title: Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study.
abstract: BACKGROUND
  Nipple-sparing mastectomy has become an accepted treatment for appropriately selected breast cancers. No reports have correlated patient satisfaction following nipple-sparing mastectomy with objective observer assessments.
  
  
  METHODS
  From 2001 to 2008, nipple-sparing mastectomy and immediate reconstruction were performed on 141 patients. After institutional review board approval, patients completed questionnaires rating their satisfaction with various aspects of their nipple-areola complex using a Likert-type scale. Three independent observers then reviewed the nipple-areola complex in 34 patients and rated the outcome using the same scale.
  
  
  RESULTS
  The survey completion rate was 53 percent and the mean follow-up was 50.4 months (range, 9 to 100 months). A majority of patients rated appearance, symmetry, color, position, and texture as good or excellent. A majority of patients rated sensation and arousal as fair or poor. Fifty-seven patients (73.1 percent) stated they would definitely undergo nipple-sparing mastectomy again. Patients with larger volumes of breast tissue removed (p = 0.010), larger preoperative body mass index (p = 0.034), or larger tissue expander volumes (p = 0.007) reported lower satisfaction. Patient assessments for appearance, color, symmetry, and position correlated with those of objective observers.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. djohanr@ccf.org
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.forename: Earl
authors.initials: E
authors.lastname: Gage
authors.forename: James
authors.initials: J
authors.lastname: Gatherwright
authors.forename: Sabrina
authors.initials: S
authors.lastname: Pavri
authors.forename: Jimmy
authors.initials: J
authors.lastname: Firouz
authors.forename: Steven
authors.initials: S
authors.lastname: Bernard
authors.forename: Randall
authors.initials: R
authors.lastname: Yetman
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012677:Sensation; D016896:Treatment Outcome; D055815:Young Adult