Plastic Surgery Research Council
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Presenter: Presenter: Pablo Baltodano, MD
Co-Authors: Bailey, C; Ohkuma R; Mohan R; Rad AN; Manahan MA; Sacks JM; Cooney DS; Tsangaris T; Rosson GD
Johns Hopkins Hospital

BACKGROUND: Post-mastectomy breast reconstruction plays an integral role in patients' overall treatment and survivorship experience. However, loss of the nipple areolar complex can be psychologically and sexually devastating. Although recent literature has shown that nipple-sparing mastectomies (NSM) provide robust cosmetic results and are oncologically safe, few studies have investigated quality of life (QoL) outcomes associated with NSM.

METHOD: We performed an IRB-approved retrospective chart review of 20 patients who underwent NSM with implant-based or autologous reconstruction and 20 control patients who underwent non-NSM with reconstruction matched by reconstruction type and operative time period. We compared pre and post-op responses to the BREAST-Q, a validated QoL questionnaire for breast reconstruction, within and between groups.

RESULTS: Our NSM and non-NSM groups were statistically similar in terms of age [mean age: NSM=50.3+/-9.3 years (range=36-69), non-NSM=49.9+/-8.4 years (range=39-66)] and BMI [mean BMI: NSM=24.8+/-4.1 (range=18.2-33.7), non-NSM=25.4+/-6.0 (range=19.2-35)]. We found significant post-op improvement in the NSM group for satisfaction with breasts (p=.00045), psychosocial wellbeing (p=.00014), and sexual wellbeing (p=.0018). No post-op improvement was found in any dimension of the control group s BREAST-Q scores. Furthermore, we found a strong trend towards significance in our comparison of pre- to post-op change in sexual wellbeing between NSM and controls (p=.052). There were no significant between-group differences in occurrence of post-op complications. Finally, sensitivity analysis excluding irradiated patients showed no difference in the aforementioned BREAST-Q domains and complications.

DISCUSSION: Psychological concerns regarding malignancy may negatively impact pre-operative patient QoL. Even though mastectomy and breast reconstruction involves complex surgery, scarring and discomfort, which theoretically could decrease QoL, NSM appears to provide a significant improvement in QoL after reconstruction compared to non-nipple sparing mastectomies.

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