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. 2017 Feb;6(1):4-13.
doi: 10.21037/gs.2016.08.01.

Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

Ellen S Satteson  1 , Benjamin J Brown  2 , Maurice Y Nahabedian  3
Affiliations

Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

Ellen S Satteson et al. Gland Surg. 2017 Feb.

Abstract

Background: Nipple-areola complex (NAC) reconstruction transforms a mound of soft tissue into a breast and often marks the final stage of breast reconstruction after mastectomy.

Methods: A systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles were classified based on the nipple reconstructive technique-either composite nipple sharing or local flap with nipple-sparing mastectomy (NSM) used as a control. A standardized "Satisfaction Score" (SS) for "nipple appearance" and "nipple sensation" was calculated for each technique. A Fisher's exact test was used to compare the SS with local flap reconstruction with NSM.

Results: Twenty-three studies met the systematic review inclusion criteria. Nine NSM articles were identified with patient satisfaction data from 473 patients. The weighted average SS for NSM was 80.5%. Fourteen local flap technique articles were identified with satisfaction data from 984 patients and a weighted average SS of 73.9%. This was a statistically significant difference (P=0.0079). C-V and badge local flap techniques were associated with the highest SS, 92.6% and 90.5%, respectively. C-V and modified C-V flap technique was associated with a higher SS when compared to those using one or more other flap techniques (P=0.0001).

Conclusions: While patient satisfaction with nipple reconstruction is high regardless of technique, it is higher with NSM. When NSM is not an option, local flap reconstruction with a C-V or modified C-V flap may be associated with higher satisfaction than alternative local flap techniques.

Keywords: Mastectomy; breast reconstruction; meta-analysis; nipple reconstruction; nipple-areola complex (NAC) reconstruction; nipple-areola reconstruction; preferred reporting items for systematic reviews and meta-analysis (PRISMA).

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Conflict of interest statement

Conflicts of Interest: Dr. Nahabedian is a speaker/consultant for LifeCell, Sientra, and Allergan. Dr. Satteson and Dr. Brown have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Relevant article identification process. One article contained patient satisfaction data for both nipple-sparing mastectomy (NSM) and local flap nipple reconstruction.
Figure 2
Figure 2
Forest plot showing satisfaction scores with nipple-sparing mastectomy (NSM) (1,2,4-6,8).
Figure 3
Figure 3
Forest plot showing satisfaction scores with local flap nipple reconstruction (1,11-23).
See this image and copyright information in PMC

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