title: A systematic review of risks and benefits with nipple-areola-reconstruction.
abstract: BACKGROUND
  Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims of the present systematic review were to evaluate the quality of evidence for benefits and risks with NAC reconstruction, and to examine the evidence for different techniques.
  
  
  METHODS
  Relevant databases were searched. Inclusion criteria were controlled studies comprising ≥20 patients and a case series of ≥50 patients. Included articles had to meet criteria defined in a PICO (Patient, Intervention, Comparison, and Outcome). Data extraction and collection were performed according to the QUADAS tool. The level of evidence of the selected articles was assessed according to the Oxford Centre for Evidence-Based Medicine 2009 guidelines, and total evidence for the different research questions was graded according to the GRADE-system.
  
  
  RESULTS
  A total of 362 abstracts were retrieved following the search. Of these 325 did not meet the inclusion criteria and were excluded, leaving 37 studies to be included in the review. Among these, 36 were case series and one a small randomised non-blinded study Conclusions: The existing quality of evidence for risks and benefits of the operation is very low. It is unclear what the complication frequencies are after the reconstruction, and what effect on quality-of-life the operation has. Prospective studies of high quality are needed to evaluate the health effects and risks with NAC reconstruction.
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Haukeland University Hospital , Bergen , Norway.
authors.forename: Camilla Morken
authors.initials: CM
authors.lastname: Kristoffersen
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Haukeland University Hospital , Bergen , Norway.
authors.forename: Håvard
authors.initials: H
authors.lastname: Seland
authors.affiliation: b Department of Plastic and Reconstructive Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.|c Department of Clinical Sciences, Malmö, Lund University , Lund , Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Hansson
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D009558:Nipples / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: NAC; areola; complications; evidence based medicine; nipple; prom; reconstruction