title: Nipple-areolar Complex Reconstruction following Postmastectomy Breast Reconstruction: A Comparative Utility Assessment Study.
abstract: BACKGROUND
  Nipple-areola complex (NAC) reconstruction occurs toward the final stage of breast reconstruction; however, not all women follow through with these procedures. The goal of this study was to determine the impact of the health state burden of living with a reconstructed breast before NAC reconstruction.
  
  
  METHODS
  A sample of the population and medical students at McGill University were recruited to establish the utility scores [visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG)] of living with an NAC deformity. Utility scores for monocular and binocular blindness were determined for validation and comparison. Linear regression and Student's t test were used for statistical analysis, and significance was set at P < 0.05.
  
  
  RESULTS
  There were 103 prospective volunteers included. Utility scores (VAS, TTO, and SG) for NAC deformity were 0.84 ± 0.18, 0.92 ± 0.11, and 0.92 ± 0.11, respectively. Age, gender, and ethnicity were not statistically significant independent predictors of utility scores. Income thresholds of <$10,000 and >$10,000 revealed a statistically significant difference for VAS (P = 0.049) and SG (P = 0.015). Linear regression analysis showed that medical education was directly proportional to the SG and TTO scores (P < 0.05).
  
  
  CONCLUSIONS
  The absence of NAC in a reconstructed breast can be objectively assessed using utility scores (VAS, 0.84 ± 0.18; TTO, 0.92 ± 0.11; SG, 0.92 ± 0.11). In comparison to prior reported conditions, the quality of life in patients choosing to undergo NAC reconstruction is similar to that of persons living with a nasal deformity or an aging neck requiring rejuvenation.
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Sinno
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Ali
authors.initials: A
authors.lastname: Izadpanah
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Joshua
authors.initials: J
authors.lastname: Vorstenbosch
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Tassos
authors.initials: T
authors.lastname: Dionisopoulos
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Marc A M
authors.initials: MA
authors.lastname: Mureau
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin