Nipple-sparing Mastectomy And Immediate Breast Reconstruction - A Propensity Core Matched Analysis Of Clinical And Health-related Quality Of Life Outcomes
Thais O. Polanco, MD1, Scott West, MPH1, Meghana G. Shamsunder, MPH1, Vadehi Patel, BA1, Robert J. Allen, Jr., MD1, Tracy-Ann Moo, MD1, Evan Matros, MD, MMSc1, Joseph H. Dayan, MD1, Joseph J. Disa1, Babak J. Mehrara, MD1, Andrea L. Pusic, MD, MHS, FACS, FRCSC2, Collen M. McCarthy, MD1, Jonas A. Nelson, MD1.
1Memorial Sloan Kettering, New York, NY, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
Background: Nipple-sparing mastectomy (NSM) has the potential to improve breast cosmesis following mastectomy and reconstruction in selected patients. Large scale studies describing clinical and patient-reported health-related quality of life (HR-QoL) outcomes are limited and have demonstrated mixed results. This study aimed to examine clinical and HR-QoL outcomes through a matched analysis of NSM and non-NSM patients using the BREAST-Q.
Methods: Propensity score matching analysis (1:1 matching, no replacement) was performed for patients undergoing NSM and non-NSM with immediate bilateral breast reconstruction. Patients with a history of radiotherapy were excluded. Matched covariates included age, BMI, race, smoking history, chemotherapy status, reconstruction type, bra size, and history of psychiatric diagnosis. Outcomes of interest included complications and BREASTQ scores for satisfaction and quality of life domains.
Results: Overall 1792 patients were examined for matching, with 248 having NSM. After matching, NSM and non-NSM patients did not significantly differ in baseline, cancer, and surgical characteristics. NSM patients demonstrated a complication profile similar to non-NSM patients. Mastectomy skin flap necrosis rates we slightly higher in NSM patients (9.3% vs. 4.4%, p=0.51), though this did not reach significance. Preoperative and postoperative satisfaction with breast scores (through 3 years) did not significantly differ, and demonstrated stability over time. Additionally, all QoL domains also demonstrated no significant difference (Table 1).
Conclusion: In this matched analysis of bilateral mastectomy patients without radiation, NSM with immediate reconstruction resulted in clinical outcomes comparable to non-NSM procedures without a significant increase in complications. Satisfaction and QoL based on the BREAST-Q were stable and similar across time; NSM did not confer superior outcomes. Further studies are warranted to better understand patient perception of final reconstruction aesthetics to evaluate the value of NSM on HR-QoL.
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