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Background <p>Nipple-sparing mastectomy (NSM) confers similarly excellent patient-reported outcomes (PROs) as skin-sparing mastectomy; however, the relative weight of individual patient- and treatment-related factors on satisfaction with breasts and psychosocial well-being following NSM is unclear. We assessed predictors of PROs following NSM.</p> Methods <p>Patients undergoing NSM between April 2018 and July 2021 at a single institution were included in a prospective examination. Routinely collected preoperative and postoperative BREAST-Q responses were recorded. Univariable and multivariable linear regression identified predictors of satisfaction with breasts and psychosocial well-being.</p> Results <p>333 patients underwent NSM; median age was 43 years (interquartile range [IQR] 37–49 years). Of patients, 86% received two-stage reconstruction with tissue expander (TE) followed by an implant; 12% received postmastectomy radiation (PMRT). At 1 year, receipt of PMRT predicted lower satisfaction (<i>b</i> = − 32 [95% confidence interval (CI) − 42– − 22], <i>p</i> &lt; 0.001) and psychosocial well-being (<i>b</i> = − 43 [− 56– − 30], <i>p</i> &lt; 0.001), as did TEs, compared with autologous tissue reconstruction for both satisfaction (<i>b</i> = −15 [− 27– − 3.4], <i>p</i> = 0.012) and well-being (<i>b</i> = −31 [− 52– − 11], <i>p</i> =0.004). At 2 years, PMRT remained a significant negative predictor of satisfaction (<i>b</i> = −14 [95% CI −24– − 3.5], <i>p</i> = 0.009) and well-being (<i>b</i> = −16 [95% CI −31– − 0.97], <i>p</i> = 0.04) but reconstruction type was not (<i>p</i> = ns). Full-thickness skin-flap necrosis predicted poorer satisfaction at 1 year (<i>b</i> = −19 [95% CI − 34– − 4.6], <i>p</i> = 0.01) but not at 2 years (<i>p</i> = ns). Higher preoperative psychosocial well-being was positively associated with postoperative scores at 1 and 2 years.</p> Conclusions <p>Receipt of PMRT is persistently and negatively associated with PROs at up to 2 years after NSM. Longer follow-up is needed to assess the impact of reconstruction type on these outcomes.</p>

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Predictors of Satisfaction with Breasts and Psychosocial Well-Being After Nipple-Sparing Mastectomy

  • 期刊论文

  • 发表日期：

    2026年4月30日

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  • Kate R. Pawloski,
  • Jonas A. Nelson,
  • Varadan Sevilimedu,
  • Tiana Le,
  • Audree B. Tadros,
  • Monica Morrow,
  • Virgilio Sacchini,
  • Tracy-Ann Moo

摘要

Background

Nipple-sparing mastectomy (NSM) confers similarly excellent patient-reported outcomes (PROs) as skin-sparing mastectomy; however, the relative weight of individual patient- and treatment-related factors on satisfaction with breasts and psychosocial well-being following NSM is unclear. We assessed predictors of PROs following NSM.

Methods

Patients undergoing NSM between April 2018 and July 2021 at a single institution were included in a prospective examination. Routinely collected preoperative and postoperative BREAST-Q responses were recorded. Univariable and multivariable linear regression identified predictors of satisfaction with breasts and psychosocial well-being.

Results

333 patients underwent NSM; median age was 43 years (interquartile range [IQR] 37–49 years). Of patients, 86% received two-stage reconstruction with tissue expander (TE) followed by an implant; 12% received postmastectomy radiation (PMRT). At 1 year, receipt of PMRT predicted lower satisfaction (b = − 32 [95% confidence interval (CI) − 42– − 22], p < 0.001) and psychosocial well-being (b = − 43 [− 56– − 30], p < 0.001), as did TEs, compared with autologous tissue reconstruction for both satisfaction (b = −15 [− 27– − 3.4], p = 0.012) and well-being (b = −31 [− 52– − 11], p =0.004). At 2 years, PMRT remained a significant negative predictor of satisfaction (b = −14 [95% CI −24– − 3.5], p = 0.009) and well-being (b = −16 [95% CI −31– − 0.97], p = 0.04) but reconstruction type was not (p = ns). Full-thickness skin-flap necrosis predicted poorer satisfaction at 1 year (b = −19 [95% CI − 34– − 4.6], p = 0.01) but not at 2 years (p = ns). Higher preoperative psychosocial well-being was positively associated with postoperative scores at 1 and 2 years.

Conclusions

Receipt of PMRT is persistently and negatively associated with PROs at up to 2 years after NSM. Longer follow-up is needed to assess the impact of reconstruction type on these outcomes.