Skip to main content

Advertisement

Springer Nature Link
Log in

Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?

  • Brief Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P < .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Fisher B, Andersen S, Bryant J, Margolese RG, Deutsh M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241. doi:10.1056/NEJMoa022152

    Article  PubMed  Google Scholar 

  2. Veronesi U, Salvadori B, Luini A, Banfi A, Zucali R, DelVecchio M, Saccozzi R, Beretta E, Boracchi P, Farante G (1990) Conservative treatment of early breast cancer: long term results of 1232 cases treated with quadrantectomy, axillary dissection and radiotherapy. Ann Surg 211:250–258

    CAS  PubMed  Google Scholar 

  3. Andersen BL (1985) Sexual functioning morbidity among cancer survivors, current status and future research directions. Cancer 55:1835–1842. doi:10.1002/1097-0142(19850415)55:8<1835::AID-CNCR2820550832>3.0.CO;2-K

    Article  CAS  PubMed  Google Scholar 

  4. Derogatis LR (1979) Breast and gynaecological cancers: their unique impact on body image and sexual identity in women. Front Radiat Ther Oncol 14:1–11

    CAS  PubMed  Google Scholar 

  5. Hopwood P, Maguire P (1988) Body image problems in cancer patients. Br J Psychiatry Suppl. Jul;(2):47–50

  6. Al-Ghazal SK, Fallowfield L, Blamey RW (1999) Does cosmetic outcomes from treatment of primary breast cancer influence psychosocial morbidity? Eur J Surg Oncol 25(6):571–573. doi:10.1053/ejso.1999.0708

    Article  CAS  PubMed  Google Scholar 

  7. Schain W (1985) Breast cancer surgeries and psychosexual sequelae: implications for remediation. Semin Oncol Nurs 1:200–205. doi:10.1016/S0749-2081(85)80009-7

    Article  CAS  PubMed  Google Scholar 

  8. Schover LR, Yetman RJ, Tuason LJ (1995) Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image and sexuality. Cancer 75(1):54–64. doi:10.1002/1097-0142(19950101)75:1<54::AID-CNCR2820750111>3.0.CO;2-I

    Article  CAS  PubMed  Google Scholar 

  9. Schover LR (1991) The impact of breast cancer on sexuality, body image and intimate relationships. Cancer J Clin 41:112–120

    Article  CAS  Google Scholar 

  10. Al-Ghazal SK, Fallowfield L, Blamey RW (2000) Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36(15):1938–1943. doi:10.1016/S0959-8049(00)00197-0

    Article  CAS  PubMed  Google Scholar 

  11. Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26:17–19. doi:10.1053/ejso.1999.0733

    Article  CAS  PubMed  Google Scholar 

  12. Petit JY, Veronesi U, Orecchia R, Rey P, Didier F, Giraldo A, Luini A, De Lorenzi F, Rietjens M, Garusi C, Intra M, Yamaguchi S, Martella S (2003) The nipple-sparing mastectomy : early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori 89:288–291

    PubMed  Google Scholar 

  13. Petit JY, Veronesi U, Luini A, Orecchia A, Rey PC, Martella S, Didier F, De Lorenzi F, Rietjens M, Garusi C, Galimberti VE, Leida E, Lazzari R, Giraldo A (2005) When mastectomy becomes inevitable: the nipple-sparing approach. Breast 14:527–531. doi:10.1016/j.breast.2005.08.028

    Article  CAS  PubMed  Google Scholar 

  14. Petit JY, Veronesi U, Orecchia A, Luini A, Rey Rojas AI, Intra M, Didier F, Martella S, Rietjens M, Garusi C, De Lorenzi F, Gatti G, Leon ME, Casadio C (2006) Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat 96(1):47–51. doi:10.1007/s10549-005-9033-7

    Article  PubMed  Google Scholar 

  15. Wellish DK, Schain WS, Barett Noone R, Little JW (1987) The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg Nov 80(5):699–704

    Article  Google Scholar 

  16. Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Eur J Cancer 37:189–197. doi:10.1016/S0959-8049(00)00353-1

    Article  CAS  PubMed  Google Scholar 

  17. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. doi:10.2307/2529310

    Article  CAS  PubMed  Google Scholar 

  18. Sanger CK, Reznikoff M (1981) Comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy. Cancer 48:2341–2346. doi:10.1002/1097-0142(19811115)48:10<2341::AID-CNCR2820481034>3.0.CO;2-3

