Background: The effect of postoperative sensation on quality-of-life (QoL) following nipple-sparing mastectomy (NSM) with implant-based reconstruction is not well-described. We evaluated the impact of breast and nipple sensation on QoL using BREAST-Q.
Methods: Patients undergoing NSM with implant reconstruction from 2008-2020 were mailed a survey to characterize their postoperative sensation. BREAST-Q metrics were compared between totally numb patients and those with sensation.
Results: A total of 349 patients were included. Overall, 131 (38%) responded; response rates regarding breast and nipple sensation were 36% (N=124/349) and 34% (N=117/349). Median time from surgery to survey completion was 6 years. The majority had bilateral procedures (101, 77%), including direct-to-implant (99, 76%) and tissue expander (32, 24%) reconstruction. Regarding breast sensation (Table 1), the majority of patients reported their reconstructed breasts as totally numb (47, 38%) or much less sensation than before surgery (59, 48%). Regarding nipple sensation, the majority of patients reported their nipples were totally numb (67, 57%) or had much less sensation than before surgery (37, 32%). Total numbness of reconstructed breasts resulted in a significantly lower chest physical well-being (Mean Score 73.5 vs. 81.2 respectively, P=0.048, Table 2). Total numbness of postoperative nipple(s) resulted in significantly lower chest physical (Mean Score 74.8 vs. 85.2 respectively, P=0.007), psychosocial (Mean Score 77.4 vs. 84.4 respectively, P=0.041), and sexual well-being (Mean Score 55.7 vs. 68.3 respectively, P=0.002).
Conclusions: Long-term breast and nipple sensation are significantly diminished after NSM with implant reconstruction. Patients with preserved sensation experience better physical, psychosocial, and sexual well-being.