title: Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast.
abstract: OBJECTIVE
  We conducted a retrospective study to assess the safety, cosmetic outcome, and patients' satisfaction after skin-sparing (SSM) and nipple-sparing mastectomy (NSM) for breast cancer with immediate reconstruction of the breast (SMIBR).
  
  
  METHODS
  The subjects were patients, who underwent SMIBR, breast-conserving surgery (BCS), and total mastectomy (MST) between 2000 and 2004 at Osaka University Hospital. Cosmetic outcome was estimated by 4 reviewers by scoring postoperative photographs of the patients. Patient satisfaction was evaluated with a questionnaire for assessment of quality of life for Japanese breast cancer patients.
  
  
  RESULTS
  Of the 74 patients who had undergone SMIBR, 4 developed local recurrences (5%). The local recurrence rate for SMIBR patients was greater than that for BCS (4/178) and MST (3/178, P = .10). The distant recurrence rate was similar for all three types of patients (5% for SMIBR, 5% for BCS, and 9% for MST). The median averaged score by 4 reviewers for the estimated cosmetic outcomes was 7.8 for the SMIBR and 7.5 for the BCS group (P = .20), and for age-adjusted patients, the corresponding scores were 8.2 and 8.0 (P = .70). There was no difference in cosmetic outcome between the SSM and NSM subgroups (P = .09). Average scores for patient satisfaction (social activity, physical aspects, and general condition) were the same for the 3 groups. For body image, the BCS and SMIBR groups had higher scores than the MST group (p < 0.05). Average scores for questions relating to bodily pain and sexual aspects were higher for the BCS than the MST group, but were not different between SMIBR and BCS groups. Similar trends for the 3 groups were observed when patients were divided into subgroups by tumor size or axillary dissection.
  
  
  CONCLUSIONS
  SMIBR is safe with a comparatively low local recurrence rate and the same distant recurrence rate as for BCS and MST. Moreover, it results in objective cosmetic outcome and patient satisfaction as good as those for BCS, and greater patient satisfaction with body image than that for MST.
authors.affiliation: Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Satsuki
authors.initials: S
authors.lastname: Ueda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Yano
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Okishiro
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Imasato
authors.forename: Kenzo
authors.initials: K
authors.lastname: Shimazu
authors.forename: Seun J
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Miyoshi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tanji
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Taguchi
authors.forename: Shinzaburo
authors.initials: S
authors.lastname: Noguchi
mesh_terms: D000328:Adult; D001828:Body Image; D001943:Breast Neoplasms / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology; D015412:Mastectomy, Segmental / Q000379:methods* / Q000523:psychology; D015413:Mastectomy, Simple / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009558:Nipples / Q000601:surgery; D017060:Patient Satisfaction; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome