Impact of Nipple-Areolar Complex Reconstruction on Patient Reported Outcomes After Alloplastic Breast Reconstruction: A BREAST-Q Analysis

Introduction: The nipple-areola complex (NAC) is essential for breast aesthetics and self-image. However, large-scale studies on patient satisfaction after NAC reconstruction in implant-based breast reconstruction are limited, especially those accounting for confounders. This study aims to evaluate the long-term impact of NAC reconstruction on patient-reported outcomes (PROs) using the BREAST-Q, hypothesizing that NAC reconstruction yields better PROs than no reconstruction. Methods: A single center retrospective analysis of patients who underwent skin-sparing mastectomy with 2-stage alloplastic reconstruction between 2015 and 2021 was performed. NAC reconstruction methods included local flaps and tattoos. Patients were excluded if they had nipple-sparing mastectomy, autologous reconstruction, adjuvant radiation, direct-to-implant or unilateral reconstruction and incomplete BREAST-Q data. BREAST-Q was assessed preoperatively and two years post-implant exchange. Results: Overall, 372 patients were included in the study, with 210 not undergoing NAC reconstruction and 162 undergoing NAC reconstruction within two years of implant exchange. Preoperatively, no significant difference existed between cohorts for all BREAST-Q domains. Postoperatively, NAC reconstruction patients reported significantly higher scores across all BREAST-Q domains, with clinically meaningful improvements in Sexual Well-Being and Satisfaction with Breasts. Analysis of the change in BREAST-Q scores from preoperative to 2-years postoperative revealed significant improvements in Sexual Well-Being (+6 points p=0.006) and Satisfaction with Breasts (+9 points, p=0.003) among patients who underwent NAC reconstruction compared to patients that did not undergo NAC reconstruction. Conclusion: NAC reconstruction enhances patient satisfaction following implant-based breast reconstruction. Providers should discuss these benefits with appropriate patients, emphasizing the potential impact on breast satisfaction and sexual well-being.