahman R, Martinez M, McVeigh A, Park-Lee H, Jewell S, Qin N, Otterburn D |
| Journal | J Plast Reconstr Aesthet Surg |
| Volume | 117 |
| Pagination | 235-246 |
| Date Published | 04/23/2026 |
| ISSN | 1878-0539 |
| Abstract | BACKGROUND: Targeted nipple-areola complex (NAC) reinnervation (TNR) aims to restore nipple sensation after gender-affirming (GA) chest surgery and oncologic mastectomy; however, the outcomes have not been systematically synthesized. METHODS: We performed a PRISMA systematic review (PROSPERO CRD420250653209; March 20, 2025) of the PubMed, Embase, Scopus, Web of Science, and ClinicalTrials.gov databases. Two independent reviewers performed screening and data extraction. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis pooled postoperative Semmes-Weinstein (SW) monofilament thresholds as mean differences (TNR minus control) at the longest comparable follow-up. Included studies were observational (prospective and retrospective cohorts and case series). RESULTS: Ten studies were included (4 GA; 6 oncologic/prophylactic), representing 281 unique patients. The meta-analysis included three comparative cohorts. TNR was associated with improved nipple sensation (-1.40 SW units; 95% CI -1.95, -0.86; I² 58.1%). In a GA subgroup (2 studies), the pooled effect was similar (-1.54; 95% CI -2.28, -0.80; I² 74.9%). Single-arm studies reported recovery of protective sensation after TNR. In the largest comparative cohort with multidimensional quantitative sensory testing, NAC cold detection differed by 11.1 °C (95% CI 7.6, 14.6), and NAC 2-point discrimination was present in 40% of TNR patients versus 0% of controls. In a nipple erection substudy, nipple erection was reported in 73% (16/22) of TNR nipples versus 39% (7/18) of controls. CONCLUSIONS: TNR was associated with improved postoperative NAC sensory outcomes, but the available evidence was observational and subject to moderate-to-serious risk of bias. Larger prospective multicenter studies with standardized sensory testing, longer follow-up, and validated patient-reported outcomes are needed. |
| DOI | 10.1016/j.bjps.2026.04.020 |
| PubMed ID | 42127453 |