XXXX Satisfaction and Nipple-Areola Sensitivity After Bilateral Prophylactic Mastectomy and Immediate Implant Breast Reconstruction in a High Breast Cancer Risk Population: Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy.

@entity1 @entity4098 @entity0 @entity272
BACKGROUND: Prophylactic @entity272 ( @entity272 ) and nipple-sparing mastectomy (NSM) both are associated with major risk reduction in @entity1 with high @entity0 risk. Skin-sparing mastectomy followed by nipple-areola complex (NAC) reconstruction is standard of care, but NSM is increasingly being performed. Preservation of the NAC in NSM may increase @entity1 satisfaction. Therefore, we measured NAC sensitivity after NSM and compared @entity1 satisfaction as well as body image after @entity272 with NSM. METHODS: @entity1 who underwent prophylactic bilateral @entity272 or NSM and immediate implant breast reconstruction between 2002 and 2012 were eligible. @entity1 satisfaction was assessed using the Breast-Q reconstruction questionnaire, body image using Hopwood's body image scale (BIS), and satisfaction with the (reconstructed) NAC using a study-specific questionnaire. In the NSM group, NAC sensitivity was assessed using Semmes Weinstein monofilaments with a 5-point scale and compared with NAC sensitivity in a nonoperated control group. RESULTS: The @entity272 group comprised 25 @entity1 (50 SSMs) and the NSM group 20 @entity1 (39 NSMs). Median follow-up was 65 months in the @entity272 group compared with 27 months in the NSM group (P < 0.01). In univariable analyses, Breast-Q scores were favorable in the @entity272 group compared with the NSM group with trends for higher "satisfaction with breasts" (66.2 vs 56.6; P = 0.06) and "satisfaction with outcome" (76.1 vs 61.5; P = 0.09). Mean BIS score of 7.1/30 in the @entity272 group and 9.3/30 in the NSM group (P = 0.35). Adjusted for follow-up, there were no significant differences in Breast-Q scores, nor in BIS scores. Interestingly, satisfaction with the (reconstructed) NAC was similar after @entity272 and NSM. @entity4098 was lower in the NSM group (mean score, 1.9; 95% confidence interval, 1.5-2.3) compared with the control group (mean score, 4.7; 95% confidence interval, 4.6-4.9; P < 0.01). CONCLUSIONS: Breast-Q scores regarding satisfaction with breasts and overall outcome were in favor of the @entity272 group. Residual NAC sensitivity after NSM was low. This suggests that @entity272 followed by NAC reconstruction is a balanced alternative to NSM. We observed no significant differences in body image and NAC-specific satisfaction between the NSM and @entity272 groups.
