A Critical Assessment of Patient Outcomes and Satisfaction Reporting in Nipple Reconstruction Literature: A 14-Year Systematic Review

Introduction: Nipple reconstruction (NR) offers increased satisfaction among breast reconstruction patients. However, there is great variability in the way that post-NR outcomes and satisfaction are reported in literature, despite the advent of the standardized BREAST-Q. This poses significant difficulty in synthesizing findings across studies.

Methods: A systematic review of literature assessing NR outcomes and satisfaction was conducted using PubMed, Web of Science, and Cochrane Library from 2010-2023 via PRISMA guidelines. Data was collected on methods of evaluating and reporting patient satisfaction and postoperative outcomes.

Results: Among the 16 articles included, all discussed postoperative aesthetic outcomes of the nipple. Postoperative complications were discussed in 75%, though only 6.3% defined parameters for surgical complications. Patient-reported satisfaction was included in 87.5% of studies. When comparing the five items included in BREAST-Q to measures of NR satisfaction used in these studies, nipple height was addressed in all, overall look in 75%, shape in 43.8%, color in 25%, and natural appearance in 12.5%. However, 81.3% of studies also utilized measures of satisfaction that differed from those of BREAST-Q. Additionally, patient race was not reported in 93.8% of studies.

Conclusion: A standardized method of reporting patient outcomes and satisfaction in NR is warranted via wider implementation of the NR component of BREAST-Q. Incorporating additional measures of NR satisfaction to BREAST-Q, like nipple position or size, would also improve surgeons’ understanding of patient outcomes and satisfaction. Better characterization of demographics and race can also modify best practices to improve NR outcomes among specific populations.