Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast Conserving Surgery and Nipple-Sparing Mastectomy

Abstract Background Previously, we demonstrated that lumpectomy (L) patients reported higher appearance satisfaction (AS), appreciation of a pleasurable breast caress (PBC), and persistence of the breast during intimacy (BI) than mastectomy with reconstruction (MR) which we used to describe breast specific sensuality (BSS). Our current objective is to compare BSS between L and nipple-sparing mastectomy (NSM). Design An anonymous, cross-sectional survey was distributed to breast cancer survivors between 2014 and 2016. Eligible patients underwent surgery between 2000 and 2014, were >18 years old, English speaking, and >1 year past surgery. Demographics, treatment details, Female Sexual Function Index metrics, and investigator generated questions regarding AS and BSS were collected. Results Of the 600 women who participated, 585 surveys were eligible. Surgical modality was reported as L by 406 (69.4%), mastectomy alone (M) by 50 (8.5%), and MR by 129 (22.1%). Nipple preservation data was available for 47 of 129 (36.4%) of MR, with 21 NSM and 26 non-nipple-sparing mastectomy (nNSM). Favorable post-operative AS was reported by 76.2% of L and 71.4% of NSM (p=0.039). L was more comfortable being seen undressed than NSM (82.4% vs. 71.4%, p=0.0003). The chest remained a part of intimacy for 65.4% of L vs. 42.9% of NSM (p=0.0009). PBC was reported more frequently by L than NSM (66.2% vs. 20%, p= Conclusion NSM was significantly less satisfied with appearance, less comfortable being seen undressed, had decreased persistence of breast intimacy, and experienced a less pleasurable breast caress than lumpectomy. Counseling patients regarding these findings will empower informed decision making, optimize expectations, and may enhance postoperative satisfaction.