Breast sensation following nipple-sparing mastectomy versus breast-conserving surgery: a mixed-methods study

Nipple-sparing mastectomy (NSM) and breast-conserving surgery (BCS) allow for preservation of the breast or nipple-areolar complex (NAC). However, this does not guarantee retained sensation in these regions. The prevalence of altered post-operative sensation and its importance to patients remains unclear.

This study aims to determine the prevalence of breast and NAC sensation loss in NSM and BCS; to assess its importance to patients; and to compare these outcomes between NSM and BCS.

The BREAST-Q Sensation Module and four study-specific questions were sent to NSM or BCS patients at the Westmead Breast Cancer Institute. Comparisons were made between NSM versus BCS, implant-based versus tissue-based NSM reconstruction, BCS with versus without a formal mammaplasty, and treatment with radiotherapy versus without. Semi-structured interviews were also held.

78.8 % and 79.3 % of women experienced breast and/or NAC sensation change, respectively (n = 174). 69.9 % and 44.6 % of NSM patients retained varying levels of breast and NAC sensation, respectively (n = 83). 58.4 % and 60.5 % of BCS patients encountered breast and NAC sensation decrease, respectively (n = 91). Interviews (n = 34) showed that preserved sensation was sometimes of an altered quality and involved neuropathic symptoms. BREAST-Q Sensation scores were worse for NSM than for BCS. NSM reconstruction type did not impact outcomes. NSM patients with radiotherapy had worse BREAST-Q Symptoms scores than those without. BCS mammaplasty status did not influence outcomes, except for patient-reported NAC sensation. Sensation was important to 79.8 % of respondents. NAC sensation was more important to NSM than to BCS patients.

Altered sensation is prevalent and significant to both NSM and BCS patients. Future research relating these findings to intraoperative techniques is required.