Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction

Wei, Cindy H.; Scott, Amie; Price, Alison N.; Miller, Helen C.; Klassen, Anne F.; Jhanwar, Sabrina M.; Mehrara, Babak J.; Disa, Joseph J.; McCarthy, Colleen M.; Matros, Evan; Cordeiro, Peter G.; Sacchini, Virgilio; Pusic, Andrea L.

doi:10.1111/tbj.12542

Cited by 159 publications

(120 citation statements)

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“…Skin‐ and nipple‐sparing mastectomy have been associated with superior cosmetic and quality‐of‐life outcomes32 33. Previously there were concerns regarding the oncological safety of these procedures; however, they have been proven to not increase rates of recurrence in patients undergoing mastectomy and have contributed to improving outcomes in breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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BackgroundBreast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population.MethodsData were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy.ResultsOf 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early‐stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy.ConclusionBreast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant‐based approaches.

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Section: Discussionmentioning

confidence: 99%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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“…One may wonder why the surgeon should go to the trouble of saving the nipple-areolar complex if it can be easily reconstructed in a later operation under local anesthesia. The reasons are that patients generally report low satisfaction with a reconstructed nipple [6] and psychosocial wellbeing and sexual wellbeing are lower in SSM compared to NSM [7]. …”

Section: Introductionmentioning

confidence: 99%

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

et al. 2017

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Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. NSM is closely similar except that the nipple-areola complex (NAC) is also conserved. Meta-analyses indicate that outcomes for SSM and NSM do not differ from those for non-conservative mastectomies. Recurrence rates in the NAC after NSM are acceptably low (0-3.7%). Other studies indicate that NSM is associated with high patient satisfaction and good psychological adjustment. Indications are carcinoma or DCIS that require mastectomy (including after neoadjuvant chemotherapy). NSM is also suitable for women undergoing risk-reducing bilateral mastectomy. Tumor not less than 2cm from the NAC is recommended, but may be less important than no evidence of nipple involvement on mandatory intraoperative nipple margin assessment. A positive margin is an absolute contraindication for nipple preservation. Other contraindications are microcalcifications close to the subareolar region and a positive nipple discharge. Complication rates are similar to those for other types of post-mastectomy reconstructions. The main complication of NSM is NAC necrosis, however as surgeon experience matures, frequency declines. Factors associated with complications are voluminous breast, ptosis, smoking, obesity, and radiotherapy. Since the access incision is small, breast tissue may be left behind, so only experienced breast surgeons should do these operations; close collaboration with the plastic surgeon. For breast cancer patients requiring mastectomy, NSM should be the option of choice.

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“…As we did not evaluate test-retest reliability in this study, we cannot comment on consistency over time for electronic administration. In addition, the sample was cross-sectional, and we were therefore unable to demonstrate the responsiveness of the BREAST-Q to clinical change [13, 14]. …”

Section: Discussionmentioning

confidence: 99%

“…For example, the BREAST-Q was used to compare satisfaction with silicone and saline implant reconstruction after mastectomy; this analysis revealed that satisfaction with the breast was higher among those who received silicone implants [13]. Another study reported psychosocial and sexual well-being after nipple-sparing and skin-sparing mastectomies with reconstruction and found that nipple-sparing mastectomy was associated with higher QOL [14]. Other researchers used the BREAST-Q to evaluate the effect of a decision aid for different breast reconstruction options [15].…”

Section: Introductionmentioning

confidence: 99%

Validation of the electronic version of the BREAST-Q in the army of women study

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Klassen

et al. 2017

The Breast

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Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery-specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach’s α coefficients (≥0.78) and item-total correlations (range of means, 0.65–0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.

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Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction

Cited by 159 publications

References 31 publications

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications

Validation of the electronic version of the BREAST-Q in the army of women study

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