Impact of Mastectomy Flap Necrosis on Patient-Reported Quality-of-Life Measures After Nipple-Sparing Mastectomy: A Preliminary Analysis.

Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE

Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-

Quality of Life* ; Breast Neoplasms*/surgery ; Breast Neoplasms*/pathology ; Breast Neoplasms*/psychology ; Patient Reported Outcome Measures* ; Nipples*/surgery ; Nipples*/pathology ; Surgical Flaps*/pathology ; Necrosis*; Humans ; Female ; Middle Aged ; Follow-Up Studies ; Adult ; Mastectomy/adverse effects ; Patient Satisfaction ; Prognosis ; Mammaplasty/psychology ; Mammaplasty/methods ; Postoperative Complications/psychology ; Postoperative Complications/etiology ; Aged ; Organ Sparing Treatments/methods

Background: Mastectomy skin flap necrosis (SFN) is common following nipple-sparing mastectomy (NSM), but studies on its quality-of-life (QOL) impact are limited. We examined patient-reported QOL and satisfaction after NSM with/without SFN utilizing the BREAST-Q patient-reported outcome measure (PROM) survey.
Patients and Methods: Patients undergoing NSM between April 2018 and July 2021 at our institution were examined; the BREAST-Q PROM was administered preoperatively, and at 6 months and 1 year postoperatively. SFN extent/severity was documented at 2-3 weeks postoperatively; QOL and satisfaction domains were compared between patients with/without SFN.
Results: A total of 573 NSMs in 333 patients were included, and 135 breasts in 82 patients developed SFN (24% superficial, 56% partial thickness, 16% full thickness). Patients with SFN reported significantly lower scores in the satisfaction with breasts (p = 0.032) and psychosocial QOL domains (p = 0.009) at 6 months versus those without SFN, with scores returning to baseline at 1 year in both domains. In the "physical well-being-of-the-chest" domain, there was an overall decline in scores among all patients; however, there were no significant differences at any time point between patients with or without SFN. Sexual well-being scores declined for patients with SFN compared with those without at 6 months and also at 1 year, but this did not reach significance (p = 0.13, p = 0.2, respectively).
Conclusions: Patients undergoing NSM who developed SFN reported significantly lower satisfaction and psychosocial well-being scores at 6 months, which returned to baseline by 1 year. Physical well-being of the chest significantly declines after NSM regardless of SFN. Future studies with larger sample sizes and longer follow-up are needed to determine SFN's impact on long-term QOL.
(© 2024. Society of Surgical Oncology.)

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P30CA008748 NIH/NCI Cancer Center Support Grant

Keywords: BREAST-Q; Breast cancer; Breast satisfaction; Mastectomy; Nipple-sparing mastectomy; Patient-reported outcome measures; Skin flap necrosis

Date Created: 20240711 Date Completed: 20240921 Latest Revision: 20241001

20241001

10.1245/s10434-024-15681-3

38990221