Nipple-Sparing Mastectomy Improves Long-Term Nipple But Not Skin Sensation After Breast Reconstruction: Quantification of Long-Term Sensation in Nipple Sparing Versus Non-nipple Sparing Mastectomy. Issue 6 (June 2017)

• Record Type: Journal Article
• Authors: Rodriguez-Unda, Nelson A.; Bello, Ricardo J.; Clarke-Pearson, Emily M.; Sanyal, Abanti; Cooney, Carisa M.; Manahan, Michele A.; Rosson, Gedge D.
• Is Part Of: Annals of plastic surgery. Volume 78:Issue 6(2017:Jun.)
• Publication Date: 2017-06
• Subjects: breast reconstruction -- nipple-sparing mastectomy -- breast sensation -- PSSD -- breast sensibility -- autologous reconstruction; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000000900
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non–nipple-sparing mastectomy. Methods: Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included. Breast measurements were taken in 4 quadrants (upper/lower lateral, upper/lower medial) and nipple. Averaged skin cutaneous thresholds [(UL+LL+UM+LM)/4] and nipple sensation between NSM and NNSM were compared as the primary outcome measure. A generalized estimating equations model was used; univariate and multivariate variable analyses were done when appropriate. Results: Forty-four patients (74 breasts) were examined (53 NNSM vs 21 NSM). The groups were further subdivided into autologous versus implant-based reconstruction. Averaged cutaneous skin thresholds for quadrants were better for the NSM, 51.8(±24.5) g/mm 2 versus NNSM, 56.5(±25.7) g/mm 2, although this difference was not statistically significant. However, NSM breasts measured higher nipple or nipple area sensitivity, 44.5(±30.8) g/mm 2 versus NNSM, 83.8(±27.4) g/mm 2 ( P < 0.001). In a multivariate regression analysis, a predictor of decreased sensation was the number of revision surgeries, especially after third revision. Conclusions: Breast sensation is decreased after reconstruction in both NSM and NNSM, but nipple sensation or nipple area is better preserved in NSM breasts. Number of revision surgeries (>3) was a predictor of decreased sensation.