Nipple-areolar Complex Reconstruction following Postmastectomy Breast Reconstruction: A Comparative Utility Assessment Study

The goal of breast reconstruction following mastectomy is ultimately the creation of a breast that is aesthetically pleasing and closely resembles its natural configuration. Breast reconstruction is generally performed in multiple stages and may include many revisions to address issues with shape and symmetry.1–3 As such, there is no clear indication as to when the reconstructive process is complete.1 It is considered by some to be when patients are satisfied with the appearance of their breast or when no more procedures are required.1 Nipple reconstruction is a fundamental part of the reconstructive process as patients associate this step with the endpoint of the reconstructive process.2,4 Moreover, it provides improved aesthetic outcomes and self-esteem.5,6 Despite the multitude of techniques described to preserve nipple shape and projection over time, none have been able to attain consistent results.2,7–15 The most commonly used flaps are associated with loss of nipple projection in up to 70% of cases over the course of the first 3 years postoperatively.12 Matching the color of the areola to the contralateral breast can be problematic. Intradermal tattooing has a tendency to fade over time, reduce nipple projection, and is often difficult when matching pigment color in unilateral cases.2,16 In spite of these limitations, many women will choose to undergo nipple reconstruction to restore body image.2 There is currently a void in the literature in objective assessments of the health state of living with a breast reconstruction before nipple-areola complex (NAC) reconstruction. Moreover, studies in the literature have reported conflicting outcomes.2,16–20 Some have demonstrated increased satisfaction rates following NAC reconstruction,2,16,17,19 whereas others have observed either dissatisfaction with reconstruction, particularly in younger patients, or greater satisfaction with breast mound reconstruction only.18,20 Utility scores are standardized tools offering a validated means of measuring the health state preference of a disease state or health condition. They range from 0 (death) to 1 (perfect health).21 Utility scores have been used previously to quantify the risk-benefit ratio for a range of conditions and assist in surgical decision making.21–32 Furthermore, they may aid in the design of quantitative comparisons in economic decision analysis for resource allocation in treatment and research pertaining to individual health states.33,34 The goal of this study was to determine the health burden of living without NAC reconstruction through an objective utility assessment.