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Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?

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Abstract

We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P < .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.

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Acknowledgment

This study has been supported by AVON Italy.

Author information

Authors and Affiliations

  1. Psycho-Oncology Unit, Department of Medicine (Prof. A. Goldhirsch), European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    F. Didier, R. Bedolis, A. Maldifassi, E. Scaffidi & F. Lupo

  2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    D. Radice, S. Gandini, N. Rotmensz & B. Santillo

  3. Department of Breast Surgery, European Institute of Oncology, Milan, Italy

    A. Luini & V. Galimberti

  4. Department of Plastic Surgery, European Institute of Oncology, Milan, Italy

    S. Martella & J. Y. Petit

Authors
  1. F. Didier
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  2. D. Radice
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  3. S. Gandini
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  4. R. Bedolis
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  5. N. Rotmensz
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  6. A. Maldifassi
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  7. B. Santillo
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  8. A. Luini
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  9. V. Galimberti
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  10. E. Scaffidi
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  11. F. Lupo
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  12. S. Martella
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  13. J. Y. Petit
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Corresponding author

Correspondence to F. Didier.

Appendix 1

Appendix 1

Assessment of the patients’ satisfaction with cosmetic results, physical and emotional impact of mastectomy

In this questionnaire you will be asked how you feel about the physical and emotional impact of mastectomy with or without nipple sparing.

We would like to know from you how you felt about your physical aspect BEFORE your diagnosis:

  1. 1.

    Did you feel unsatisfied with your body?

  2. 2.

    Did you feel physically attractive?

  3. 3.

    Did you feel feminine?

  4. 4.

    Did you find it difficult to look at yourself naked?

  5. 5.

    Did you find it difficult being seen naked by your partner?

  6. 6.

    Were you satisfied with the size of your breast?

  7. 7.

    Were you satisfied with the shape of your breast?

  8. 8.

    Were you satisfied with the appearance of your nipple?

During the last four weeks:

  1. 9.

    Have you felt unsatisfied with your body?

  2. 10.

    Have you felt physically attractive?

  3. 11.

    Have you felt less physically attractive because of the disease or its treatment?

  4. 12.

    Have you been feeling feminine?

  5. 13.

    Have you been feeling less feminine because of the disease or its treatment?

  6. 14.

    Did you find it difficult to look at yourself naked?

  7. 15.

    Did you find it difficult being seen naked by your partner?

  8. 15bis.

    Did you experience feelings of mutilation?

Regarding the breast operated and reconstructed:

  1. 16.

    Have you been satisfied with the size of your breast?

  2. 17.

    Have you been satisfied with the shape of your breast?

  3. 18.

    Have you been satisfied with your breast skin sensitivity?

  4. 19.

    Have you been satisfied with the appearance of your scar?

  5. 20.

    Has the other breast been remodeled? YES NO

If YES, we would like to know:

  1. 21.

    Have you been satisfied with the size?

  2. 22.

    Have you been satisfied with the shape?

  3. 23.

    Have you been satisfied with your breast skin sensitivity?

  4. 24.

    Have you been satisfied with the appearance of your scar?

Now we would like to know from you, regarding cosmetic results of plastic surgery:

  1. 25.

    Do you consider the overall result of the surgery is similar to the natural aspect of your breast?

  2. 26.

    Have you been satisfied with cosmetic result of the plastic surgery overall?

  3. 27.

    Did your surgery results meet with your expectations?

  4. 28.

    Did you regret having had the breast reconstruction?

  5. 29.

    Did you have nipple sparing surgery? YES NO

Please, answer only if YES:

  1. 30.

    Have you been satisfied having preserved your nipple?

  2. 31.

    Did the preservation of your nipple help you to cope with the disease and surgical consequences?

  3. 32.

    Did the preservation of your nipple help you to feel less mutilated (disabled)?

Please answer only if it has NOT been possible to preserve your nipple:

  1. 33.

    Would you have preferred to keep your nipple?

Please indicate, why: …………………………………

During the last four weeks:

  1. 34.

    Have you felt satisfied with the appearance of your nipple?

  2. 35.

    Have you felt satisfied with your nipple sensitivity?

Now we would ask you some questions about an aspect of life which could be important for a woman, regarding sexuality.

We would like to know, BEFORE the disease:

  1. 36.

    Was sexuality an important part of your life?

  2. 37.

    Did you feel sexually attractive?

  3. 38.

    Was your breast important to your sexual life?

  4. 39.

    Was your nipple important to your sexual life?

During the last 4 weeks:

  1. 40.

    Was sexuality an important part of your life?

  2. 41.

    Did you feel interested in sexual activities?

  3. 42.

    Did you feel sexually attractive?

  4. 43.

    Have you been feeling less sexually attractive because of the disease or its treatment?

  5. 44.

    Were you sexually active?

Please, answer only of you have been sexually active during the last four weeks.

  1. 45.

    Did you feel enjoyment during sexual activities?

  2. 46.

    Did your breast play an important part in your sexuality?

  3. 47.

    Did your nipple play an important part in your sexuality?

  4. 48.

    Have you noticed a change regarding your partner in your sexual intimacy?

  5. 49.

    Have you noticed a diminished frequency of breast caressing in your partner?

  6. 50.

    Have you noticed that you have a reduced sexual drive?

Now we would like to know from you if during the last 12 months:

  1. 51.

    If there has been personal situation, a part from your disease and breast surgery, that would have interfered with your sexuality? YES NO

    Only if you want, please indicate:

    1. ○

      Family problems

    2. ○

      Grief

    3. ○

      Partner problems

    4. ○

      Separation

    5. ○

      Work problems

    6. ○

      Job loss

    7. ○

      Having to renounce to maternity because of the disease or your treatments

    8. ○

      Economic problems

    9. ○

      Impact of hormonal therapy (if you take an hormonal therapy)

Other……………………………………………………

We would like to know during the last four weeks:

  1. 52.

    Have you been frightened by the possibility of disease recurrence

Now we would like you to answer these three last questions:

  1. 53.

    How would you grade on a scale from 0 to 10 your satisfaction with cosmetic results of the your surgery overall:

  1. 54.

    If you are married or have a partner, has your partner expressed an opinion about the cosmetic result of your surgery overall: YES NO

  1. 55.

    If YES, could you please indicate your partner’s opinion regarding the cosmetic result of your surgery?

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Didier, F., Radice, D., Gandini, S. et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?. Breast Cancer Res Treat 118, 623–633 (2009). https://doi.org/10.1007/s10549-008-0238-4

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