Breast reconstruction surgeons describe two kinds of breast sensation – “touch” and “deep touch.” “Touch” refers to the sensation on the surface of your skin. “Deep touch” is the pressure you feel against your chest wall when you're hugged. Skin-sparing procedures may help preserve some of the touch sensation, whether you choose an implant or a flap procedure. Flaps do offer the possibility of nerve regeneration within the flaps, however. And since fat is softer and may transmit pressure easier, some reconstructive surgeons think reconstruction using your own fat might increase the sensation of deep touch. But you should experience deep touch with implants, as well.
No matter what reconstruction procedure you choose, you'll probably experience significant numbness of your breasts. The good news is that your numbness will likely lessen over time, even years after surgery. For some women, though, the numbness never improves to any significant degree. Nerve regeneration in your breasts occurs at the outside edges first, moving inward toward the nipple area. Your nipples themselves will never regain the erotic sensation they had before, though, even with a nipple-sparing mastectomy.
If you choose flap reconstruction, there will be numbness at your donor site as well. The pattern of nerve regeneration is similar to your breasts. Again, feeling returns farther out from the site first, gradually returning to the area closest to the incision last.
Some surgeons are attempting to reattach severed nerves during reconstruction. At present, the results are not yet proven, though various claims are made. The network of nerves in the breast looks like a river with many branches heading in a myriad of directions. Which nerve ultimately connects to which area of the breast is extremely complicated and almost impossible to ascertain. Since many women experience spontaneous nerve regeneration as part of their body's own healing process, it's difficult to determine if the return of sensation was due to the surgeon's intervention or would have happened on its own.
As your body heals following reconstruction, you may begin noticing strange zings, itches, and prickly feelings in your breasts and donor sites. These are good signs. They show that the nerves in those areas are functioning and are likely regenerating. Celebrate!
P.S. My own spin on breast sensation: Most of the time I'm doing anything, I'm wearing a bra. Most of the time when I'm hugging people, I'm wearing a bra. Bras mute skin sensation. And since I never noticed a lessening in “deep touch” sensation, hugs after two breast reconstructions feel the same as before.
Lessened breast skin sensation is only an issue for me when I'm sans bra. Well, I guess that's the same for everyone... Hugging, without a bra, still feels great. I don't feel a loss. It involves so much more of me than the skin feeling on the very front of my breasts. It involves “deep touch” and let me add “emotional touch.”
I discovered a strange phenomenon, though, while working on this blog post. I'm not sure what to make of it. I could have sworn almost all my skin sensation had returned. I decided to perform an experiment, to be sure. I closed my eyes and lightly ran a bobby pin over my breasts. I found there was more numbness than I experience in my day-to-day (and night-to-night) life. I've apparently overestimated the actual return of sensation to my own breasts! How is this possible? I have a theory.
I believe our memory can fill in lost details regarding sensation – or lack of it. I'd noticed this about my nipples—my recollection of the feeling is so close, so vivid, that it's almost there in my skin. I call on it when I need to... We've all experienced this with visual or auditory memory, but I think it's also true of “touch memory.” Add the touch memory to the visual reality of your partner enjoying your new breasts, and you may also perceive...imagined? phantom? self-hypnotic?...return of sensation. I'm not going to do a Google search on this one. I've experienced it myself.