Product Description

This systematic review and meta-analysis compared patient-reported outcomes and complication rates after nipple-sparing mastectomy (NSM) versus skin-sparing mastectomy (SSM) followed by immediate breast reconstruction, pooling 13 comparative studies with 3,895 patients. In meta-analyses of validated BREAST-Q scores, NSM was associated with significantly better sexual well-being (mean difference of approximately 8 points) and psychosocial well-being (approximately 5 points), whereas satisfaction with breasts, physical well-being, satisfaction with outcome, and overall complication rates did not differ significantly between the two approaches. NSM nonetheless carried procedure-specific risks—nipple-areola complex necrosis, delayed wound healing, mastectomy-flap necrosis, near-total loss of objective nipple sensation, and a less favorable nipple position—that should inform preoperative counseling. The authors conclude that the choice between NSM and SSM must be individualized, balancing oncologic treatments, complication risk profile, anatomy, and patient preferences, and that NSM should be offered to patients who value preservation of the nipple-areola complex only when it is considered oncologically safe.

Intended Audience

This educational activity is intended for all CME-related persons including plastic surgery practitioners, residents, and other healthcare professionals.

Learning Objectives

After viewing this course, the participant should be able to:

1. Differentiate nipple-sparing from skin-sparing mastectomy based on preservation of the nipple-areola complex and describe the implications of each technique for immediate breast reconstruction.
2. Compare patient-reported outcomes after nipple-sparing and skin-sparing mastectomy, including psychosocial, sexual, physical, and breast-related well-being, satisfaction with breasts and outcome, and nipple sensation and position.
3. Evaluate complication profiles associated with each mastectomy approach, including wound-healing problems, mastectomy flap necrosis, nipple-areola complex necrosis, infection, capsular contracture, and reconstruction failure.
4. Interpret BREAST-Q scores and other patient-reported outcome measures, including the magnitude and clinical relevance of reported differences, when counseling patients about expected quality-of-life outcomes.
5. Apply individualized patient-selection principles that integrate oncologic safety, anatomy, degree of ptosis, reconstructive plan, complication risk, and patient preferences when considering nipple-sparing mastectomy.

Faculty:

Marloes E. Clarijs, MD; Noelle J. M. C. Vrancken Peeters, BSc; Sophie A. F. van Dongen, BSc; Linetta B. Koppert, MD, PhD, MHS; Andrea L. Pusic, MD, MHS; Marc A. M. Mureau, MD, PhD; Bianca F. M. Rijken, MD, PhD

Plastic and Reconstructive Surgery Editors

Editor-in-Chief: Kevin C. Chung, MD

Co-editor: Amy S. Colwell, MD

CME Faculty:

Meir Retchkiman, MD

Lesley Wong, MD

Accreditation

The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation

The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 CreditTM: 1.0

Media: Journal Article

Release Date: 7/31/2026

Expiration Date: 7/31/2029*

Estimated time to complete this course: 1 hour

*Course access ends on course expiration date

Disclosure Policy

The American Society of Plastic Surgeons (ASPS) requires all instructors, planners, reviewers, managers and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. ASPS also requires faculty/authors to disclose when off-label/unapproved uses of product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following planners and faculty members have have the following disclosures:

Andrea L. Pusic, MD, MHS - Co-Developer of the BREAST-Q (owned by Memorial Sloan-Kettering Cancer Center) and may receive royalties when it is used in for-profit, industry sponsored clinical trials.

The following planners and faculty members have no relevant financial relationships or affiliations to disclose:

Marloes E. Clarijs, MD

Noelle J. M. C. Vrancken Peeters, BSc

Sophie A. F. van Dongen, BSc

Linetta B. Koppert, MD, PhD, MHS

Marc A. M. Mureau, MD, PhD

Bianca F. M. Rijken, MD, PhD

Meir Retchkiman, MD

Lesley Wong, MD

Recognition Statement

The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-in to reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.

Product Code: