Satisfaction with Long-Term Aesthetic and 10 Years Oncologic Outcome following Risk-Reducing Mastectomy and Implant-Based Breast Reconstruction with or without Nipple Preservation

SIMPLE SUMMARY: Women at significant increased risk of developing breast cancer may choose to undergo removal of both breasts (mastectomy) with reconstruction of the breasts using silicone implants. This study aimed to compare satisfaction, aesthetic and cancer related outcomes in women undergoing bilateral mastectomy comparing those who had the nipples removed and then a nipple reconstruction with women who had surgery with preservation of the nipples. Ninety-three women participated, sixty (64.5%) had nipple preservation and thirty-three (35.5%) nipples removed. Nipple projection was shorter in the reconstructed nipple group than the preserved nipple group. There was no significant difference in overall symmetry, satisfaction regarding nipple preservation or overall nipple satisfaction. There were no diagnoses of breast cancer in the study population who were followed up for approximately 10 years. We concluded that women who undergo nipple preserving surgery maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction. ABSTRACT: Incidence of bilateral risk-reducing mastectomies (RRMs) is increasing. The aim of this study was to compare satisfaction, aesthetic and oncological outcomes in women undergoing RRM with implant-based reconstruction comparing nipple-sparing mastectomy (NSM) with skin-sparing mastectomy (SSM) (sacrificing the nipple +/− nipple reconstruction). Women who had undergone bilateral RRM between 1997 and 2016 were invited. Aesthetic outcome and nipple symmetry were evaluated using standardized anthropometric measurements. The oncological outcome was assessed at last documented follow up. Ninety-three women (186 breasts) participated, 60 (64.5%) had NSM, 33 (35.5%) SSM. Median time between surgery and participation was 98.4 months (IQR: 61.7–133.9). Of the women, 23/33 (69.7%) who had SSM underwent nipple reconstruction. Nipple projection was shorter in the reconstructed SSM group than the maintained NSM group (p < 0.001). There was no significant difference in overall symmetry (p = 0.670), satisfaction regarding nipple preservation (p = 0.257) or overall nipple satisfaction (p = 0.074). There were no diagnoses of breast cancer at a median follow up of 129 months (IQR: 65–160.6). Women who undergo nipple-sparing RRM maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction. Although satisfaction with the nipples was higher in the NSM group, this did not reach statistical significance. No breast cancers developed after RRM with long-term follow up.