Nipple-Sparing Mastectomy and Immediate Implant-Based Breast Reconstruction - A Propensity Matched Analysis of Clinical and Health-Related Quality of Life Outcomes
George Kokosis, MD, Scott West, MPH, Carrie Stern, MD, Thais O. Polanco, MD, Meghana G. Shamsunder, MPH, Vadehi G. Patel, BS, Hanna Slutsky, BS, Monica Morrow, MD, Tracey-Ann Moo, MD, Virgilio Sacchini, MD, Michelle Coriddi, MD, Peter Coriddi, MD, Evan Matros, MD, MMSc, MPH, Joseph Disa, MD, Babak Mehrara, MD, Jonas A. Nelson, MD, MPH.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
BACKGROUND: Nipple-sparing mastectomy (NSM) has the potential to improve breast cosmesis following mastectomy and reconstruction in selected patients. Current clinical and patient-reported health-related quality of life (HR-QoL) outcome studies however are limited and demonstrate mixed results. This study aims to examine clinical and HR-QoL outcomes through a matched analysis of NSM and skin sparing mastectomy (SSM) patients with implant-based reconstruction using the BREAST-Q. METHODS: A Propensity score matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing NSM and SSM with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, BMI, race, smoking history, chemotherapy status, reconstruction type, bra size, and history of psychiatric diagnosis. Outcomes of interest included complications and BREAST-Q scores.
RESULTS: Overall 1717 patients were examined for matching, with 488 patients (244 NSM and 244 SSM) included in the final analyses. Matched NSM and SSM patients did not significantly differ in baseline, cancer, and surgical characteristics. NSM patients demonstrated a complication profile similar to SSM patients. Mastectomy skin flap necrosis rates were slightly higher in NSM patients (9% vs. 7.4%, p=0.62), though non-significant. Postoperative satisfaction with breast scores did not significantly differ and demonstrated stability over a 3-year time period in both cohorts. Additionally, all HR-QoL domains demonstrated no significant differences. CONCLUSIONS: In this matched analysis of bilateral mastectomy patients without radiation, NSM with immediate implant-based reconstruction did not improve patient reported outcomes or clinical outcomes compared to SSM, though results were stable over time.
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