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. 2024 Oct;31(10):6795-6803.
doi: 10.1245/s10434-024-15681-3. Epub 2024 Jul 11.

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

V Morgan Jones  1 , Jonas A Nelson  2 , Varadan Sevilimedu  3 , Tiana Le  1 , Robert J Allen Jr  2 , Babak J Mehrara  2 , Andrea V Barrio  1 , Deborah M Capko  1 , Alexandra S Heerdt  1 , Audree B Tadros  1 , Mary L Gemignani  1 , Monica Morrow  1 , Virgilio Sacchini  1 , Tracy-Ann Moo  4
Affiliations

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

V Morgan Jones et al. Ann Surg Oncol. 2024 Oct.

Abstract

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.

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

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Figures

Fig. 1.
Fig. 1.
BREAST-Q preoperative and postoperative version 2.0 domains.
Fig. 2.
Fig. 2.
BREAST-Q median scores by domain. (A) Satisfaction with breasts; (B) psychosocial quality of life; (C) physical well-being of the chest; (D) sexual well-being. Abbreviations: Preop preoperatively, Postop postoperatively
See this image and copyright information in PMC

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