    Article  CAS  PubMed  Google Scholar 

  19. Polivy J (1977) Psychological effects of mastectomy on a woman’s feminine self-concept. J Nerv Ment Dis 164:77–87. doi:10.1097/00005053-197702000-00001

    Article  CAS  PubMed  Google Scholar 

  20. Nano MT, Gill PG, Kollias J et al (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75(11):940–947

    Article  PubMed  Google Scholar 

  21. Schain WS, D’Angelo TM, Dunn ME, Lichter AS, Pierce LJ (1994) Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences. Cancer 73(4):1221–1228. doi:10.1002/1097-0142(19940215)73:4<1221::AID-CNCR2820730416>3.0.CO;2-S

    Article  CAS  PubMed  Google Scholar 

  22. Sacchini V, Pinotti JA, Barros AC, Luini A, Pluchinotta A, Pinotti M, Boratto MG, Ricci MD, Ruiz CA, Nisida AC, Veronesi P, Petit JY, Arnone P, Bassi F, Disa JJ, Garcia-Etienne CA, Borgen PI (2006) Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?. J Am Coll Surg 203(5):704–714. doi:10.1016/j.jamcollsurg.2006.07.015

    Article  PubMed  Google Scholar 

  23. Banerjee A, Gupta S, Bhattacharya N (2008) Preservation of nipple-areola complex in breast cancer- a clinicopathological assessment. J Plast Reconstr Aesthet Surg 61(10):1195–1198. doi:10.1016/j.bjps.2007.08.005

    Article  PubMed  Google Scholar 

  24. Ueda S, Tamaki Y, Yano K, Okishiro N, Yanagisawa T, Imasato M, Shimazu K, Kim SJ, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S (2008) Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery 143(3):414–425. doi:10.1016/j.surg.2007.10.006

    Article  PubMed  Google Scholar 

  25. Chung AP, Sacchini V (2008) Nipple-sparing mastectomy: where are we now? Surg Oncol 17(4):261–266. doi:j.suronc.2008.03.004

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study has been supported by AVON Italy.

Author information

Authors and Affiliations

  1. Psycho-Oncology Unit, Department of Medicine (Prof. A. Goldhirsch), European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    F. Didier, R. Bedolis, A. Maldifassi, E. Scaffidi & F. Lupo

  2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    D. Radice, S. Gandini, N. Rotmensz & B. Santillo

  3. Department of Breast Surgery, European Institute of Oncology, Milan, Italy

    A. Luini & V. Galimberti

  4. Department of Plastic Surgery, European Institute of Oncology, Milan, Italy

    S. Martella & J. Y. Petit

Authors
  1. F. Didier
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. D. Radice
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. S. Gandini
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. R. Bedolis
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. N. Rotmensz
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. A. Maldifassi
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. B. Santillo
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. A. Luini
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. V. Galimberti
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. E. Scaffidi
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. F. Lupo
    View author publications

    You can also search for this author inPubMed Google Scholar

  12. S. Martella
    View author publications

    You can also search for this author inPubMed Google Scholar

  13. J. Y. Petit
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to F. Didier.

Appendix 1

Appendix 1

Assessment of the patients’ satisfaction with cosmetic results, physical and emotional impact of mastectomy

In this questionnaire you will be asked how you feel about the physical and emotional impact of mastectomy with or without nipple sparing.

We would like to know from you how you felt about your physical aspect BEFORE your diagnosis:

  1. 1.

    Did you feel unsatisfied with your body?

  2. 2.

    Did you feel physically attractive?

  3. 3.

    Did you feel feminine?

  4. 4.

    Did you find it difficult to look at yourself naked?

  5. 5.

    Did you find it difficult being seen naked by your partner?

  6. 6.

    Were you satisfied with the size of your breast?

  7. 7.

    Were you satisfied with the shape of your breast?

  8. 8.

    Were you satisfied with the appearance of your nipple?

During the last four weeks:

  1. 9.

    Have you felt unsatisfied with your body?

  2. 10.

    Have you felt physically attractive?

  3. 11.

    Have you felt less physically attractive because of the disease or its treatment?

  4. 12.

    Have you been feeling feminine?

  5. 13.

    Have you been feeling less feminine because of the disease or its treatment?

  6. 14.

    Did you find it difficult to look at yourself naked?

