Nipple-Sparing Mastectomy and Immediate Implant-Based Breast Reconstruction: A Propensity Score Matched Analysis of Satisfaction and Health Related 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.

Prepectoral vs. Submuscular Implant-based Breast Reconstruction: A Matched-Pair Comparison of Outcomes

“…Many factors, such as radiation, have been shown to radically alter complication profiles of reconstruction. [53][54][55][56][57] It is important, therefore, to consider patient expectations and the patient experience in breast reconstruction. To this end, future work should include measurement of patient-reported outcomes and with longer follow-up.…”

Prior COVID-19 Infection Predisposes to Worse Outcomes After Autologous Breast Reconstruction

“…Propensity-score matching was performed using a 1:1 matching ratio with logistic regression using nearest-neighbor methodology with a tolerance level of 0.01 and difference between propensity scores of ≤0.1 11 . Consistent with current literature in breast reconstruction, our propensity-score matching model included the following baseline variables: age, race, Hispanic ethnicity, body mass index, essential hypertension, diabetes mellitus, history of breast cancer, history of chemotherapy, and history of radiation treatment 12,13 . Only baseline comorbidities documented within 1 year of reconstruction were included.…”

“…11 Consistent with current literature in breast reconstruction, our propensity-score matching model included the following baseline variables: age, race, Hispanic ethnicity, body mass index, essential hypertension, diabetes mellitus, history of breast cancer, history of chemotherapy, and history of radiation treatment. 12,13 Only baseline comorbidities documented within 1 year of reconstruction were included.…”

Propensity Scoring in Plastic Surgery Research: An Analysis and Best Practice Guide

“…16 As an illustration, consider a recent study performed at our institution comparing patient-reported outcomes among patients who had undergone implant-based reconstruction following nipple-sparing or skin-sparing mastectomies. 17 The primary aim was to compare these surgical methods and their impact on patient-reported outcomes by studying patients with an equal likelihood of receiving either nipple-sparing or skin-sparing mastectomy (mimicking the equal likelihood of treatment allocation in RCTs). Because we had only observational data from electronic medical records, patient selection needed to account for differences between the two groups in age, body mass index, race, smoking history, use of neoadjuvant chemotherapy, bra size, and psychiatric health, all of which affect mastectomy selection and patient-reported outcomes.…”