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The Necessity of the Nipple: Redefining Completeness in Breast Reconstruction

Weissler, E. Hope BA*; Schnur, Julie B. PhD; Lamelas, Andreas M. MD*; Cornejo, Marisa BA*; Horesh, Elan MD, MPH*; Taub, Peter J. MD*

doi: 10.1097/SAP.0000000000000943
Breast Surgery

Introduction Satisfaction with breast reconstruction is thought to be greatest among patients who complete nipple and areolar complex (NAC) reconstruction. Anecdotally, many patients are known to decline NAC reconstruction. The authors aimed to characterize the epidemiology of and factors associated with incomplete breast reconstruction.

Methods Breast reconstruction patients with follow-up in a single institution's electronic medical record system were reviewed. Chi-squared and independent t-tests were used to identify variables associated with lack of NAC reconstruction; associated variables (P < 0.05) were used to build a binary logistic regression.

Results Four hundred thirty-three patients were reviewed. Reconstructions consisted of an average of 4.0 ± 2.0 procedures over 503 (range, 2–3,652) days. One hundred twelve patients had NAC reconstruction or tattooing (25.9%) and 73 (17.6%) had both—226 women (54.6%) had neither. On multivariate analysis, a history of any implant removal was associated with a 93.4% decreased chance of NAC reconstruction (P = 0.002), whereas prophylactic or early-stage mastectomy was associated with 52.9% increased chances of NAC reconstruction (P = 0.009).

Conclusions Over half of the present cohort did not complete any NAC reconstruction. Patients with later-stage cancer and a history of implant removal were less likely to have NAC reconstruction. The high prevalence of incomplete reconstructions suggests that the classical definition of breast reconstruction completion as requiring NAC reconstruction may be outdated or not applicable to all populations. Instead, “completion” should be considered a subjective determination varying between patients.

From the *Division of Plastic and Reconstructive Surgery, Departments of Surgery, and †Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.

Received June 7, 2016, and accepted for publication, after revision September 21, 2016.

Conflicts of interest and sources of funding: This research was funded in part by the National Cancer Institute of the National Institutes of Health under Award Number R21CA173163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. None of the authors have any financial interest in or commercial association with any of the products or devices discussed in this article.

Reprints: Elizabeth Hope Weissler, BA, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 50 E 98th St, New York, NY 10029. E-mail:

E.H.W. helped conceptualize and initiate the project, collected medical chart data, analyzed data, drafted article and finalized it for submission. J.S. helped conceptualize project, critically analyzed data, and revise the article. A.M.L. helped draft the article and revise and finalize it for submission. E.H. helped critically analyze data and draft and revise the article. M.C. helped collect medical chart data and revise the article. P.J.T. helped conceptualize and initiate the project, critically analyze data, and with drafting and revision of the article.

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