Postoperative Quality of Life (BREAST‐Q) in Patients With Breast Cancer After Nipple‐Sparing Mastectomy With/Without Reconstruction

BACKGROUND: Recent advances in multi-modality treatments (including systemic chemotherapy, endocrine therapy, and radiotherapy) have led to a paradigm shift in the surgical management of breast cancer toward less aggressive approaches. This evolution has established breast-conserving (or breast-reconstructive) surgery as the new standard of care, placing a greater emphasis on aesthetic outcomes. Nipple-sparing mastectomy (NSM) has emerged as an oncologically safe option that is increasingly paired with immediate or delayed breast reconstruction. The NSM approach is also used prophylactically for high-risk individuals with BRCA gene mutations. Compared with traditional total mastectomy, an NSM with breast reconstruction preserves the nipple-areolar complex (NAC), offering significant psychosocial and aesthetic advantages that improve patients' cosmetic appearance and body image. However, some breast cancer patients hesitate to undergo the second stage of breast reconstruction after completing the initial NSM. PATIENTS AND METHODS: We conducted a retrospective cohort study using the BREAST-Q questionnaire to assess the postoperative satisfaction and quality of life (QOL) among patients with breast cancer who underwent an NSM with or without subsequent breast reconstruction. RESULTS: We analyzed the cases of 73 patients who underwent breast cancer surgery between December 2016 and December 2022 at a single institution. The cohort was divided into two groups: the breast reconstruction (BR) group (n = 45), that is, the patients who underwent tissue expander or silicone breast implant reconstruction after an NSM, and the non-breast reconstruction (NBR) group (n = 28), comprising patients who underwent an NSM with no intent to pursue subsequent reconstruction. We evaluated and compared the post-NSM overall BREAST-Q scores between the BR and NBR groups. CONCLUSIONS: The results revealed no significant difference in overall postoperative satisfaction or QOL between the BR and NBR groups. However, the BR group demonstrated significantly higher scores in the specific domains of psychosocial and sexual well-being, a trend that was particularly pronounced among the patients with small-to-intermediate breast volumes.