Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 1, Num. 2, 2005, pp. 111-113

Journal of Cancer Research and Therapeutics, Vol. 1, No. 2, April-June, 2005, pp. 111-113

Brief Communications

Custom-made nipple prosthesis: A long-term satisfaction survey

Janes Simon

Department of surgery, New Cross hospital, Wolverhampton, WV10 0QP
Correspondence Address:Department of surgery, New Cross hospital, Wolverhampton, WV10 0QP

Code Number: cr05023

Abstract

BACKGROUND: Nipple-areola reconstruction or prosthesis completes the process of breast reconstruction. Although custom made nipple prosthesis (CNP) have been used for almost 10 years, little follow-up data on patient satisfaction is available. We assessed long-term patient satisfaction with CNP.
MATERIALS AND METHODS: All patients undergoing CNP from 2000 to 2001 were sent anonymous postal questionnaires. Perceived benefit and satisfaction with size, colour, and projection, were assessed using a modified Likart scale (1 not satisfied, 5 very satisfied). Results are expressed as median and interquartile range (IQR).
RESULTS: Of 52 patients who had CNP, 29 responded to the questionnaire (56% response rate), median age (IQR) 56.1 years (52-61). The median time since CNP was 2 years (0.6-3), 67% felt they had benefited from the prosthesis and 39% wore their CNP regularly. Most patients were highly satisfied with CNP size, colour and projection, median score 5 (4-5) for each variable. Patients with CNP < 3 years were more likely to be satisfied with CNP than those with CNP for = 3 years, 60% vs 18%, p = 0.04. Patients who were satisfied with their CNP (median age 52.9 years, IQR 45.3-59.2 years), were younger than patients not satisfied with their CNP (median age 59 years, IQR 54.7-62 years), p = 0.031, Z = -2.16. Three patients had subsequent nipple reconstruction, a further 7 (24%) wanted nipple reconstruction. All respondents thought CNP should be offered at the time of initial surgery.
CONCLUSIONS: Most patients are highly satisfied with CNP, with highest satisfaction in the first 3 years after CNP. CNP should be offered at the time of initial surgery.

Keywords: Custom nipple prosthesis, Survey, Breast reconstruction

Introduction

The psychological value of breast reconstruction following mastectomy is well documented, encompassing diminished anxiety[1] and enhanced body image.[2] Nipple-areola reconstruction (NAR) or prosthesis completes this process of breast reconstruction. However, surgical NAR techniques have variable long-term results[3]: up to 11% experience flap necrosis, and one-third of patients require further corrective surgery.[4] Other long-term complications include loss of colour and projection, in addition to scarring at the donor site with some techniques.

Mass produced prosthesis were used as an early alternative to surgical NAR, but commercially available nipple prostheses have a uniform appearance, and are produced with little anatomical detail or colour variation [Figure - 1]. In contrast, a custom-made nipple prosthesis (CNP) reproduces the natural skin texture, and can match the size, shape and colour of the original nipple.[3] This approach is thought to provide a more psychologically and cosmetically acceptable prosthesis. Although CNP has been used for almost 10 years, no follow-up data on patient satisfaction is available. We aimed to assess long-term patient satisfaction of our breast cancer patients who underwent CNP. [Figure 2]

Materials and Methods

Production of a custom made prosthesis
An impression is taken of the existing nipple, into which a layer of molten wax is poured. The anatomical surface of the wax pattern is pressed into wet plaster, producing a mould. When the plaster has set, the wax is boiled out, leaving behind an open mould. The open mould is then filled with silicone that has been colour matched to the patient′s nipple, and processed in a dry heat furnace for one hour. Once cured, the prosthesis is removed and excess material trimmed away. The CNP is held in place using Vaseline or a medical adhesive.

Survey
All patients undergoing CNP from 2000 to 2001 were sent an anonymous postal questionnaire, to assess various aspects of their CNP. All patients underwent mastectomy or wide local excision including the nipple areola complex (NAC) for biopsy proven breast cancer. Perceived benefit and satisfaction with size, colour, and projection, were assessed using a modified Likart scale (1 not satisfied, 5 very satisfied). Data was recorded on a standardised proforma. Results are expressed as median and interquartile range (IQR). Categorical data were compared using the Chi-square test and continuous data compared using the Mann-Whitney test. p < 0.05 was considered significant throughout.

Results

Of 52 patients who had CNP following breast reconstruction, 29 responded to the questionnaire (56% response rate), median age 56.1 years (IQR 52-61 years). The median time since CNP was 2 years (IQR 0.9-3 years), and 67% felt they had benefited from the prosthesis. 39% wore their CNP regularly, for a median of 8 hours per day (IQR 2-13 hours). The most commonly used method for securing the prosthesis to the skin was Vaseline (11 patients, 38%), two patients used adhesive (7%) and three patients used both Vaseline and adhesive (10%). Most patients were highly satisfied with CNP size, colour and projection, median score 5 (IQR 4-5) for each variable.

Comments on CNP were generally positive, and suggested improved psychosocial confidence including: "it made me feel complete"; "it made me feel like a woman"; three women said it allowed them to enjoy swimming again, another felt able to wear a bikini for the first time in 18 months. Only two patients reported problems maintaining suction with the CNP, and another was unable to use the prosthesis because of a skin reaction to the silicone.

Patients who were satisfied with their CNP (median age 52.9 years, IQR 45.3-59.2 years), were significantly younger than those who were not satisfied with their CNP (median age 59 years, IQR 54.7-62 years), p = 0.031, Z = -2.16. In addition, patients who had their CNP for less than 3 years were more likely to be satisfied with CNP than those with CNP for = 3 years, 60% vs 18%, p = 0.04. Three patients had subsequent nipple reconstruction, a further 7 (24%) wanted nipple reconstruction. Finally, all respondents thought CNP should be offered at the time of initial surgery.

Discussion

In this first follow up survey of CNP satisfaction, we have found most patients are highly satisfied with CNP, with highest satisfaction in the first 3 years of CNP use. Patients satisfied with their CNP also tended to be younger, which may be due to enhanced perception of body image in younger women.[2] Our findings are consistent with a previous study that compared characteristics of women who did or did not chose surgical NAR following mastectomy, which found that women choosing NAR were younger and more satisfied with the final result than those who chose not to undergo surgical NAR.[5] It was interesting to note that one-quarter of patients wanted surgical NAR. This, together with the fact that CNP satisfaction was lower after three years of use, suggests it may be worthwhile offering surgical NAR after this time has elapsed.

CNP is a quick and inexpensive alternative to surgical nipple reconstruction, with considerable shape and colour advantages over the commercially available varieties [Figure - 1]. The whole process takes 2-3 hours, and can be performed by any maxillofacial laboratory on an outpatient basis. This offers substantial cost benefits in comparison to surgical reconstruction, which involves both theatre and inpatient time. Our results suggest CNP should be more widely available, and offered alongside reconstruction at the time of initial breast cancer surgery if nipple loss is anticipated.

References

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