  7. 15.

    Did you find it difficult being seen naked by your partner?

  8. 15bis.

    Did you experience feelings of mutilation?

Regarding the breast operated and reconstructed:

  1. 16.

    Have you been satisfied with the size of your breast?

  2. 17.

    Have you been satisfied with the shape of your breast?

  3. 18.

    Have you been satisfied with your breast skin sensitivity?

  4. 19.

    Have you been satisfied with the appearance of your scar?

  5. 20.

    Has the other breast been remodeled? YES NO

If YES, we would like to know:

  1. 21.

    Have you been satisfied with the size?

  2. 22.

    Have you been satisfied with the shape?

  3. 23.

    Have you been satisfied with your breast skin sensitivity?

  4. 24.

    Have you been satisfied with the appearance of your scar?

Now we would like to know from you, regarding cosmetic results of plastic surgery:

  1. 25.

    Do you consider the overall result of the surgery is similar to the natural aspect of your breast?

  2. 26.

    Have you been satisfied with cosmetic result of the plastic surgery overall?

  3. 27.

    Did your surgery results meet with your expectations?

  4. 28.

    Did you regret having had the breast reconstruction?

  5. 29.

    Did you have nipple sparing surgery? YES NO

Please, answer only if YES:

  1. 30.

    Have you been satisfied having preserved your nipple?

  2. 31.

    Did the preservation of your nipple help you to cope with the disease and surgical consequences?

  3. 32.

    Did the preservation of your nipple help you to feel less mutilated (disabled)?

Please answer only if it has NOT been possible to preserve your nipple:

  1. 33.

    Would you have preferred to keep your nipple?

Please indicate, why: …………………………………

During the last four weeks:

  1. 34.

    Have you felt satisfied with the appearance of your nipple?

  2. 35.

    Have you felt satisfied with your nipple sensitivity?

Now we would ask you some questions about an aspect of life which could be important for a woman, regarding sexuality.

We would like to know, BEFORE the disease:

  1. 36.

    Was sexuality an important part of your life?

  2. 37.

    Did you feel sexually attractive?

  3. 38.

    Was your breast important to your sexual life?

  4. 39.

    Was your nipple important to your sexual life?

During the last 4 weeks:

  1. 40.

    Was sexuality an important part of your life?

  2. 41.

    Did you feel interested in sexual activities?

  3. 42.

    Did you feel sexually attractive?

  4. 43.

    Have you been feeling less sexually attractive because of the disease or its treatment?

  5. 44.

    Were you sexually active?

Please, answer only of you have been sexually active during the last four weeks.

  1. 45.

    Did you feel enjoyment during sexual activities?

  2. 46.

    Did your breast play an important part in your sexuality?

  3. 47.

    Did your nipple play an important part in your sexuality?

  4. 48.

    Have you noticed a change regarding your partner in your sexual intimacy?

  5. 49.

    Have you noticed a diminished frequency of breast caressing in your partner?

  6. 50.

    Have you noticed that you have a reduced sexual drive?

Now we would like to know from you if during the last 12 months:

  1. 51.

    If there has been personal situation, a part from your disease and breast surgery, that would have interfered with your sexuality? YES NO

    Only if you want, please indicate:

    1. ○

      Family problems

    2. ○

      Grief

    3. ○

      Partner problems

    4. ○

      Separation

    5. ○

      Work problems

    6. ○

      Job loss

    7. ○

      Having to renounce to maternity because of the disease or your treatments

    8. ○

      Economic problems

    9. ○

      Impact of hormonal therapy (if you take an hormonal therapy)

Other……………………………………………………

We would like to know during the last four weeks:

  1. 52.

    Have you been frightened by the possibility of disease recurrence

Now we would like you to answer these three last questions:

  1. 53.

    How would you grade on a scale from 0 to 10 your satisfaction with cosmetic results of the your surgery overall:

  1. 54.

    If you are married or have a partner, has your partner expressed an opinion about the cosmetic result of your surgery overall: YES NO

  1. 55.

    If YES, could you please indicate your partner’s opinion regarding the cosmetic result of your surgery?

Rights and permissions

Reprints and permissions

About this article

Cite this article

Didier, F., Radice, D., Gandini, S. et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality?. Breast Cancer Res Treat 118, 623–633 (2009). https://doi.org/10.1007/s10549-008-0238-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-008-0238-4

Keywords