From the Departments of Plastic, Reconstructive, and Hand Surgery and Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center; and GROW-School for Oncology and Developmental Biology and Department of Anatomy and Embryology, Maastricht University.
Plast Reconstr Surg. 2022 Aug 1;150(2):243-255. doi: 10.1097/PRS.0000000000009306. Epub 2022 Jun 3.
Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex.
The authors performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis. The authors searched four electronic databases for studies investigating which nerve branches supply the female breast and nipple/nipple-areola complex or describing the trajectory and other anatomical features of these nerves. Inclusion criteria for meta-analysis were at least five studies of known sample size and with numerical observed values. Pooled prevalence estimates of nerve branches supplying the nipple/nipple-areola complex were calculated using random-effects meta-analyses; the remaining results were structured using qualitative synthesis. Risk of bias within individual studies was assessed with the Anatomical Quality Assurance checklist.
Of 3653 studies identified, 19 were eligible for qualitative synthesis and seven for meta-analysis. The breast skin is innervated by anterior cutaneous branches and lateral cutaneous branches of the second through sixth and the nipple/nipple-areola complex primarily by anterior cutaneous branches and lateral cutaneous branches of the third through fifth intercostal nerves. The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve supply the largest surface area of the breast skin and nipple/nipple-areola complex. The lateral cutaneous branch of the fourth intercostal nerve is the most consistent contributory nerve to the nipple/nipple-areola complex (pooled prevalence, 89.0 percent; 95 percent CI, 0.80 to 0.94).
The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve are the most important nerves to spare or repair during reconstructive and cosmetic breast surgery. Future studies are required to elicit the course of dominant nerves through the breast tissue.
本文回顾了主要的尸体研究，旨在提供有关女性乳房和乳头/乳晕复合体神经支配的现代概述。
作者进行了一项符合系统评价和荟萃分析首选报告项目的系统评价和荟萃分析。作者在四个电子数据库中搜索了研究女性乳房和乳头/乳晕复合体的神经分支供应或描述这些神经的轨迹和其他解剖特征的研究。荟萃分析的纳入标准是至少有五项具有已知样本量和数值观测值的研究。使用随机效应荟萃分析计算供应乳头/乳晕复合体的神经分支的汇总患病率估计值；其余结果采用定性综合法进行结构描述。使用解剖质量保证检查表评估单个研究的偏倚风险。
在确定的 3653 项研究中，有 19 项适合定性综合分析，7 项适合荟萃分析。乳房皮肤由第二至第六肋间的前皮支和外侧皮支支配，乳头/乳晕复合体主要由第三至第五肋间的前皮支和外侧皮支支配。第四肋间神经的前皮支和外侧皮支供应乳房皮肤和乳头/乳晕复合体的最大表面积。第四肋间神经的外侧皮支是供应乳头/乳晕复合体最一致的神经（汇总患病率为 89.0%；95%置信区间为 0.80 至 0.94）。
在重建和美容乳房手术中，第四肋间神经的前皮支和外侧皮支是最重要的需要保留或修复的神经。需要进一步研究以阐明主导神经在乳房组织中的走行。
