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Breast J. 2016 Jan-Feb;22(1):10-7. doi: 10.1111/tbj.12542.

Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction.

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Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.


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.


BREAST-Q; breast reconstruction; health-related quality of life; implant reconstruction; nipple-sparing mastectomy

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