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Prospective Study Comparing Surgeons’ Pain and Fatigue Associated with Nipple-Sparing versus Skin-Sparing Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nipple-sparing mastectomy (NSM) is more technically challenging than skin-sparing mastectomy (SSM) but offers quality-of-life and cosmetic advantages. However, surgeon physical symptoms related to NSM workload have not been documented.

Methods

This was a prospective study using questionnaires to compare surgeon-reported physical symptoms before, during, and after NSM versus SSM. Surgeons also answered general questions about each mastectomy. Bilateral cases were performed simultaneously by two surgeons, who completed independent questionnaires.

Results

Questionnaires were completed after 82 SSMs and 44 NSMs. On a 0–10 scale, surgeons reported NSM was more physically demanding than SSM (7.0 vs. 4.5, p < 0.001). Mean visualization was more difficult (5.7 vs. 3.2, p < 0.001) and mean fatigue score was greater (5.6 vs. 3.1, p < 0.001) after NSM than SSM. The mean increase in neck pain (on a 0–4 scale) was greater for NSM than SSM, both from before-to-during surgery (0.8 vs. 0.2, p = 0.003) and before-to-after surgery (0.9 vs. 0.2, p = 0.002). The mean increase in lower back pain was greater for NSM than SSM, both from before-to-during surgery (0.7 vs. 0.2, p = 0.008) and before-to-after surgery (0.9 vs. 0.2, p = 0.003). Surgeons reported that NSM was more mentally demanding (p < 0.001), complex (p = 0.01), and difficult (p < 0.001) than SSM.

Conclusion

Surgeons experienced greater physical symptoms, mental strain, and fatigue with NSM than SSM. This raises concern that mild but repetitive pain over the course of a breast surgeon’s career may lead to repetitive stress injury.

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Acknowledgement

The authors thank the nurses and surgical technicians who contributed to this research by facilitating surgeon access to the questionnaire at the end of each operation: Diana Arsenault, Jorjan Boord, Susan Bowers, Candice Corbin, Mollie Figueroa, Joy Gloede, Chrissy Hall, Deanne Kolobow, and Lauren Tyler.

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Authors and Affiliations

  1. The Rebecca Fortney Breast Center, Anne Arundel Medical Center, 2001 Medical Parkway, Annapolis, MD, 21401, USA

    Rubie Sue Jackson MD, MPH, Thomas Sanders PhD, Robert Buras MD, Wen Liang DO, Christine Harris MD, Charles Mylander PhD, Martin Rosman MD, Luther Holton MD, Devinder Singh MD, Laura Martino BS & Lorraine Tafra MD

  2. Department of Surgery, Anne Arundel Medical Center, 2001 Medical Parkway, Annapolis, MD, 21401, USA

    Adrian Park MD

Authors
  1. Rubie Sue Jackson MD, MPH
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  2. Thomas Sanders PhD
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  3. Adrian Park MD
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  4. Robert Buras MD
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  5. Wen Liang DO
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  6. Christine Harris MD
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  7. Charles Mylander PhD
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  8. Martin Rosman MD
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  9. Luther Holton MD
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  10. Devinder Singh MD
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  11. Laura Martino BS
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  12. Lorraine Tafra MD
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Corresponding author

Correspondence to Rubie Sue Jackson MD, MPH.

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Jackson, R.S., Sanders, T., Park, A. et al. Prospective Study Comparing Surgeons’ Pain and Fatigue Associated with Nipple-Sparing versus Skin-Sparing Mastectomy. Ann Surg Oncol 24, 3024–3031 (2017). https://doi.org/10.1245/s10434-017-5929-9

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  • DOI: https://doi.org/10.1245/s10434-017-5929-9

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