Breast cancer is the most commonly diagnosed cancer worldwide and the fifth leading cause of cancer death. In 2020, there were 2.3 million new cases, and 685,000 women died from it. Breast cancer among young women under 40 years of age accounts for 5% to 10% of all cases of this cancer. The greater availability of multi-gene sequence analysis by next-generation sequencing has improved diagnosis and, consequently, the possibility of using appropriate therapeutic approaches in BRCA1/2 gene mutation carriers. Treatment of young breast cancer patients affects their reproductive potential by reducing ovarian reserve. It can lead to reversible or permanent premature menopause, decreased libido, and other symptoms of sex hormone deficiency. This requires that, in addition to oncological treatment, patients are offered genetic counseling, oncofertility, psychological assistance, and sexological counseling. Given the number of BRCA1/2 gene mutation carriers among young breast cancer patients, but also thanks to growing public awareness, among their healthy family members planning offspring, the possibility of benefiting from preimplantation testing and performing cancer-risk-reduction procedures: RRM (risk-reducing mastectomy) and RRSO (risk-reducing salpingo-oophorectomy) significantly increase the chance of a genetically burdened person living a healthy life and giving birth to a child not burdened by the parent’s germline mutation. The goal of this paper is to show methods and examples of fertility counselling for BRCA1/2 gene mutation carriers, including both patients already affected by cancer and healthy individuals.

Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) optimizes aesthetic outcomes, yet transection of intercostal sensory nerves commonly results in persistent nipple-areolar complex (NAC) anesthesia and, in some patients, denervation-related symptoms. NAC neurotization has emerged as an intraoperative strategy intended to improve protective sensation and potentially erogenous sensation by reconnecting donor intercostal nerves to the retroareolar plexus or to targets within the nipple. Here, we provide an anatomy-first narrative synthesis of the medial and lateral sensory corridors, with emphasis on the lateral cutaneous branches of T3–T5 and the reported anatomical landmarks that facilitate donor identification during NSM. We then review the biological constraints governing regeneration across the long trajectories typical of IBBR, including evidence suggesting reduced performance of acellular nerve allografts with increasing gap length and the rationale for autologous nerve transfers. Technical approaches are organized by (i) donor selection and harvest depth, (ii) graft choice, and (iii) distal coaptation strategies ranging from subareolar stump coaptation to targeted NAC reinnervation and direct nipple neurotization techniques. We also summarize the current clinical evidence regarding sensory recovery kinetics, safety and complications, operative time and cost, and propose practical checkpoints for intraoperative decision-making and standardized postoperative assessment. Collectively, available data support NAC neurotization as a feasible adjunct to NSM-IBBR, while highlighting the need for harmonized outcome reporting and longer follow-up to define comparative effectiveness among techniques.

Background and Objective: Nipple-sparing mastectomy with implant-based breast reconstruction preserves the visible nipple-areolar complex (NAC) but commonly disrupts protective, tactile, thermal, and erogenous sensation. Clinical interest has expanded, while donor selection, recipient targeting, bridge choice, implant-pocket constraints, outcome measurement, and candidacy remain unsettled. This narrative review addresses when native nerve preservation or reconstruction is anatomically credible, how implant-specific constraints affect operative planning, what the available outcomes support, and when selective non-use is appropriate. Methods: PubMed was the primary indexed database; Google Scholar and reference chaining were supplementary discovery methods. English-language, peer-reviewed sources relevant to predefined clinical questions were considered from database inception through 15 May 2026. Publications used for substantive claims were assessed in full text. Evidence was organized by directness and synthesized narratively according to study design, consistency, applicability, outcome methodology, and follow-up. No formal risk-of-bias instrument, quantitative pooling, dual independent systematic-review screening, or duplicate extraction was performed. Key Content and Findings: The direct evidence consists predominantly of technical reports and small single-center observational cohorts, with limited comparative and randomized evidence. Follow-up is generally short, sensory instruments and testing zones are inconsistent, and many reports do not provide denominators for planned, attempted, modified, or abandoned neurotization. The T3-T5 lateral intercostal corridor, particularly T4, is the principal donor region; safely preservable superficial branches may remain in continuity when oncologic resection and flap perfusion are uncompromised. Implant base width, donor length, route feasibility, and coaptation sequencing are supported technical considerations, whereas validated thresholds for acellular dermal matrix or capsule interfaces, compression, tissue expansion, route vascularity, or protected slack are absent. Subareolar stumps, retroareolar or subdermal NAC fields, posterior areolar tissue, and nipple-base targets have been used, without evidence of target superiority. Processed allograft has the strongest implant-based precedent, while direct repair, branch elongation, and autograft are anatomy-dependent alternatives; comparative biological and economic superiority is unestablished. Conclusions: NAC neurotization is selectively feasible and may improve sensation, but the evidence is heterogeneous and insufficient for firm technique or patient-selection recommendations. The proposed conditional framework supports clinical reasoning and transparent reporting; it is not a validated guideline.