Patient satisfaction after nipple-sparing mastectomy with intraoperative radiotherapy and breast reconstruction for breast cancer

Abstract

Introduction

The use of nipple-sparing mastectomy (NSM) combined with breast reconstruction is increasing in breast cancer surgeries despite its controversial safety profile. To reduce the recurrence rate of tumors in the nipple-areola complex (NAC), we used intraoperative radiotherapy (IORT). The purpose of this study was to explore patients’ feedback on this novel treatment strategy.

Patients and methods

From January 2014 to May 2018, eligible patients with breast cancer were enrolled in this study and separated into 2 groups. Patients in the NSM group underwent IORT to the NAC flap, and patients in the skin-sparing mastectomy (SSM) group underwent SSM and breast reconstruction. The postoperative satisfaction was collected and assessed using the Breast-Q reconstruction questionnaire and a standardized questionnaire; this was compared between the 2 groups.

Results

There were 46 patients (52 NSMs) in the NSM group and 20 patients (22 SSMs) in the SSM group. The breast-Q scores were higher in the NSM group than the SSM group, with trends for a ‘higher satisfaction with breasts’ (67.39 ± 20.59 vs. 55.00 ± 19.33; p = 0.026) and ‘higher sexual well-being’ (61.74 ± 22.24 vs. 49.50 ± 20.12; p = 0.039). All the patients recognized the importance of nipple preservation. Thirty-seven women (80.40%) were satisfied or very satisfied with the appearance and shape of the NAC in the NSM group, while 38/46 women (82.60%) were very unsatisfied or unsatisfied with the sensitivity of the nipples.

Conclusions

The Breast-Q scores showed great satisfaction with breasts and sexual well-being in the NSM group. However, more effort should be made in improving postoperative NAC sensitivity.

Keywords:

• Breast cancer
• intraoperative radiotherapy
• nipple-sparing mastectomy
• patient satisfaction
• Breast-Q

Acknowledgments

All authors provided a critical review of the manuscript and approved the final draft for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Health and Family Planning Technology Project of Guangzhou Municipal Health and Family Planning under Grant number [20181A011063]; the Medical Scientific Research Foundation of Guangdong Province and under Grant number [B2021098]; the Basic Research Projecty of Guangzhou Science and Technology Bureau [202102010147].