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Timing of radiation therapy in nipple‐sparing mastectomy influences outcomes and patient‐reported quality of life

The aim of this study is to assess the complication profile and impact on patient‐reported quality of life in those undergoing nipple‐sparing mastectomy (NSM) with immediate breast reconstruction and subsequent prosthetic reconstruction in patients with prior breast radiation therapy (pRT) vs those receiving adjuvant post‐mastectomy radiation therapy (PMRT). An IRB‐approved, retrospective analysis was performed from 2002 to 2014 to identify NSM patients that underwent pRT or PMRT. A 22‐item Likert scale questionnaire was administered by a third party to register patient‐reported quality of life. Forty patients met criteria for outcomes analysis, and 30 patients answered the questionnaire. Mean age was 45.6 years old and mean follow‐up was 3.8 years. Complication rates for the PMRT cohort were 61.9% vs 31.6% in the pRT cohort, P = .067, and those requiring operative intervention were PMRT 38.1% vs pRT 5.3%, P = .021. Nipple‐areolar complex survival was 100% in the pRT vs 85.7% in the PMRT, P = .233. Breast‐related quality of life scores were superior in the pRT group within multiple domains. Patients are more likely to develop complications requiring an operative intervention and have decreased breast‐related quality of life when undergoing NSM with PMRT compared to patients undergoing NSM having received pRT.