Quality of Life and Complications after Nipple- versus Skin-Sparing Mastectomy followed by Immediate Breast Reconstruction: A Systematic Review and Meta-Analysis

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This systematic review and meta-analysis compared nipple-sparing mastectomy (NSM) with skin-sparing mastectomy (SSM) followed by immediate breast reconstruction, focusing on patient-reported outcomes and complications. The authors searched Embase, MEDLINE, and Cochrane and included 13 comparative studies with 3,895 patients.<br /><br />Using BREAST-Q data, NSM showed better psychosocial well-being and sexual well-being than SSM, with statistically significant mean differences favoring NSM. However, there were no significant differences between procedures in satisfaction with breasts, satisfaction with outcome, or physical well-being. Other questionnaires also generally found high satisfaction in both groups, with no consistent difference in overall satisfaction.<br /><br />Complication rates were similar overall between NSM and SSM. Some individual studies found more wound-related problems or nipple-areola complex necrosis after NSM, while others reported more reconstruction failure or implant-related issues after SSM. In aggregate, though, no clear difference in total complication rates emerged.<br /><br />The review highlights that NSM may offer psychological and sexual quality-of-life advantages, likely because it preserves the nipple-areola complex, which has both aesthetic and emotional importance. Still, nipple position and nipple sensitivity can vary, and reconstruction type, radiotherapy, unilateral versus bilateral surgery, and patient anatomy may influence outcomes.<br /><br />The authors conclude that both NSM and SSM provide high patient satisfaction, but NSM appears superior for psychosocial and sexual well-being without increasing overall complications. Therefore, NSM should be offered to carefully selected patients when oncologically safe, with the final decision individualized based on cancer factors, complication risk, reconstruction plan, and patient preferences.

Keywords

nipple-sparing mastectomy

skin-sparing mastectomy

breast reconstruction

patient-reported outcomes

BREAST-Q

psychosocial well-being

sexual well-being

complication rates

breast satisfaction

systematic review meta-analysis