Related Experiment Video
Updated: Jun 15, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction: an 8-year outcome study
Risal Djohan1, Earl Gage, James Gatherwright
1Department of Plastic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. djohanr@ccf.org
Background:
Nipple-sparing mastectomy has become an accepted treatment for appropriately selected breast cancers. No reports have correlated patient satisfaction following nipple-sparing mastectomy with objective observer assessments.
Methods:
From 2001 to 2008, nipple-sparing mastectomy and immediate reconstruction were performed on 141 patients. After institutional review board approval, patients completed questionnaires rating their satisfaction with various aspects of their nipple-areola complex using a Likert-type scale. Three independent observers then reviewed the nipple-areola complex in 34 patients and rated the outcome using the same scale.
Results:
The survey completion rate was 53 percent and the mean follow-up was 50.4 months (range, 9 to 100 months). A majority of patients rated appearance, symmetry, color, position, and texture as good or excellent. A majority of patients rated sensation and arousal as fair or poor. Fifty-seven patients (73.1 percent) stated they would definitely undergo nipple-sparing mastectomy again. Patients with larger volumes of breast tissue removed (p = 0.010), larger preoperative body mass index (p = 0.034), or larger tissue expander volumes (p = 0.007) reported lower satisfaction. Patient assessments for appearance, color, symmetry, and position correlated with those of objective observers.
Conclusions:
The authors' study is the largest series to address patient satisfaction with the nipple-areola complex following nipple-sparing mastectomy and the only one to correlate patient self-assessment with assessment by independent observers. Overall, patients were very satisfied with appearance of the nipple-areola complex and most would choose nipple-sparing mastectomy again. A majority of patients rated sensation as fair or poor, with sensation constituting the most frequent aspect of the nipple-areola complex that patients would change. Larger body mass index, expander volumes, and volume of breast tissue removed may predict dissatisfaction postoperatively.