Nipple-Sparing Mastectomy: Initial Experience Evaluating Patients Satisfaction and Oncological Safety in a Tertiary Care Centre in Jordan

Abstract

Introduction Nipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety. Methods and results Four nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%. Conclusion Following nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.

Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review

“… Breast-reconstruction-specific PROM used? Used validated PROM(s) Used PROM(s) validated for country/language of interest AbuElnga 2021 [ 21 ] Custom questionnaire ✓ ✓ Aguiar 2017 [ 22 ] BREAST-Q ✓ ✓ ✓ ✓ Archangelo 2019 [ 23 ] Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), Body Dysmorphic Disorder Examination (BDDE) ✓ ✓ Athamnah 2021 [ 24 ] BREAST-Q ✓ ✓ ✓ Unspecified Chang 2007 [ 25 ] Functional Assessment of Chronic Illness Therapy–Breast, traditional Chinese version 4 (FACIT-B) ✓ ✓ Unspecified Cortes-Flores 2014 [ 26 ] European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, core version 30 (EORTC QLQ-C30), EORTC QLQ-BR23 ✓ ✓ ✓ Cortes-Flores 2017 [ 27 ] FSFI (Female Sexual Function Index) ✓ ✓ Denewer 2012 [ 28 ] Breast impact of treatment scale (BITS), Body satisfaction scale (BSS) ✓ ✓ Fonte...…”

Hyperbaric Oxygen Therapy for Threatened Nipple-Sparing Mastectomy Flaps

“…[2][3][4][6][7][8][15][16][17] Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement. [2][3][4][5][6]9,16 However, ischemia-related complications due to increased perfusion requirements of the breast skin and NAC remains a significant issue, with the prevalence of ischemic complications ranging from 2% to 30% in the literature. [6][7][8] With the resurgence of prepectoral positioning of implants, early identification of ischemia is even more paramount.…”

“…Nipple-sparing mastectomy has been proven to be oncologically safe in appropriately selected patients for the treatment of invasive breast cancer and breast cancer prophylaxis while also producing superior aesthetic results compared with simple and skin-sparing mastectomies 2–4,6–8,15–17 . Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement 2–6,9,16 .…”

“…Nipple-sparing mastectomy has been proven to be oncologically safe in appropriately selected patients for the treatment of invasive breast cancer and breast cancer prophylaxis while also producing superior aesthetic results compared with simple and skin-sparing mastectomies. [2][3][4][6][7][8][15][16][17] Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement. [2][3][4][5][6]9,16 However, ischemia-related complications due to increased perfusion requirements of the breast skin and NAC remains a significant issue, with the prevalence of ischemic complications ranging from 2% to 30% in the literature.…”