Abstract PO2-22-08: Nipple areolar complex changes after breast-conserving surgical therapy and periareolar mastopexy: a three-dimensional Surface Analysis
Authors: Peter Therese , Koban Konstantin , Ehrl Denis , Geiger Pamina , Harbeck Nadia , Kahlert Steffen , Luczak Carolin , Schmid Johannes , Wuerstlein Rachel , Hagemann Friederike 
Published: May 2024

Abstract
Objectives: The position and configuration of the nipple-areolar complex (NAC) have a high impact on satisfaction (objective and subjective) after breast-conserving therapy (BCT). The aim of this study is to objectively measure the changes in the NAC after breast conservation surgery by the use of the 3D whole body scanner and compare its results with the outcome reported by the patients. This will support further patients and help physicians to tailor their technique prior to breast-conserving surgery. Methods: In a unicentric pilot project 6 months after BET with periareolar mastopexy and adjuvant radiation between 2019 and 2022, 38 women were studied. The mean age was 56.3 ±11.6 and BMI was 24.6 ± 4.5 kg/m². Objective 3D parameters were collected using the Vectra Whole Body Surface Imaging System (WB360) based on breast and NAC dimensions. In addition, the patients received the BCT module and the mastopexy module items about satisfaction with the NAC from the BREAST Q questionnaire. Results: In a group of 38 women, BCT with periareolar mastopexy and irradiation showed a small but significant change in NAC position and shape (see Table 1). This small change is matched by the high satisfaction with the nipple and areola surveyed in the BREAST-Q questionnaire. More than 66% of the women were rather satisfied or very satisfied. The BREAST-Q results from the Items about satisfaction with the nipple and areola are shown in Table 2. However, 34% of participants reported being somewhat dissatisfied to very dissatisfied with the symmetry of placement. This could be due to a significant cumulative small change in nipple-sternal notch distance and nipple-midline distance. No significant difference was found when measuring the nipple-inframammary fold distance (p=0.649). The absolute difference was of 0.13 ± 1.22 mm. The change in breast diameter was of 0.55 ± 1.54 mm (relative 2,75 ± 7.95%). There was also no significance (p=0.042). This indicates that after BCT, the nipple-inframammary fold distance and breast diameter did not change significantly. Breast volume decreases insignificantly by 49.2 ± 136.1 cc (relative 12,96 ± 33.51) on the operated side (p=0.009). In particular, a difference in vertical diameter of the NAC of -4,79 mm (14,27%) was observed between the non-operated and the operated breast (p=0.005 by Wilcoxon-test). The BREAST-Q BCT Module consists of 8 domains. The higher the score, the higher the satisfaction with the questioned item. In our sample of 38 women, satisfaction with the surgeon(s) was highest (BREAST-Q score of 83,97 ± 19,12). The mean Q score for satisfaction with "psychosocial well-being" is 67,47 ± 22,03. For the item "sexual well-being", only 35 women answered sufficient questions and the mean Q score was 54,42 ± 16,43. “Satisfaction with breast” had a Q-score of 61,03 ± 19,36. The questions about "physical well-being" had a mean of 70,11 ± 16,69. The Q-score for “satisfaction with medical team”, “with office staff”, and “with information” can be seen in Table 3. Conclusions: In a nutshell, the conclusion of this study is that the Vectra XT 3D-Imaging is a useful tool to assess the cosmetic outcome in terms of NAC position and shape. Hence, it is a helpful tool to support the planning of the surgery and may have a positive impact on the outcome. Postoperatively, there was only a slight change in the NAC dimension and position compared with intraoperative planning. The 3D Surface Analysis is most useful in assessing the quality of reconstruction after BCT and additionally the NAC is therefore an important factor for patient satisfaction. Results of a multicenter study are pending.
Table 1: Descriptive statistic and Wilcoxon-test Results from the measures from the Breast and from NAC Dimension and Position (n=38)
The 3D Measures from the Breast and from NAC Dimension and Position
Table 2: Results from the BREAST-Q mastopexy modul about satisfaction with the nipples (n=38)
Satisfaction with the nipples
Table 3: Results from the BREAST-Q BCT Modul after BCT and periareolar mastopexy und adjuvant radiation (n=38)
BREAST-Q Scores
Citation Format: Therese Peter, Konstantin Koban, Denis Ehrl, Pamina Geiger, Nadia Harbeck, Steffen Kahlert, Carolin Luczak, Johannes Schmid, Rachel Wuerstlein, Friederike Hagemann. Nipple areolar complex changes after breast-conserving surgical therapy and periareolar mastopexy: a three-dimensional Surface Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-08.