Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?

Abstract

We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P \ .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.

Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

“…3,4 Despite outstanding benefit of preventive bilateral mastectomy, the procedure has its attendant consequences as women who have had removal of both breasts experienced varying degree of psychological effects and consequences on their feminine personality. 8,9,22 Putting in place mechanisms to improve information on breast cancer including its risk factors especially in rural areas would in prospect improve the health seeking behaviour thereby influencing early presentation of patient with breast cancer.…”

“…19 In addition studies by den Heijer et al, Nelson et al and Didier also reiterated the role of body image on acceptance, satisfaction and psychological adjustment following mastectomy. 8,9,23 Other reasons proffered were fear of surgery, husband opposition to such a procedure and lack of understanding of the benefits of the surgery. This finding was comparable to a study by Stefanek et al when he assessed the interest of women at average-risk and highrisk in preventive bilateral mastectomy.…”

“…8,9 Existing data suggest, that preventive mastectomy may significantly prevent or reduce the risk of breast cancer by about 100% in moderate-risk women and 90-95% in high-risk women. 10 These figures far exceeds reduction achieved by other preventive measures such as Clinical Breast Examination (CBE) which reduce the risk by 40-45% and mammography by 45-67%.…”

Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

“…a patient's native nipple using a nipple-sparing mastectomy (NSM) technique may obviate this reconstructive step (1)(2)(3)(4)(5)(6)(7)(8), it is sometimes not an option for patients from an oncologic perspective.…”

“…More often, however, local tissue rearrangement is used to create a nipple, followed by tattooing of the reconstructed nipple and the surrounding skin that is to become the areola. A variety of local flaps has been described in the literature (1,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”