Patient satisfaction, oncologic outcomes, and complications following nipple-sparing mastectomy in the radiated patient / Lindsay Potdevin, Aiste Gulla, Sulakshana Seevaratnam, Bridget Oppong, Shawna Willey, Eleni Tousimis

Objective: As selection criteria for patients to undergo nipple-sparing mastectomy (NSM) widen, patients who have previously undergone radiation therapy (RT) as part of breast conservation therapy or who will receive postmastectomy radiation (PMRT) are increasingly being considered for NSM. Recent studies have reported on complications associated with these surgeries; however, the literature on patient satisfaction in this population is lacking. The aims of this study are to assess not only complications and oncologic outcomes, but also patient-reported satisfaction for patients who are treated with both RT and NSM with immediate reconstruction. Methods: All patients from 2002 through 2014 who had either a history of breast RT prior to NSM or who received PMRT after NSM were identified via database search. Retrospective chart review was done to assess incidence of any complications, as well as oncologic outcomes. These patients were then evaluated for level of satisfaction by administration of questions from the BREAST-Q survey. Results: We identified 37 patients (mean age = 44.9 yr) at our institution who fit our criteria out of 743 patients who underwent NSM, with 45.9% having prior RT and 54% who received PMRT. Thirty-five percent of these patients experienced either major or minor complications, which included nipple-areolar complex (NAC) necrosis (2.7%), NAC malposition (10.8%), skin flap necrosis (5.4%), infection (16.2%), hematoma (5.4%), and wound breakdown (2.7%). One patient experienced metastatic recurrence and ultimate death, and 3 patients (8%) had NAC removal for oncologic concerns (ie, DCIS at nipple margin). 45.9% of patients required some form of operative revision for complications, margin re-excision, or cosmesis. Despite this, the majority of patients (70.3%) reported an overall high level of satisfaction. Conclusion: Despite a relatively high rate of complications and operative revisions. [...].