Patient Reported Outcomes and Nipple Position following Nipple-Sparing Mastectomy: A Prospective Examination of Prepectoral and Subpectoral Patients

Background • 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.

Methodology • Patient Criteria: Women > 18 years who underwent NSM with implant-based reconstruction. All patients had a minimum of 6-month follow-up and 3D images before and after surgery. • PRO ‘s and clinical outcomes were prospectively collected as part of routine clinical care. • The VECTRA XT 3D imaging system was used to take preoperative and postoperative images as part of routine care. Vectra analysis module (VAM) software was used to determine nipple displacement. Images were superimposed and markers were used to calculate the x-,y-, and z axis distances between the nipple positions in the two images. (Fig 1) • Outcome measures: BREAST-Q satisfaction with breasts and physical well-being of chest, Demographics, short term (30 day) and long term complications, surgical characteristics, and nipple displacement were collected. • Analysis: Prepectoral and subpectoral were compared on demographics, clinical characteristics, complications, BREAST-Q PROs, and X-, y-, z- coordinates in VAM for changes in nipple position.

Conclusions • Implant pocket did not impact postoperative patientreported outcomes in patients who underwent nipplesparing mastectomy. • Prepectoral had a greater incidence of return to OR compared to subpectoral with no other differences in short or long-term outcomes. • These findings are consistent with other published studies. • Patients with prepectoral reconstruction had less nipple displacement as compared to subpectoral following nipple-sparing mastectomy. • We found no significance in direction of nipple displacement • This is the first study using 3D surface imaging to investigate nipple position following NSM

References • Walia GS et al. Prepectoral Versus Subpectoral Tissue Expander Placement: A Clinical and Quality of Life Outcomes Study. Plast Reconstr Surg Glob Open. 2018 Apr 20;6(4):e1731. • Thangarajah F et al. Comparison of Subpectoral versus Prepectoral Immediate Implant Reconstruction after Skin- and Nipple-Sparing Mastectomy in Breast Cancer Patients: A Retrospective Hospital-Based Cohort Study. Breast Care (Basel). 2019 Dec;14(6):382-387. • Hart A, et al Nipple malposition after bilateral nipple-sparing mastectomy with implant-based reconstruction: Objective postoperative analysis utilizing BCCT.core computer software. Breast J. 2020 Jul;26(7):1270-1275..