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Patient Demand for Customized NAC Epitheses: A Prospective, Multicenter Observational Study
Louisa Gnann1,2, Sonia Fertsch3, Christine Mau4
1Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland. louisagnann@gmx.de.
Background:
Nipple-areola complex (NAC) reconstruction is a key aspect of breast reconstruction (BR) following mastectomy, influencing quality of life (QOL) and patient satisfaction. Yet many women remain without NAC replacement, and reasons are not fully understood. Invasive options, including surgical NAC reconstruction and 3D tattooing, yield good results but are not suitable for all. Non-invasive alternatives, such as customized nipple epitheses (CNE), provide a promising solution but remain underutilized and often excluded from clinical guidelines and patient counseling. CNE are silicone-based, adhesive devices mimicking the contralateral or original NAC in color, shape, and projection. This study explores patient preferences and unmet needs regarding NAC replacement, with a focus on CNE.
Methods:
This multicenter prospective observational study included women with NAC loss due to breast surgery who had undergone BR without NAC reconstruction. Using a structured questionnaire, we assessed patient awareness, preferences, and decision-making regarding NAC replacement, with a focus on CNE. Additionally, we examined the influence of a missing NAC on QOL.
Results:
Of 105 participants, 82.9% considered NAC replacement. CNE were preferred by 20.2%, while surgical reconstruction was chosen by 56.4%. Women favoring CNE were generally older, earlier in recovery, and more likely to have undergone breast-conserving therapy (BCT), or skin-sparing mastectomy (SSM) followed by implant-based reconstruction (IBBR).
Conclusion:
Lack of patient education, rather than lack of interest, limits CNE adoption. CNE provide an early, customizable, cost-effective alternative that addresses limitations of current methods, highlighting the need for broader awareness and access to diverse NAC replacement options.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .