Nipple-sparing mastectomy and immediate reconstruction: A propensity score-matched analysis of satisfaction and quality of life Journal Article

Authors: Kokosis, G.; Stern, C. S.; Shamsunder, M. G.; Polanco, T. O.; Patel, V. M.; Slutsky, H.; Morrow, M.; Moo, T. A.; Sacchini, V.; Coriddi, M. R.; Cordeiro, P. G.; Matros, E.; Pusic, A. L.; Disa, J. J.; Mehrara, B. J.; Nelson, J. A.
Article Title: Nipple-sparing mastectomy and immediate reconstruction: A propensity score-matched analysis of satisfaction and quality of life
Abstract: Background: Although it is intuitive that nipple-sparing mastectomy in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life are limited and show mixed results. This study aimed to use a propensity score-matching analysis to compare satisfaction and health-related quality-of-life outcomes in patients who underwent implant-based reconstruction following bilateral nipple-sparing mastectomy or skin-sparing mastectomy. Methods: A propensity score-matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing nipple-sparing or skin-sparing mastectomy with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, body mass index, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications. Results: The authors examined 1371 patients for matching and included 460 patients (nipple-sparing mastectomy, n = 230; skin-sparing mastectomy, n = 230) in the final analyses. The authors found no significant differences in baseline, cancer, and surgical characteristics between matched nipple-sparing and skin-sparing mastectomy patients, who also had similar profiles for surgical complications. Interestingly, the authors found that postoperative Satisfaction with Breasts scores and all other health-related quality-of-life domains were stable over a 3-year period and did not differ significantly between the two groups. Conclusions: Compared with skin-sparing mastectomy, bilateral nipple-sparing mastectomy did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that nipple-sparing mastectomy may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following nipple-sparing mastectomy warrant further investigation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. © 2022 Lippincott Williams and Wilkins. All rights reserved.
Keywords: quality of life; mastectomy; breast neoplasms; breast tumor; satisfaction; nipple; nipples; personal satisfaction; procedures; propensity score; humans; human; female
Journal Title: Plastic and Reconstructive Surgery
Volume: 150
Issue: 6
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2022-12-01
Start Page: 1214e
End Page: 1223e
Language: English
DOI: 10.1097/prs.0000000000009695
PUBMED: 36103660
PROVIDER: scopus
PMCID: PMC9712179
Notes: Article -- The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author Jonas A. Nelson -- Export Date: 3 January 2023 -- Source: Scopus
Citation Impact
MSK Authors
  1. Monica Morrow
    702 Morrow
  2. Joseph Disa
    245 Disa
  3. Andrea Pusic
    299 Pusic
  4. Carrie Stern
    11 Stern
  5. Virgilio Sacchini
    142 Sacchini
  6. Babak Mehrara
    374 Mehrara
  7. Peter G Cordeiro
    269 Cordeiro
  8. Evan Matros
    152 Matros
  9. Tracy-Ann Moo
    80 Moo
  10. Jonas Allan Nelson
    117 Nelson
  11. Michelle Renee Coriddi
    37 Coriddi
  12. Thais O Polanco
    23 Polanco
  13. Vaidehi Patel
    2 Patel