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Nipple–areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer

Published:November 08, 2016DOI:https://doi.org/10.1016/j.bjps.2016.10.009

      Summary

      Introduction

      Women choose to undergo nipple–areola complex (NAC) reconstruction as part of breast reconstruction following breast cancer treatment. However, the effect of this procedure on psychosocial and sexual well-being is not well studied. The present study aimed to evaluate how NAC reconstruction affects patient satisfaction with regard to psychosocial and sexual well-being.

      Methods

      A retrospective chart review was performed for all patients who underwent NAC reconstruction at Magee-Women's Hospital from January 1, 2004 to July 31, 2011. A letter and questionnaire based on the BREAST-Q were mailed to patients to request their participation in the study. Patient satisfaction and health-related quality of life were measured before and after NAC reconstruction.

      Results

      In total, 107 of 328 patients (32.6%) completed the survey. The BREAST-Q scale score for satisfaction with outcome following NAC reconstruction was 85.1 ± 15.8, with higher satisfaction scores for patients with a follow-up of <1.5 years than those with a follow-up of >2.5 years (82.5 ± 21.7 vs. 69.5 ± 19.5; p < 0.01). No significant differences were found in satisfaction with the breast mound before and after NAC reconstruction. Women scored significantly higher on the psychosocial and sexual well-being scales after NAC reconstruction (p < 0.002 and 0.00004, respectively).

      Conclusions

      This study indicates that patients are highly satisfied after undergoing NAC reconstruction. Satisfaction with the procedure, however, may decrease over time. NAC reconstruction significantly contributes to patient psychosocial and sexual well-being, and this effect did not change over time. NAC reconstruction improves patient outcomes in those who choose to undergo the procedure.

      Keywords

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      References

        • Berson M.I.
        Construction of pseudoareola.
        Surgery. 1946; 20: 808
        • Sisti A.
        • Grimaldi L.
        • Tassinari J.
        • et al.
        Nipple-areola complex reconstruction techniques: a literature review.
        Eur J Surg Oncol. 2016; 42: 441-465
        • Winocour S.
        • Saksena A.
        • Oh C.
        • et al.
        A systematic review of comparison of autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction.
        Plast Reconstr Surg. 2016; 137: 14e-23e
        • Wellisch D.K.
        • Schain W.S.
        • Noone R.B.
        • Little 3rd, J.W.
        The psychological contribution of nipple addition in breast reconstruction.
        Plast Reconstr Surg. 1987; 80: 699-704
        • Goh S.C.
        • Martin N.A.
        • Pandya A.N.
        • Cutress R.I.
        Patient satisfaction following nipple-areolar complex reconstruction and tattooing.
        J Plast Reconstr Aesthet Surg. 2011; 64: 360-363
        • Harcourt D.
        • Russell C.
        • Hughes J.
        • et al.
        Patient satisfaction in relation to nipple reconstruction: the importance of information provision.
        J Plast Reconstr Aesthet Surg. 2011; 64: 494-499
        • Jones A.P.
        • Erdmann M.
        Projection and patient satisfaction using the “Hamburger” nipple reconstruction technique.
        J Plast Reconstr Aesthet Surg. 2012; 65: 207-212
        • Clarkson J.H.
        • Tracey A.
        • Eltigani E.
        • Park A.
        The patient's experience of a nurse-led nipple tattoo service: a successful program in Warwickshire.
        J Plast Reconstr Aesthet Surg. 2006; 59: 1058-1062
        • Eskenazi L.
        A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases.
        Plast Reconstr Surg. 1993; 92: 671-680
        • Jabor M.A.
        • Shayani P.
        • Collins Jr., D.R.
        • Karas T.
        • Cohen B.E.
        Nipple-areola reconstruction: satisfaction and clinical determinants.
        Plast Reconstr Surg. 2002; 110 ([discussion 64-5]): 457-463
        • Potter S.
        • Barker J.
        • Willoughby L.
        • et al.
        Patient satisfaction and time-saving implications of a nurse-led nipple and areola reconstitution service following breast reconstruction.
        Breast. 2007; 16: 293-296
        • Spear S.L.
        • Arias J.
        Long-term experience with nipple-areola tattooing.
        Ann Plast Surg. 1995; 35: 232-236
        • Lipa J.E.
        • Addison P.D.
        • Neligan P.C.
        Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage.
        Can J Plast Surg. 2008; 16: 85-88
        • Metcalfe K.A.
        • Cil T.D.
        • Semple J.L.
        • et al.
        Long-term psychosocial functioning in women with bilateral prophylactic mastectomy: does preservation of the nipple-areolar complex make a difference?.
        Ann Surg Oncol. 2015; 22: 3324-3330
        • Wei C.H.
        • Scott A.M.
        • Price A.N.
        • et al.
        Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction.
        Breast J. 2016; 22: 10-17
        • Cano S.J.
        • Klassen A.F.
        • Scott A.M.
        • Cordeiro P.G.
        • Pusic A.L.
        The BREAST-Q: further validation in independent clinical samples.
        Plast Reconstr Surg. 2012; 129: 293-302
        • Pusic A.L.
        • Klassen A.F.
        • Scott A.M.
        • et al.
        Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q.
        Plast Reconstr Surg. 2009; 124: 345-353
        • Shestak K.C.
        • Nguyen T.D.
        The double opposing periareola flap: a novel concept for nipple-areola reconstruction.
        Plast Reconstr Surg. 2007; 119: 473-480
        • Buck 2nd, D.W.
        • Shenaq D.
        • Heyer K.
        • Kato C.
        • Kim J.Y.
        Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: the importance of completion.
        Breast. 2010; 19: 521-526
        • Anderson R.C.
        • Cunningham B.
        • Tafesse E.
        • Lenderking W.R.
        Validation of the breast evaluation questionnaire for use with breast surgery patients.
        Plast Reconstr Surg. 2006; 118: 597-602
        • Djohan R.
        • Gage E.
        • Gatherwright J.
        • et al.
        Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study.
        Plast Reconstr Surg. 2010; 125: 818-829
        • Ramon Y.
        • Ullmann Y.
        • Moscona R.
        • et al.
        Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study.
        Plast Reconstr Surg. 1997; 99: 686-691
        • Wang H.T.
        • Barone C.M.
        • Steigelman M.B.
        • et al.
        Aesthetic outcomes in breast conservation therapy.
        Aesthet Surg J. 2008; 28: 165-170
        • Didier F.
        • Radice D.
        • Gandini S.
        • et al.
        Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?.
        Breast Cancer Res Treat. 2009; 118: 623-633
        • Few J.W.
        • Marcus J.R.
        • Casas L.A.
        • Aitken M.E.
        • Redding J.
        Long-term predictable nipple projection following reconstruction.
        Plast Reconstr Surg. 1999; 104: 1321-1324
        • Losken A.
        • Mackay G.J.
        • Bostwick 3rd, J.
        Nipple reconstruction using the C-V flap technique: a long-term evaluation.
        Plast Reconstr Surg. 2001; 108: 361-369