title: Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Nipple-areola complex (NAC) reconstruction transforms a mound of soft tissue into a breast and often marks the final stage of breast reconstruction after mastectomy.
  
  
  METHODS
  A systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles were classified based on the nipple reconstructive technique-either composite nipple sharing or local flap with nipple-sparing mastectomy (NSM) used as a control. A standardized "Satisfaction Score" (SS) for "nipple appearance" and "nipple sensation" was calculated for each technique. A Fisher's exact test was used to compare the SS with local flap reconstruction with NSM.
  
  
  RESULTS
  Twenty-three studies met the systematic review inclusion criteria. Nine NSM articles were identified with patient satisfaction data from 473 patients. The weighted average SS for NSM was 80.5%. Fourteen local flap technique articles were identified with satisfaction data from 984 patients and a weighted average SS of 73.9%. This was a statistically significant difference (P=0.0079). C-V and badge local flap techniques were associated with the highest SS, 92.6% and 90.5%, respectively. C-V and modified C-V flap technique was associated with a higher SS when compared to those using one or more other flap techniques (P=0.0001).
  
  
  CONCLUSIONS
  While patient satisfaction with nipple reconstruction is high regardless of technique, it is higher with NSM. When NSM is not an option, local flap reconstruction with a C-V or modified C-V flap may be associated with higher satisfaction than alternative local flap techniques.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Satteson
authors.affiliation: Gulf Coast Plastic Surgery, Pensacola, FL, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Brown
authors.affiliation: Department of Plastic Surgery, Georgetown University, Washington, DC, USA.
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Nahabedian
keywords: Mastectomy; breast reconstruction; meta-analysis; nipple reconstruction; nipple-areola complex (NAC) reconstruction; nipple-areola reconstruction; preferred reporting items for systematic reviews and meta-analysis (PRISMA)