Effect of Nipple-Areola Complex Reconstruction on BREAST-Q Outcomes after Implant-Based Breast Reconstruction.

Abstract

The nipple-areola complex (NAC) is essential for breast aesthetics and self-image. However, large-scale studies on patient satisfaction after NAC reconstruction in implant-based breast reconstruction are limited, especially those accounting for confounders. This study aimed to evaluate the long-term impact of NAC reconstruction on patient-reported outcomes using the BREAST-Q, hypothesizing that NAC reconstruction would yield better patient-reported outcomes than no reconstruction. A single-center retrospective analysis of patients who underwent skin-sparing mastectomy with 2-stage alloplastic reconstruction between 2015 and 2021 was performed. NAC reconstruction methods included local flaps and tattoos. Patients were excluded if they had nipple-sparing mastectomy, autologous reconstruction, adjuvant radiation, direct-to-implant or unilateral reconstruction, or incomplete BREAST-Q data. BREAST-Q was assessed preoperatively and 2 years after implant exchange. Overall, 372 patients were included in the study, with 210 not undergoing NAC reconstruction and 162 undergoing NAC reconstruction within 2 years of implant exchange. Preoperatively, no significant difference existed between cohorts for all BREAST-Q domains. Postoperatively, patients undergoing NAC reconstruction reported significantly higher scores across all BREAST-Q domains, with clinically meaningful improvements in Sexual Well-Being and Satisfaction with Breasts. Analysis of the change in BREAST-Q scores from preoperatively to 2 years postoperatively revealed significant improvements in Sexual Well-Being (+6 points; P = 0.006) and Satisfaction with Breasts (+9 points; P = 0.003) among patients who underwent NAC reconstruction compared with patients who did not undergo NAC reconstruction. NAC reconstruction enhances patient satisfaction after implant-based breast reconstruction. Providers should discuss these benefits with appropriate patients, emphasizing the potential impact on breast satisfaction and sexual well-being.