Breast sensation following nipple-sparing mastectomy versus breast-conserving surgery: a mixed-methods study

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BACKGROUND: Nipple-sparing mastectomy (NSM) and breast-conserving surgery (BCS) allow for preservation of the breast or nipple-areolar complex (NAC). However, this does not guarantee retained sensation in these regions. The prevalence of altered post-operative sensation and its importance to patients remains unclear. AIMS: This study aims to determine the prevalence of breast and NAC sensation loss in NSM and BCS; to assess its importance to patients; and to compare these outcomes between NSM and BCS. METHODS: The BREAST-Q Sensation Module and four study-specific questions were sent to NSM or BCS patients at the Westmead Breast Cancer Institute. Comparisons were made between NSM versus BCS, implant-based versus tissue-based NSM reconstruction, BCS with versus without a formal mammaplasty, and treatment with radiotherapy versus without. Semi-structured interviews were also held. RESULTS: 78.8 % and 79.3 % of women experienced breast and/or NAC sensation change, respectively (n = 174). 69.9 % and 44.6 % of NSM patients retained varying levels of breast and NAC sensation, respectively (n = 83). 58.4 % and 60.5 % of BCS patients encountered breast and NAC sensation decrease, respectively (n = 91). Interviews (n = 34) showed that preserved sensation was sometimes of an altered quality and involved neuropathic symptoms. BREAST-Q Sensation scores were worse for NSM than for BCS. NSM reconstruction type did not impact outcomes. NSM patients with radiotherapy had worse BREAST-Q Symptoms scores than those without. BCS mammaplasty status did not influence outcomes, except for patient-reported NAC sensation. Sensation was important to 79.8 % of respondents. NAC sensation was more important to NSM than to BCS patients. CONCLUSION: Altered sensation is prevalent and significant to both NSM and BCS patients. Future research relating these findings to intraoperative techniques is required.

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