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COMPARING THE PSYCHOLOGICAL AND COSMETIC OUTCOMES OF NIPPLE-SPARING MASTECTOMY WITH SIMPLE MASTECTOMY
Sara Kryeziu, BS, Tara L. Huston, MD, Christine Rizk, MD.
Stony Brook University School of Medicine, Stony Brook, NY, USA.

BACKGROUND: Post-mastectomy reconstruction of the nipple-areolar complex is a crucial factor in a woman's satisfaction with reconstruction and psychological well-being. Nipple-Sparing Mastectomy (NSM) removes the major ducts of the nipples while preserving the dermis and epidermis. As a result, NSM preserves the natural appearance of the breast and may preserve nipple sensation and erectile function. The purpose of this pilot study was to investigate the influence that NSM has on women's body-image and sexuality and to assess the level of satisfaction with breast reconstruction.
METHODS: Participants in this retrospective pilot study included patients of the Carol Baldwin Breast Care Clinic at Stony Brook University Hospital who had NSM or simple mastectomy between June 2010 and June 2014. Mail-back questionnaires were sent out to 30 simple mastectomy patients and 42 nipple-sparing mastectomy patients. The questionnaire was adapted from the validated Sexual Adjustment and Body Image (SABIS) survey. Responses were collected from 15 NSM patients and 17 simple mastectomy patients. Descriptive statistics were used to summarize demographic data and patient responses. The Freeman-Halton extension of the Fisher's exact test was used to determine significant differences between the two groups. Significance was defined as p≤0.05.
RESULTS: Worsened body image was reported in 53.3% of patients who had NSM as compared with 29.4% of patients who had simple mastectomy. Negative effects on sexual satisfaction and sexual relationships were reported in a greater percentage of NSM patients than simple mastectomy patients. Following reconstruction, 40% of NSM patients reported being satisfied with nipple sensation and 66.7% of NSM patients with erectile function of the nipple. Average satisfaction with nipple appearance and position was greater in NSM patients than in simple mastectomy patients. In assessing the factors that may influence a patient's decision to undergo mastectomy, a greater number of NSM patients responded that genetic testing and the option of nipple-sparing was extremely important than simple mastectomy patients.
CONCLUSION: The preliminary data suggest that although patients undergoing NSM have a higher level of satisfaction with aesthetic outcomes of breast reconstruction, they may also experience more negative effects on body image and sexuality than do patients undergoing simple mastectomy. It is possible that patients who opt for NSM have higher expectations regarding the procedural outcomes, underestimating the effects of reconstructive surgery. Patient factors including self-consciousness and self-awareness may also contribute to psychological adjustment following mastectomy and should be explored further. Patients undergoing NSM, especially prophylactically, should be extensively counseled on the possible detrimental effects that they may experience as a result of mastectomy and breast reconstruction.


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