Mapping the Return of Sensation Following Targeted Nipple Reinnervation (TNR) in Gender-Affirming Mastectomy

BACKGROUND: Although the restoration of baseline sensation following gender-affirming mastectomy (GAM) with free nipple grafting (FNG) and targeted nipple reinnervation (TNR) has been demonstrated, the spatial and temporal pattern of multimodal sensory recovery following TNR has not been described. METHODS: 28 subjects who underwent double-incision GAM with FNG + TNR were prospectively enrolled. Quantitative sensory testing was performed at defined points within the NAC and across the chest, and patient-reported outcome measure surveys were collected preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. Statistical analysis was performed using GraphPad Prism 10 to evaluate for regional differences in sensation at each time point. RESULTS: At 12 months, all regions returned to preoperative sensory values across all modalities, except the inferior chest, which exhibited diminished thermal sensitivity. Sensory recovery followed a consistent spatial and temporal sequence: the superior and lateral chest quadrants were the first to recover sensation (1 month), followed by the NAC (3 months) and medial chest (6-9 months), and lastly the inferior chest (ultimately incomplete). Light touch, pinprick, and pressure-pain returned earliest (1 month), while light touch and 2PD recovered second (3-9 months), and thermal sensation returned last (6-12 months). At 12 months, 82% of patients reported "complete," or "a lot," of NAC sensation, and 85.7% reported some degree of NAC erogenous sensation. No phantom or chronic pain occurred, and hypersensitivity was rare (7.1%). CONCLUSION: TNR performed with GAM and FNG reliably restores multimodal chest and NAC sensation in defined spatial and temporal patterns. Additionally, hypersensitivity rates are low.