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Does Nipple Sensation Go Away After Female-to-Male or Female-to-Nonbinary Top Surgery?
Some patients considering female-to-male (FTM) or female-to-nonbinary (FTN) top surgery question whether the sensation of the nipple-areola complexes is or can be preserved. Unsurprisingly, the complete loss of sensation is virtually never a deal breaker with regard to deciding to pursue top surgery.
This blog explores how top surgery affects nipple sensation, the impact of the different techniques on sensation and what patients can expect long-term.
5 Min Read:
Table of Contents
- What Happens to Nipple Sensation After Top Surgery?
- Techniques and Their Impact on Sensation
- Will Sensation Come Back?
- Pursuing Your Top Surgery
What Happens to Nipple Sensation After Top Surgery?
Top surgery involves removing breast tissue, fat and skin (depending on the procedure), reshaping the chest into a flat contoured or androgynous appearance. Depending on the patient’s chest configuration, breast size and other factors, different surgical techniques are used and each method has a different effect on the nerves connected to the nipple-areola complexes.
Spoiler alert: Every procedure will have a substantial impact on sensation.
In procedures in which the nipple-areola complex is completely removed and regrafted to the chest, such as with the double-incision technique, the sensory nerves are cut resulting in complete sensory loss. In contrast, keyhole and periareolar techniques, which preserve some tissue connections, may allow for better nerve continuity and a greater chance of sensation returning over time.
Techniques and Their Impact on Sensation
The following lists the most common FTM and FTN top surgery procedures along with their impact on nipple-areola complex sensation:
- Double Incision with Free Nipple Grafts. This is the most appropriate technique for patients with medium to large chests. It entails the removal of the nipple-areola complexes and placing them back on as grafts. The nerve supply is completely cut so there is no immediate sensation. Long term there can be some tactile sensation so when they are touched, some feeling may be present.
- Double Incision without Nipples. No nipples – no sensation.
- Keyhole. This technique is most ideal for patients with very small chests and good skin elasticity. It involves an incision at the lower half of the areola with the upper half still attached to the surrounding tissue. There may be some sensation retained following surgery. Long-term this can improve significantly.
- Periareolar/Concentric Circle. This approach involves a circumferential removal of skin around the areola with half of the deeper layers remaining attached to the surrounding tissues. There can be some preserved sensation which may improve with time.
- Androgynous Breast Reduction. This approach keeps the nipple-areola complexes attached to deeper tissues, allowing the possibility of retaining a significant amount of sensation and even sensuality. Several factors will determine the degree of this.
- Androgynous Breast Reduction with Free Nipple Grafts. Just like with the double incision with free nipple grafts, this involves the removal of the nipple-areola complexes and placing them back on as grafts. The nerve supply is completely cut so there is no immediate sensation. Long term there can be some tactile sensation so when they are touched, some feeling may be present.
- Androgynous Breast Reduction without Nipples. No nipples – no sensation.
Will Sensation Come Back?
With time, there can be some ingrowth of nerve fibers into the areolas and the areola grafts resulting in the appearance or improvement of sensation. However, there is no guarantee as nerve regeneration is unpredictable. The sensation that may develop is typically very coarse where only pressure or indistinct touch is perceived. Generally, what you have at two years following top surgery is what you can expect long term.
Interestingly, though, I have had a few patients over the years state that they actually re-developed not only very good sensation in their free nipple grafts but also sensuality.
As stated earlier, the maintenance of nipple-areola complex sensation following gender affirming top surgery is virtually never an issue or deal breaker.
Pursuing Your Top Surgery
Gender affirming top surgery is an absolutely transformative procedure — physically, mentally and emotionally. Live your life with far greater confidence, wholeness and happiness.
Start your journey by consulting with Dr. Steven H. Turkeltaub who is board-certified by the American Board of Plastic Surgery and specializes in gender affirming top surgery. He provides his expertise and compassion to patients in the Scottsdale and Phoenix metropolitan area as well as to those throughout Arizona and across the United States.
If you would like to learn more about our state-of-the-art top surgery options, please call the Arizona Center for Breast Surgery at (480) 451-3000 to schedule your consultation. You may also contact us via our online form.