Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy (NSM) and Reconstruction

Key Takeaways

• In a single-center cohort, NSM with implant based reconstruction produced clinically and statistically higher psychosocial and sexual well-being than skin-sparing mastectomy (SSM) with delayed nipple reconstruction, while physical well-being and breast-specific satisfaction were comparable.

• Surgical-site complication rates were low and not significantly different between groups.

Paper Info

The Breast Journal, January 2016

Design: Single institution (MSK) retrospective cohort with prospective PROs

Background

Preserving the nipple–areola complex has aesthetic appeal, but its impact on health-related quality of life (HRQOL) versus SSM with nipple reconstruction has been under-reported.

Objective

To determine whether nipple preservation improves patient-reported psychosocial, sexual, physical, and satisfaction outcomes after implant-based breast reconstruction.

Methods

Population

• 254 women (52 NSM, 202 SSM)

Inclusion

• Immediate two stage implant based reconstruction

• >5 mo follow up

• Therapeutic or prophylactic mastectomy

• <Stage IIB

Outcome measures

• Breast Q reconstruction module

Analysis

• t-test for Breast Q domains

• Multivariate linear regression controlling for confounders

  • BMI, cup size, time-to-survey, RT, ppx vs therapeutic

Results

Multivariate findings – NSM independently increased psychosocial (β 6.8, p = 0.05) and sexual well-being (β 7.5, p = 0.05). No other covariate reached significance.

Complications – Overall events were infrequent; full-thickness flap necrosis (7.7 % NSM vs 5.9 % SSM) was the commonest; differences were nonsignificant.

Conclusion

Within the limits of a retrospective, non-randomized design, NSM offers a measurable psychosocial and sexual quality-of-life advantage over SSM with nipple reconstruction, without added morbidity. These data support discussing NSM’s psychological benefits during shared decision-making.

Strengths & Limitations

Strengths

• Validated PROs

• Multivariate adjustment for confounders

Limitations

• Small NSM sample (n=52)

• Retrospective design

• No preop/baseline Breast-Q scores

• Longer follow up in SSM cohort

  
  

Future Directions

• Larger prospective or matched studies with baseline PROs.

• Inclusion of objective aesthetic and sensory assessments alongside BREAST-Q.

Clinical Relevance

When possible, nipple sparing techniques should be employed