title: The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction.
abstract: BACKGROUND
  Satisfaction with breast reconstruction is thought to be greatest among patients who complete nipple and areolar complex (NAC) reconstruction. Anecdotally, many patients are known to decline NAC reconstruction. The authors aimed to characterize the epidemiology of and factors associated with incomplete breast reconstruction.
  
  
  METHODS
  Breast reconstruction patients with follow-up in a single institution's electronic medical record system were reviewed. Chi-squared and independent t-tests were used to identify variables associated with lack of NAC reconstruction; associated variables (P < 0.05) were used to build a binary logistic regression.
  
  
  RESULTS
  Four hundred thirty-three patients were reviewed. Reconstructions consisted of an average of 4.0 ± 2.0 procedures over 503 (range, 2-3,652) days. One hundred twelve patients had NAC reconstruction or tattooing (25.9%) and 73 (17.6%) had both-226 women (54.6%) had neither. On multivariate analysis, a history of any implant removal was associated with a 93.4% decreased chance of NAC reconstruction (P = 0.002), whereas prophylactic or early-stage mastectomy was associated with 52.9% increased chances of NAC reconstruction (P = 0.009).
  
  
  CONCLUSIONS
  Over half of the present cohort did not complete any NAC reconstruction. Patients with later-stage cancer and a history of implant removal were less likely to have NAC reconstruction. The high prevalence of incomplete reconstructions suggests that the classical definition of breast reconstruction completion as requiring NAC reconstruction may be outdated or not applicable to all populations. Instead, "completion" should be considered a subjective determination varying between patients.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Departments of Surgery, and †Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: E Hope
authors.initials: EH
authors.lastname: Weissler
authors.forename: Julie B
authors.initials: JB
authors.lastname: Schnur
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Lamelas
authors.forename: Marisa
authors.initials: M
authors.lastname: Cornejo
authors.forename: Elan
authors.initials: E
authors.lastname: Horesh
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013653:Tattooing; D016896:Treatment Outcome