Impact of Nipple-Sparing Mastectomy on Patient Reported Outcomes after Immediate Breast Reconstruction: A Multi-Institutional Study
Katherine B. Santosa, MD, MS1, Ji Qi, MS1, Hyungjin M. Kim, ScD1, Jennifer B. Hamill, MPH1, Andrea L. Pusic, MD, MHS2, Yoon Sun Chun, MD2, Edwin G. Wilkins, MD, MS1, Jeffrey H. Kozlow, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Brigham Health, Boston, MA, USA.
PURPOSE: Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) has increased in popularity due to its oncologic safety in many women and perceived superior aesthetic results, compared with skin-sparing mastectomy/IBBR. Despite the growing utilization of NSM, few studies have evaluated the impact of mastectomy type on patient-reported outcomes (PROs) and complications. The goals of this study were to compare PROs and complication rates for women undergoing immediate IBBR following either NSM or skin-sparing mastectomy with subsequent nipple reconstruction (SNR).
METHODS: The Mastectomy Reconstruction Outcomes Consortium (MROC) Study prospectively assessed PROs and complications in patients undergoing immediate IBBR at 11 centers in North America. Patients were recruited from 2012- 2015. PROs (satisfaction, as well as physical, psychosocial and sexual well-being) and complications were evaluated two years postoperatively, using the BREAST-Q and medical records, respectively. Multivariable models were used to compare outcomes for NSM and SNR cohorts.
RESULTS: Of the 600 women analyzed, 286 (47.7%) underwent NSM. Controlling for clinical covariates and baseline scores, we found no significant cohort differences in satisfaction with breast, or in psychosocial, physical or sexual well-being. The largest adjusted mean difference was seen with satisfaction, where the SNR cohort scored 3.2 points higher than the NSM group (95% CL = -0.40, 6.77), a difference that was likely not clinically meaningful. Mastectomy type was not a significant predictor for major complications (p = 0.17) or reconstructive failure (p=0.84).
CONCLUSION: Mastectomy type (NSM vs. SNR) had no significant effects on PROs or complication rates in immediate IBBR. These findings can help patients and their providers in the mastectomy approach and reconstruction decision-making process.
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