From the Divisions of Plastic and Reconstructive Surgery and Breast Surgery, Department of Surgery, University of California, San Francisco; the Department of Pediatrics, McMaster University; and Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2019 Apr;143(4):1010-1017. doi: 10.1097/PRS.0000000000005426.
Nipple-sparing mastectomy and immediate reconstruction has become increasingly popular for prophylactic and therapeutic indications. Patient-reported outcomes instruments such as the BREAST-Q provide important information regarding patient satisfaction and aesthetic and functional outcomes. However, a validated patient-reported outcomes scale specifically addressing nipple-related outcomes following nipple-sparing mastectomy is not currently available.
The authors developed a new scale measuring nipple outcomes by adapting nipple reconstruction questions from the BREAST-Q breast reconstruction module. Patients completed the questions using the think-aloud method and underwent semistructured cognitive interviews to discuss their nipple-sparing mastectomy experience to elicit new concepts. Interviews were coded and additional questions were added based on this analysis after receiving additional input from a multidisciplinary group of breast cancer providers. The final scale was distributed electronically to a larger group with solicitation for any issues that were not addressed in the question set.
Ten patients completed the initial questionnaire. Analysis of the cognitive interviews identified nipple sensation, position, projection, scarring, symmetry, and surgical expectations as key content areas. After revising the questionnaire, an additional 35 patients completed it electronically. All respondents felt the questions were clear and no additional issues needed to be addressed. Feedback was used to clarify the instructions for how to respond to the questions if bilateral nipple-sparing mastectomy had been performed.
Through qualitative patient interviews and adaptation of existing BREAST-Q questions, appropriate nipple-focused questions were developed to assess outcomes following nipple-sparing mastectomy. Incorporating these questions into patient-reported outcomes assessment of patients undergoing nipple-sparing mastectomy can help improve future techniques and optimize outcomes.
保乳手术和即刻重建因其具有预防性和治疗性指征而越来越受到欢迎。患者报告的结果指标，如 BREAST-Q，提供了关于患者满意度以及美学和功能结果的重要信息。然而，目前尚无专门针对保乳手术后乳头相关结果的经过验证的患者报告结果量表。
作者通过改编 BREAST-Q 乳房重建模块中的乳头重建问题，开发了一种新的测量乳头结果的量表。患者使用出声思考法完成问题，并进行半结构化认知访谈，以讨论他们的保乳手术经验，以引出新概念。对访谈进行编码，并根据该分析以及从一组多学科乳腺癌提供者那里获得的额外意见添加了额外的问题。最终的量表通过电子方式分发给更大的群体，并征求对问题集中未涉及的任何问题的意见。
10 名患者完成了初始问卷。认知访谈的分析确定了乳头感觉、位置、突出度、疤痕、对称性和手术期望作为关键内容领域。在修改问卷后，又有 35 名患者通过电子方式完成了问卷。所有受访者都认为问题很清楚，不需要解决其他问题。反馈用于澄清如何回答如果进行了双侧保乳手术的问题的说明。
通过对患者的定性访谈和对现有 BREAST-Q 问题的改编，开发了适当的以乳头为重点的问题来评估保乳手术后的结果。将这些问题纳入接受保乳手术的患者的患者报告结果评估中，可以帮助改进未来的技术并优化结果。
