"Going Flat" in Nipple-Sparing Mastectomy-An Analysis of Patient-Reported Outcome Measurements of Preliminary 57 Procedures.

[BACKGROUND] Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) has become an increasingly popular procedure offering satisfactory aesthetic outcomes with adequate oncologic safety. However, outcomes of NSM without IBR have been rarely evaluated. We aim to assess the clinical outcomes of NSM in patients refusing IBR with a focus on patient-reported outcome measurements.

[METHODS] This retrospective study enrolled female breast cancer patients who underwent NSM but refused IBR from February 2010 to April 2022 in a single institution. Clinical outcomes and patient-reported aesthetic results were evaluated and analyzed.

[RESULTS] During the study period, there were 57 cases of primary breast cancer patients who underwent NSM but refused IBR. The mean operative duration was 186.6 min, and median length of hospital stay was 4 days. Median intraoperative blood loss was 30 mL with the median resected specimen weight at 360.5 g. There was no incidence of margin involvement in this study. The complication rate was 12.3% with all of them being minor complications with Clavien-Dindo I and II scores. Locoregional recurrence and distant metastasis during the study period were 5.3% and 1.8%, respectively, with a mean follow-up period of 64.4 months. There was no mortality during the study duration. Aesthetic outcomes assessed via the BREAST-Q questionnaire were satisfactory with mean scores ranging between 35.1 and 68.4.

[CONCLUSION] This study concludes that NSM in patients refusing IBR is an alternative compared to conventional mastectomy with acceptable aesthetic outcomes. These findings underscore the importance of individualized patient choices in breast cancer treatment.