Sexual Well-Being After Nipple-Sparing Mastectomy: Does Preservation of the Nipple Matter?

Jennifer M Racz; Christin A Harless; Tanya L Hoskin; Courtney N Day; Minh-Doan T Nguyen; Ann M Harris; Judy C Boughey; Tina J Hieken; Amy C Degnim

doi:10.1245/s10434-022-11578-1

Sexual Well-Being After Nipple-Sparing Mastectomy: Does Preservation of the Nipple Matter?

Ann Surg Oncol. 2022 Apr 6. doi: 10.1245/s10434-022-11578-1. Online ahead of print.

Authors

Jennifer M Racz¹, Christin A Harless², Tanya L Hoskin³, Courtney N Day³, Minh-Doan T Nguyen², Ann M Harris³, Judy C Boughey², Tina J Hieken², Amy C Degnim^{4

5}

Affiliations

¹ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
² Department of Surgery, Mayo Clinic, Rochester, MN, USA.
³ Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Surgery, Mayo Clinic, Rochester, MN, USA. degnim.amy@mayo.edu.
⁵ Mayo Clinic Rochester, Rochester, MN, USA. degnim.amy@mayo.edu.

PMID: 35385996
DOI: 10.1245/s10434-022-11578-1

Abstract

Introduction: The primary aim of this study was to evaluate patient-reported outcome measures in patients undergoing mastectomy with and without breast reconstruction (immediate or delayed) with and without nipple preservation.

Methods: All female patients undergoing mastectomy between 2011 and 2015 at Mayo Clinic Rochester were identified and were mailed the BREAST-Q survey. Breast satisfaction, psychosocial well-being, and sexual well-being were evaluated and compared by surgery type using Wilcoxon rank-sum tests for univariate analysis and linear regression for multivariable analysis adjusting for potential confounders.

Results: Of 1547 patients, 771 completed the BREAST-Q survey (response rate 50%). Of these 771 respondents, 237 (31%) did not have reconstruction, 198 (26%) had nipple-sparing mastectomy with reconstruction (NSM), and 336 (44%) had skin-sparing mastectomy with reconstruction (SSM) ± nipple-areolar complex (NAC) reconstruction (via surgery ± tattoo). Patients with breast reconstruction had consistently higher BREAST-Q scores versus those without. Comparing NSM with all SSMs, there was no difference in satisfaction with breasts (mean 71.8 vs. 70.2, p = 0.21) or psychosocial well-being (mean 81.9 vs. 81.3, p = 0.47); however, sexual well-being was significantly higher in the NSM group on univariate (mean 64.5 vs. 58.0, p = 0.002) and multivariable (β = -4.69, p = 0.03) analysis. Sexual well-being scores were similar for NSM and the SSM subgroups with any type of NAC reconstruction.

Conclusions: This study demonstrates that NSM positively impacts patient sexual well-being after breast reconstruction compared with SSM, particularly SSM without nipple reconstruction or tattoo. SSM with any type of NAC reconstruction achieved similar satisfaction and sexual well-being to those undergoing NSM.