Table 2. Summary of studies on patient satisfaction with local flap nipple reconstruction.
| Study | Subjects (response rate) | Follow-up | Surgical technique | Responses considered “satisfied” | Satisfaction (%) | Other results | |
|---|---|---|---|---|---|---|---|
| Nipple appearance | Nipple sensation | ||||||
| Chen et al. (11) | 11 (100.0) | 12–27 months, mean 17 | Badge flap + tattooing on free or pedicled TRAM flap reconstruction | Score out of 100% | 90.5 | NA | Mean pigmentation score 8.5/10 |
| Cheng et al. (12) | 22 (88.0) | 6–36 months, mean 18 | Modified S dermal-fat flap + tattooing on free or pedicled TRAM, implant-only or LD + implant | Moderately pleased, very pleased | 86.4 | 13.6 | 50% satisfied with nipple projection; 90.9% satisfied with nipple symmetry; 54.5% satisfied with nipple size; 100% satisfied with nipple color; 100% would recommend the procedure |
| Costa and Ferreira (13) | 122 | Survey at 3 years | C-V flap + tattooing on double-pedicled TRAM or implant | Good, excellent | 92.6 | NA | 35% satisfaction in patients who underwent NAC reconstruction with skin graft from medial thigh |
| Didier et al. (1) | 92 (67.8) | Survey at 1 year | Unspecified | Quite a bit, much, very much | 43.0 | 20.0 | 72% felt sexually attractive compared to 98% pre-operatively; 34% found it difficult to look at themselves naked |
| El-Ali et al. (14) | 50 (100.0) | 6–36 months, mean 15.4 | Modified C-V flap + tattooing on LD, pedicled TRAM or implant | Good, very good | 80.0 | 28.0 (sensation present) | 82% satisfied with reconstructed NAC compared to opposite side; 82% reported body image improvement |
| Goh et al. (15) | 91 (100.0) | 1–86 months, mean 38.5* | Various flaps + tattooing on TRAM, DIEP, LD +/– implant or implant | Satisfactory, good, excellent | 88.0* | NA | 95% rated NAC position “about right”*; 87% rated NAC dimension “about right”*; 58% rated NAC projection “about right”* |
| Gullo et al. (16) | 161 | Survey at 1 year | Star flap enhanced by scar tissue° + tattooing on DIEP, TRAM or implant | Good (5–6.9/10), very good (³7/10) | 6.61/10 (SS =66.1%) | 4.11/10 (SS =41.1%) | Color satisfaction score of 6.36; position satisfaction score of 7.24; symmetry satisfaction score of 7.97 |
| Harcourt et al. (17) | 127 (51.4) | 3–84 months | Unspecified | Satisfied, very satisfied | 71.6 | 56.5 | 81.9% satisfied with nipple color; decision regret most strongly correlated with dissatisfaction and high depression score |
| Jabor et al. (18) | 43 (41.0) | ³6 months | Various flaps + immediate tattooing on TRAM, LD + implant or implant | Good, excellent | 64.0 | NA | No significant difference in NAC satisfaction with different breast mound or NAC types; factors most disliked in descending order: projection, color, size, texture, position; mean interval between mound and NAC reconstruction of 9.71 & 7.25 months in satisfied & unsatisfied patients, respectively (P=0.003) |
| Losken et al. (19) | 11 (“poor”) | 3–7 years, mean 5.3 | C-V flap + tattooing on TRAM flap | Score out of 100% | 81.0 | 26.0 | 42% satisfied with projection; 62% satisfied with pigmentation |
| Lossing et al. (20) | 21 (100.0) | 29–46 months, mean 36 | Modified S-flap + tattooing on lateral thoracodorsal flap | Score out of 10 | 8.2/10 (SS =82%) | 29.0 (sensation present) | Overall breast reconstruction satisfaction score of 8.9 |
| Otterburn et al. (22) | 199 | >1 year | C-V flap + tattooing on TRAM, implant or LD + implant | Score out of 5 | 3.8/5 (SS =76%) | 1.3/5 (SS =26%) | Color satisfaction score of 3.2/5; position satisfaction score of 4.2/5; projection satisfaction score of 3.3/5 |
| Valdatta et al. (23) | 29 (100.0) | Survey at 1 year | C-V flap + tattooing on | Score out of 10 | 6.65/10 (SS =66.5%) | 5.57/10 (SS =55.7%) | Color satisfaction score of 6.14; position satisfaction score of 7.85; projection satisfaction score of 6.28; symmetry satisfaction score of 7.42 |
*, data includes results for ten additional patients who underwent composite nipple sharing; ˚, primary procedure in 98 patients, secondary procedure for projection failure in 63 patients. TRAM, transverse rectus abdominus muscle; NA, not applicable; LD, latissimus dorsi muscle; NAC, nipple-areolar complex; DIEP, deep inferior epigastric perforator flap.