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Quality of Life Outcomes Associated with Nipple Sparing Mastectomy and Breast Reconstruction
Christopher R. Bailey, BA, Rika Ohkuma, MD, Raja Mohan, MD, Ariel N. Rad, MD, PhD, Michele A. Manahan, MD, Justin M. Sacks, MD, Damon S. Cooney, MD, PhD, Theodore Tsangaris, MD, PhD, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE: Breast reconstruction after mastectomy plays an integral role in patients' overall sense of the treatment and survivorship experience; however, loss of the nipple areolar complex can be psychologically and sexually devastating. Though recent literature has shown that nipple-sparing mastectomies (NSM) provide robust cosmetic results and are thought to be safe from an oncologic standpoint, few studies have investigated the quality of life (QOL) outcomes associated with NSM.
METHODS: We performed an IRB-approved retrospective chart review of 20 patients who underwent NSM and implant based or autologous reconstruction (mean age: 50.3 +/- 9.3 (range 36-69), mean BMI: 24.8 +/- 4.1 (range 18.2-33.7)) and of 20 control patients who underwent non-nipple sparing mastectomy with reconstruction matched by type of reconstruction and operative date (mean age: 49.9 +/- 8.4 (range 39-66), mean BMI: 25.4+/- 6.0 (range 19.2-35)). We then compared pre and post-operative responses to the BREAST-Q©, a validated quality of life questionnaire related to breast reconstruction, within and between our study and control populations.
RESULTS: We found significant post-operative improvement in the NSM group with regard to satisfaction with breasts (p=.00045), psychosocial wellbeing (p=.00014) and sexual wellbeing (p=.0018). No post-operative improvement was found in any dimension of the BREAST-Q© in the control group. Furthermore, we found a strong trend towards significance in our comparison of improvement in the sexual wellbeing score between NSM and controls (p=.052). Finally, there was no significant difference between groups in the occurrence of postoperative complications. Sensitivity analysis excluding irradiated patients showed no difference in the aforementioned BREAST-Q© domains and complications.
CONCLUSION: Psychological concern for malignancy seemed to negatively impact pre-operative scores; however, reconstructive surgery improved patients' post-operative QOL even though reconstruction involves complex surgery, scarring and discomfort. NSM appears to provide a significant improvement in QOL after reconstruction compared to non-nipple sparing mastectomies.


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