Autologous Reconstruction Following Nipple Sparing Mastectomy Achieves Equivalent Aesthetic Outcome as Natural Breasts

We determined the aesthetic outcomes of autologous breast reconstruction in comparison to cosmetically altered or natural breasts. We also examined the effect of perceptions on aesthetic outcomes of breast reconstruction. Images of 10 patients (autologous breast reconstruction following bilateral nipple sparing mastectomy (NSM) (n=5), bilateral breast reduction (n=1), bilateral mastopexy (n=1), bilateral augmentation (n=1), unoperated natural breasts (n=2)), were compiled into a blind three-part survey. Part one asked participants to determine whether the presented breasts are reconstructed after mastectomy and measure aesthetic outcomes (1=poor and 4=excellent). Part two ranks breasts from most desirable to least desirable. Part three presents side-by-side unlabeled pre and postoperative images of patients who have undergone autologous breast reconstruction and asks to select the more aesthetically pleasing breasts. Two thousand images were quantified from 100 surveys (83.3% response rate). Age range of participants was 18-80. Response was not statistically different based on demographics. The rate of correctly identifying breasts as reconstruction after NSM was 62.8% and as natural was 64%. Mean aesthetic scores between the reconstructed and natural breasts were equivalent. Breasts perceived as reconstruction scored significantly lower in five aesthetic factors. The top 3 most desired breasts were augmentation, reconstruction after NSM, and unoperated natural breasts. In paired pre- and postoperative photo comparison, all responses favored postoperative breasts. Aesthetic outcomes after autologous breast reconstruction can be equivalent to natural breasts. Breasts perceived as reconstruction are ranked poorer in aesthetic factors compared to those perceived as natural breasts.