Patient Satisfaction following Nipple-Sparing Mastectomy and Immediate Breast Reconstruction: An 8-Year Outcome Study [Outcomes Article]

Abstract

The authors' study is the largest series to address patient satisfaction with the nipple-areola complex following nipple-sparing mastectomy and the only one to correlate patient self-assessment with assessment by independent observers. Overall, patients were very satisfied with appearance of the nipple-areola complex and most would choose nipple-sparing mastectomy again. A majority of patients rated sensation as fair or poor, with sensation constituting the most frequent aspect of the nipple-areola complex that patients would change. Larger body mass index, expander volumes, and volume of breast tissue removed may predict dissatisfaction postoperatively.

Nipple-Sparing Mastectomy via Inframammary Fold: Reconstructive Red Flags

“…Factors that exhibited trends related to increased skin flap necrosis in our study included increased excised specimen weight (p=0.0704), smoking (p=0.0726), and medical comorbidities including hypertension and diabetes (p=0.0665), which supports existing literature (Djohan et al, 2010;Komorowski et al, 2006;Munhoz et al, 2013). The adverse effect of increased body mass index on breast reconstruction has been previously discussed, likely due to excessive stress placed on the subdermal plexus as well as comorbidities associated with obesity (Colwell et al, 2014;Alderman, Wilkins, Kim, & Lowery, 2002;Bailey et al, 1989;Mosahebi, Ramakrishnan, Gittos, & Collier, 2007).…”

“…We used the following key terms to search all databases: nipple-sparing mastectomy, inframammary fold, immediate reconstruction, skin flap necrosis, nipple necrosis, and reconstructive criteria. The literature reflects a wide range of nipple-areolar complex necrosis rates between 0-48% (Salgarello et al, 2010;Rusby, Smith, & Gui, 2010 Sacchini et al, 2006;Spear et al, 2011;Djohan et al, 2010;Crowe et al, 2004;Colwell et al, 2014;Salibian, Harness, & Mowlds, 2013;Endara, Chen, Verma, Nahabedian, & Spear, 2013 reconstruction, Gould et al (2013) found that their overall incidence of any (partial or total) nipple necrosis was 20% via a non-IMF approach. In a review of 64 NSM via various approaches, Wijayanayagam et al noted a total NAC necrosis rate of 20%, partial NAC necrosis 84%, and total skin-sparing skin flap necrosis of 17%.…”

Nipple-sparing mastectomy in breast cancer patients: The role of adjuvant radiotherapy (Review)

“…In the majority of patients, the entire breast tissue below the NAC was removed (Table I). Additionally, certain studies did not provide a detailed description of the surgical techniques used (3,4,9,3,26,28,47). In other studies, the aim was to remove as much breast tissue as possible (49), or to leave a certain degree of breast tissue beneath the NAC in order to ensure the blood supply of the NAC (17,18,29,33).…”

“…Djohan et al (26) demonstrated high patient satisfaction rates with the appearance of the NAC following NSM, as determined by self-assessment and assessment by independent observers in a cohort of 141 patients, with a median follow-up period of 8 years. Other studies confirmed these good cosmetic outcomes (25,27,28).…”

“…The indications of NSM have been extended from a prophylactic scenario and small tumors distant from the NAC to larger and multi-centric tumors (4,5). There are several studies and reviews on NSM (1,2,5-10), a number of which focus on oncological safety (3,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), cosmetic outcome (24)(25)(26)(27)(28)(29) and surgical techniques (24)(25)(26)(27)(28)(29)(30)(31)(32). The role of adjuvant radiotherapy (RT), including dose-fractionation concepts and techniques (6), remains unclear.…”