title: Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction.
abstract: Nipple-sparing mastectomy (NSM) is considered an oncologically safe option for select patients. As many patients are candidates for nipple-sparing or skin-sparing mastectomy (SSM), reliable patient-reported outcome data are crucial for decision-making. The objective of this study was to determine whether patient satisfaction and/or health-related quality of life (HRQOL) were improved by preservation of the nipple with NSM compared to SSM and nipple reconstruction. Subjects were identified from a prospectively maintained database of patients who completed the BREAST-Q following mastectomy and breast reconstruction between March and October 2011 at Memorial Sloan Kettering Cancer Center. Fifty-two patients underwent NSM followed by immediate expander-implant reconstruction. A comparison group consisted of 202 patients who underwent SSM followed by immediate expander-implant reconstruction and later nipple reconstruction. HRQOL and satisfaction domains as measured by BREAST-Q scores were compared in multivariate linear regression analyzes that controlled for potential confounding factors. NSM patients reported significantly higher scores in the psychosocial (p = 0.01) and sexual well-being (p = 0.02) domains compared to SSM patients. There was no significant difference in the BREAST-Q physical well-being, satisfaction with breast, or satisfaction with outcome domains between the NSM and SSM groups. NSM is associated with higher psychosocial and sexual well-being compared to SSM and nipple reconstruction. Preoperative discussion of such HRQOL outcomes with patients may facilitate informed decision-making and realistic postoperative expectations.
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Wei
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Amie M
authors.initials: AM
authors.lastname: Scott
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Alison N
authors.initials: AN
authors.lastname: Price
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Helen Catherine
authors.initials: HC
authors.lastname: Miller
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klassen
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Jhanwar
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Colleen
authors.initials: C
authors.lastname: McCarthy
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.affiliation: Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Virgilio
authors.initials: V
authors.lastname: Sacchini
authors.affiliation: Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology*; D015414:Mastectomy, Subcutaneous / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D017060:Patient Satisfaction; D011788:Quality of Life
keywords: BREAST-Q; breast reconstruction; health-related quality of life; implant reconstruction; nipple-sparing mastectomy