Predictors of Satisfaction with Breasts and Psychosocial Well-Being After Nipple-Sparing Mastectomy

Nipple-sparing mastectomy (NSM) confers similarly excellent patient-reported outcomes (PROs) as skin-sparing mastectomy; however, the relative weight of individual patient- and treatment-related factors on satisfaction with breasts and psychosocial well-being following NSM is unclear. We assessed predictors of PROs following NSM.

Patients undergoing NSM between April 2018 and July 2021 at a single institution were included in a prospective examination. Routinely collected preoperative and postoperative BREAST-Q responses were recorded. Univariable and multivariable linear regression identified predictors of satisfaction with breasts and psychosocial well-being.

333 patients underwent NSM; median age was 43 years (interquartile range [IQR] 37-49 years). Of patients, 86% received two-stage reconstruction with tissue expander (TE) followed by an implant; 12% received postmastectomy radiation (PMRT). At 1 year, receipt of PMRT predicted lower satisfaction (b = - 32 [95% confidence interval (CI) - 42- - 22], p < 0.001) and psychosocial well-being (b = - 43 [- 56- - 30], p < 0.001), as did TEs, compared with autologous tissue reconstruction for both satisfaction (b = -15 [- 27- - 3.4], p = 0.012) and well-being (b = -31 [- 52- - 11], p =0.004). At 2 years, PMRT remained a significant negative predictor of satisfaction (b = -14 [95% CI -24- - 3.5], p = 0.009) and well-being (b = -16 [95% CI -31- - 0.97], p = 0.04) but reconstruction type was not (p = ns). Full-thickness skin-flap necrosis predicted poorer satisfaction at 1 year (b = -19 [95% CI - 34- - 4.6], p = 0.01) but not at 2 years (p = ns). Higher preoperative psychosocial well-being was positively associated with postoperative scores at 1 and 2 years.

Receipt of PMRT is persistently and negatively associated with PROs at up to 2 years after NSM. Longer follow-up is needed to assess the impact of reconstruction type on these outcomes.