PURPOSE: Nipple sparing mastectomy (NSM) may now be performed in carefully selected patients with minimal risk of local cancer recurrence.  Advocates of NSM assert that cosmetic outcomes of the nipple areolar complex (NAC) following breast reconstruction are superior to those following non-nipple sparing resections and that patient satisfaction is greater.  However, to date, little has been published regarding patient satisfaction with the NAC following NSM and reconstruction.

METHOD: From 2001 to 2007, we performed NSM in 139 patients followed by immediate breast reconstruction.  All patients were sent a questionnaire asking that they rate their satisfaction with various aspects of the NAC, including appearance, symmetry, color, position, sensation, function and texture. They were then asked to indicate which characteristics they would change and whether they would choose to undergo NSM again. 

RESULTS: Of 139 possible respondents, 54.7 % completed the survey.  The mean age for our respondents was 46.6 years with mean follow-up of 52 months.  Thirty-nine patients underwent unilateral procedures, and 35 were bilateral in a total of 109 operated breasts.  Seventy-one percent indicated that the appearance of the NAC was good or excellent, 21.1 % as fair and 7.9 % as poor.  Regarding texture of the NAC, 67.1 % of respondents rated their result as good or excellent, 26.3 % as fair and 6.6 % as poor.  Regarding symmetry, 65.8 % rated their results as excellent or good, 22.4 % as fair and 11.8 % as poor.   Regarding color, 81.3 % rated their result as good or excellent, 14.5 % as fair, and 5.3 % as poor.  NAC position was rated as good or excellent by 59.2 %, fair by 27.6 % and poor by 13.2 %.  When assessing sensation, 11.8 % rated the sensation of the NAC as good or excellent, 30.3 % as fair and 57.9% as poor.  Arousal was rated as good or excellent by 28.9 %, fair by 38.2 % and poor by 32.9 %.   Eighty-two percent indicated they would change at least one aspect of their result, and 42.1 % would change more than one aspect.  Among those who would change at least one aspect of their result, a large majority 74.6 % indicated they would change sensation with fewer indicating they would change other aspects of their result.  When asked whether they would have NSM again, 72.4 % indicated they would definitely have the procedure, 11.8 % maybe yes, 6.6 % maybe no and 7.9 % definitely no. 

CONCLUSION: Our study is the largest series to address patient satisfaction with the NAC among patients undergoing NSM.  Our results reflect a high level of patient satisfaction with overall appearance of the NAC as well as an overall positive response to undergoing the procedure again.  A significant majority of patients rated sensation as fair or poor, and sensation constituted the most frequent aspect of the NAC that patients would change.  Interestingly, our data also suggest that appearance of the NAC may be more important to satisfaction with arousal than sensation.