Background: Nipple areola complex (NAC) reconstruction is the final stage in breast reconstruction for many women. Although population preferences toward NAC cosmesis have been investigated, it is unclear if these preferences align with those of women undergoing NAC reconstruction. This study aimed to assess the aesthetic and sensory preferences of women following mastectomy to inform subsequent NAC reconstruction. Methods: We distributed a survey containing software-edited patient photographs to evaluate preferences in NAC position, diameter, and pigmentation, to Facebook groups for women undergoing breast reconstruction. We also queried respondents regarding the importance of NAC sensation to their sexuality, quality of life, self-esteem, body image, and gender identity. Results: We received 109 responses from women with a mean age of 52.7 years (SD 9.04 years). Most women were White (93.6%) and had undergone autologous (n = 76, 69.7%) or implant-based (n = 25, 22.9%) reconstruction. Respondents most preferred NACs positioned middle (y-axis) and lateral (x-axis) on round breasts and inferolaterally on teardrop-shaped breasts. Regardless of underlying breast shape, the most popular NAC diameter was 38 mm, followed by 42 mm. Respondents preferred NACs pigmented one shade darker than the underlying skin tone for all except Fitzpatrick III breasts, where pigmentation equal to skin tone was preferred. Patients reported that NAC appearance, tactile sensation, and erogenous sensation were more important for sexuality (53%) than for quality of life (36%), self-esteem (34%), body image (33%), or gender identity (24%). Conclusions: Women after mastectomy in this survey most preferred a NAC pigmented one tone darker than their skin tone and sized one quarter the base width of their breast. Middle (y-axis) and lateral (x-axis) NAC positioning was preferred on round breasts, and inferolateral positioning was preferred on teardrop-shaped breasts. Patients reported that tactile and erogenous sensation were most important for sexual wellness.
