title: Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction.
abstract: BACKGROUND
  Total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex skin has become more widely accepted. Few studies looking at outcomes after TSSM and immediate reconstruction have focused on patient-reported outcomes and trends in satisfaction over time.
  
  
  METHODS
  Prospective evaluation of patients undergoing TSSM and immediate expander-implant reconstruction was performed. Patients completed the BREAST-Q questionnaire preoperatively and again at 1 month, 6 months, and 1 year postoperatively. Mean scores in each BREAST-Q domain were assessed at each time point. Domains were scored on a 0- to 100-point scale.
  
  
  RESULTS
  Survey completion rate was 55%; BREAST-Q scores were calculated from responses from 28 patients. Mean overall satisfaction with breasts declined at 1 month (69.8 to 46.1, P<0.001), but then returned to baseline by 1 year. Mean scores also declined at 1 month in the psychosocial (75.7-67.4, P=0.2) and sexual (58.3-46.7, P=0.06) domains, but returned to baseline by 1 year. Mean nipple satisfaction score was 76.4 at 1 year, with 89% of patients reporting satisfaction with nipple appearance. Satisfaction with nipple position and sensation was lower, with only 56% of patients reporting satisfaction with nipple position and 40% with nipple sensation.
  
  
  CONCLUSIONS
  After TSSM and immediate reconstruction, patient satisfaction with their breasts, as well as psychosocial and sexual well-being, returns to baseline by 1 year. Although overall nipple satisfaction is high, patients often report dissatisfaction with nipple position and sensation; appropriate preoperative counseling is important to set realistic expectations.
authors: From the Divisions of *Plastic and Reconstructive Surgery, and †Breast Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; and ‡Division of Breast Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors: Anne Warren
authors: AW
authors: Peled
authors: Erin
authors: E
authors: Duralde
authors: Robert D
authors: RD
authors: Foster
authors: Allison Stover
authors: AS
authors: Fiscalini
authors: Laura J
authors: LJ
authors: Esserman
authors: E Shelley
authors: ES
authors: Hwang
authors: Hani
authors: H
authors: Sbitany
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D015626:Tissue Expansion