OasisLMS

This systematic review and meta-analysis evaluates patient-reported outcomes and complication rates after nipple-sparing mastectomy (NSM) versus skin-sparing mastectomy (SSM) followed by immediate breast reconstruction. From 1,202 identified citations, the authors included 13 comparative studies encompassing 3,895 patients. Meta-analyses of BREAST-Q data demonstrated significantly higher scores after NSM in the Sexual Well-being domain, with an approximately 8-point mean difference, and the Psychosocial Well-being domain, with an approximately 5-point mean difference. No significant differences were found in Satisfaction with Breasts, Physical Well-being, or Satisfaction with Outcome, and studies using non-BREAST-Q questionnaires generally found no difference in overall satisfaction.

Intended Audience

This educational activity is intended for all CME-related persons including plastic surgery practitioners, residents, and other healthcare professionals.

Learning Objectives

After viewing this course, the participant should be able to:

1. Differentiate nipple-sparing from skin-sparing mastectomy based on preservation of the nipple-areola complex and describe the implications of each technique for immediate breast reconstruction.
2. Compare patient-reported outcomes after nipple-sparing and skin-sparing mastectomy, including psychosocial, sexual, physical, and breast-related well-being, satisfaction with breasts and outcome, and nipple sensation and position.
3. Evaluate complication profiles associated with each mastectomy approach, including wound-healing problems, mastectomy flap necrosis, nipple-areola complex necrosis, infection, capsular contracture, and reconstruction failure.
4. Interpret BREAST-Q scores and other patient-reported outcome measures, including the magnitude and clinical relevance of reported differences, when counseling patients about expected quality-of-life outcomes.
5. Apply individualized patient-selection principles that integrate oncologic safety, anatomy, degree of ptosis, reconstructive plan, complication risk, and patient preferences when considering nipple-sparing mastectomy.

Marloes E. Clarijs, MD; Noelle J. M. C. Vrancken Peeters, BSc; Sophie A. F. van Dongen, BSc; Linetta B. Koppert, MD, PhD, MHS; Andrea L. Pusic, MD, MHS; Marc A. M. Mureau, MD, PhD; Bianca F. M. Rijken, MD, PhD

Editor-in-Chief: Kevin C. Chung, MD

Co-editor: Amy S. Colwell, MD

Meir Retchkiman, MD; Lesley Wong, MD

• Systems-based Practice
• Medical Knowledge
• Practice-based Learning and Improvement

Accreditation
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation
The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 CreditTM: 1.0
Media: Journal Article
Release Date: 7/31/2026
Expiration Date: 7/31/2029*
Estimated time to complete this course: 1 hour
*Course access ends on course expiration date

Disclosure Policy
The American Society of Plastic Surgeons (ASPS) requires all instructors, planners, reviewers, managers and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. ASPS also requires faculty/authors to disclose when off-label/unapproved uses of product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following planners and faculty members have have the following disclosures:
Andrea L. Pusic, MD, MHS - Co-Developer of the BREAST-Q (owned by Memorial Sloan-Kettering Cancer Center) and may receive royalties when it is used in for-profit, industry sponsored clinical trials.

The following planners and faculty members have no relevant financial relationships or affiliations to disclose:
Marloes E. Clarijs, MD
Noelle J. M. C. Vrancken Peeters, BSc
Sophie A. F. van Dongen, BSc
Linetta B. Koppert, MD, PhD, MHS
Marc A. M. Mureau, MD, PhD
Bianca F. M. Rijken, MD, PhD
Meir Retchkiman, MD
Lesley Wong, MD

Recognition Statement
The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)
Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-in to reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.