Nipple reconstruction in autologous breast reconstruction after areola-sparing mastectomy

Abstract

Introduction: The number of patients requesting prophylactic mastectomy with immediate reconstruction is rising. The oncological safety of techniques preserving the nipple and/or areola complex is still controversial. Nevertheless, nipple-sparing mastectomy (NSM) and areola-sparing mastectomy (ASM) are becoming increasingly popular. After ASM, traditional nipple reconstruction techniques can be a disappointment and can lead to a deep groove around the new nipple. We describe a technique to overcome these issues and analyzed how three types of mastectomy (skin-sparing mastectomy or SSM, ASM, and NSM) compare to one another by looking into the number of wound infections, extra procedures for the loss of projection, nipple necrosis, and BREAST-Q scores.

Methods: We retrospectively analyzed 467 breast reconstructions performed in 351 patients between 2011 and 2017 at the University Hospital of Gent. Patients were asked to fill out the BREAST-Q questionnaire and patient-reported outcomes were analyzed and correlated to demographic information.

Results: Patients undergoing a nipple reconstruction after ASM are experiencing similar rates of wound problems, extra surgical procedures for the loss of projection and necrosis, compared to women with a history of SSM. When considering the "satisfaction with breast" and "satisfaction with outcome" modules of the BREAST-Q, we noted that nipple-sparing mastectomy (NSM) patients report lower scores than SSM and ASM patients and ASM patients seem to report a higher "satisfaction with nipple," than the other two treatment groups.

Conclusion: An ASM is a valuable alternative to a nipple-sparing mastectomy and leads to a good esthetic result and patient satisfaction.

Keywords: Microsurgery; Patient reported outcomes.