Comparison of nipple sparing and skin sparing mastectomy with immediate reconstruction based on patient reported outcomes

Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are widely accepted surgical options for breast cancer patients undergoing immediate reconstruction. However, the impact of preserving the nipple-areolar complex on patient-reported outcomes (PROs) remains uncertain, particularly in clinically matched settings. This retrospective study included patients who underwent unilateral NSM or SSM followed by immediate implant-based breast reconstruction at Hubei Cancer Hospital between January 2022 and January 2024. Patients were propensity score matched (2:1) based on age, body mass index, preoperative breast size, neoadjuvant chemotherapy, implant plane, and postmastectomy radiation therapy. PROs were assessed using the BREAST-Q (version 2.0) and the decision regret scale. Univariate and multivariate linear regression analyses were conducted to identify predictors of satisfaction and regret. A total of 87 patients were included after matching (NSM: n = 58; SSM: n = 29). NSM patients reported significantly higher satisfaction with breasts (mean 58.1 vs. 52.9, P = 0.038) and sexual well-being (mean 52.4 vs. 38.9, P = 0.035). Although psychosocial well-being and decision regret showed favorable trends in the NSM group, differences were not statistically significant. Multivariate analysis revealed that reduction in breast size was significantly associated with decreased satisfaction and psychosocial well-being, while increased breast size was linked to greater decision regret. No significant differences were observed in complication rates between groups. Notably, none of the SSM patients received nipple reconstruction during follow-up. NSM was associated with greater satisfaction in breast and sexual well-being compared to SSM in matched breast cancer patients undergoing implant-based reconstruction. These findings support prioritizing NSM when oncologically feasible and highlight the potential role of delayed nipple reconstruction and expectation management in improving postoperative satisfaction for SSM patients.