Journal
PLASTIC AND RECONSTRUCTIVE SURGERY
Volume 140, Issue 2, Pages 219-226Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PRS.0000000000003505
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- LifeCell Corp. (Branchburg, N.J.)
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Background: Loss of the nipple-areola complex can be psychologically and sexually devastating. Nipple-sparing mastectomy provides robust cosmetic results, but few studies have investigated the quality-of-life outcomes associated with it. Methods: The authors performed an institutional review board-approved retrospective study of 32 patients who underwent nipple-sparing mastectomy with implant-based or autologous reconstruction and 32 control patients who underwent non-nipple-sparing mastectomy with reconstruction matched by reconstruction type and operative period. They then compared premastectomy and postreconstruction responses to the BREAST-Q, a validated and breast reconstruction-specific quality-of-life questionnaire, within and between their study and control populations. Results: The nipple-sparing and non-nipple-sparing mastectomy groups were statistically similar in terms of mean age [49.9 +/- 8.5 years (range, 36 to 69 years) and 47.7 +/- 10.3 years (range, 26 to 68 years) (p = 0.29), respectively] and mean body mass index [24.3 +/- 3.5 kg/m(2) (range, 17.9 to 33.7 kg/m(2)) and 25.5 +/- 5.4 kg/m(2) (range, 19.2 to 39.2 kg/m(2)) (p = 0.29), respectively]. There were no significant between-group differences in occurrence of postreconstruction complications. The authors found significantly higher mean postreconstruction scores in the nipple-sparing mastectomy group within the Satisfaction with Breasts (p = 0.039) and the Satisfaction with Outcome (p = 0.017) domains. Finally, they noted higher median postreconstruction scores in the nipple-sparing mastectomy group within the Psychosocial Well-being (p = 0.043) and Satisfaction with Breasts (p = 0.004) domains. Conclusions: Psychological concerns regarding malignancy may negatively impact premastectomy patient quality of life. Reconstructive surgery improves patients' postmastectomy quality of life. Nipple-sparing mastectomy appears to provide significantly better improvement in postreconstruction quality of life, specifically in the Satisfaction with Breasts and Satisfaction with Outcome domains of the BREAST-Q, compared with non-nipple-sparing mastectomies.
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