PC35. PATIENT REPORTED OUTCOMES AND NIPPLE POSITION FOLLOWING NIPPLE-SPARING MASTECTOMY (NSM): A PROSPECTIVE EXAMINATION OF PREPECTORAL AND SUBPECTORAL PATIENTS

Abstract

PURPOSE: Nipple-sparing mastectomy (NSM) is becoming more popular. The role of pocket dissection (prepectoral vs subpectoral) in implant-based reconstruction on patient reported outcomes (PRO’s) and nipple position following NSM has not yet been explored. We hypothesize that prepectoral reconstruction results in superior PRO’s and more anatomical nipple position compared to subpectoral reconstructions following NSM. METHODS: Surgical details and short-term complication in NSM patients from 2018 to 2021 were prospectively collected. PROs were obtained preoperatively, 6 and 12 months postoperatively. Nipple displacement from baseline was analyzed using three-dimensional(3D) surface imaging by three independent researchers. RESULTS: 216 patients who underwent 391 NSM were divided into two cohorts, subpectoral and prepectoral. There were no differences in demographics or comorbidities between cohorts. Prepectoral patients (N=83 (86%) vs. 54 (44%); p<0.001) reported better physical well-being of the chest preoperatively (median 76, IQR 67,92 vs 72, IQR 64,80; p=0.022). No other differences in PRO’s or complications were observed. Linear regression suggested that radiation is the most important factor impacting satisfaction following NSM. 3D photographs for 97 patients were analyzed and 175 nipple positions were measured in 3 dimensions. Controlling for implant size, there was greater elevation and less projection of the nipple compared to baseline in subpectoral cohort (elevation: median -16 mm, IQR -24,-7 vs -3 mm, IQR -12,5; p<0.001; projection: median -1 mm, IQR -9,6 vs -6 mm, IQR -14,4; p=0.002). CONCLUSION: Implant pocket did not impact PRO’s or short-term complications in patients who underwent NSM. Patients with prepectoral reconstruction had less nipple displacement and more nipple projection following NSM.