Determinants of Nipple-Areola Complex Reconstruction After Breast Reconstruction: A Preference-Sensitive Decision Rather Than a Predictable Final Step
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Updated: Nov 1, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Daihun Kang1,2, Seung Eun Hong3,4
1Department of Plastic and Reconstructive Surgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Background:
Nipple-areola complex reconstruction (NACR) is commonly regarded as the final stage of breast reconstruction, yet a substantial proportion of patients do not pursue NACR despite technically successful breast mound reconstruction. The factors influencing this decision remain incompletely understood.
Methods:
This retrospective cohort study included patients who underwent skin-sparing mastectomy followed by immediate breast reconstruction at a single university-affiliated hospital between January 2020 and December 2024, with a minimum postoperative follow-up of 12 months. Clinical and treatment-related factors associated with the decision to undergo NACR were analyzed using Firth penalized logistic regression.
Results:
Among 57 eligible patients, 19 (33.3%) underwent NACR. Increasing age (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.65-0.89; p = 0.001), receipt of adjuvant radiotherapy (adjusted OR, 0.02; 95% CI, 0.00-0.33; p = 0.006), and postoperative complications (adjusted OR, 0.03; 95% CI, 0.00-0.37; p = 0.007) were independently associated with a decreased likelihood of NACR. The primary model demonstrated good apparent discrimination (AUROC, 0.939; 95% CI, 0.848-1.000). Reconstruction modality, patient-reported aesthetic satisfaction, and follow-up duration were not independently associated with NACR.
Conclusion:
Cumulative treatment burden and postoperative recovery experiences, rather than reconstructive technique or satisfaction, appear to shape patient decisions regarding NACR, supporting its conceptualization as a preference-sensitive decision within the broader context of survivorship. Given the small sample, the model performance reflects apparent performance and should be regarded as exploratory and hypothesis-generating.
Level Of Evidence Iv:
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