Aesthetic and Sensory Preferences for the Nipple-Areola Complex Among Postmastectomy Women

Background Nipple areola complex (NAC) reconstruction is the final stage in breast reconstruction for many women. Although general population preferences on NAC aesthetics and sensation have been studied, it is unclear if these preferences align with the preferences of women who have undergone mastectomy. Therefore, this study aimed to assess the aesthetic and sensory preferences of women who have undergone mastectomy to inform subsequent NAC reconstruction and neurotization. Methods We conducted a cross-sectional, Facebook-based, crowdsourcing campaign to distribute a survey on NAC aesthetics (e.g., position, size, pigmentation) and sensation to women with a history of mastectomy. Analyses assessed aesthetic and sensory preferences stratified by breast shape. Results We received 109 responses from women with a median age of 51 years (interquartile range, 47-58 years). Most women were White (94%) and married (68%), with more than a high school education (83%) and a family income of $100,000 or more (39%). Their surgical histories included mastectomy (n = 109, 100%), autologous breast reconstruction (n = 59, 54.1%), implant-based breast reconstruction (n = 49, 45.0%), and NAC reconstruction (n = 26, 23.7%). On round breasts, respondents preferred NACs positioned in the middle of the vertical axis and laterally on the horizontal axis. On teardrop-shaped breasts, respondents preferred inferolateral NAC positioning. The most popular NAC diameter was one third the base width of the breast. Respondents preferred NAC pigmentation one shade darker than skin tone. Respondents indicated that NAC appearance, tactile sensation, and erogenous sensation were more important for sexuality and quality of life than for self-esteem, body image, or gender identity. Conclusions Optimal NAC aesthetics included a NAC one third the base width of the breast, pigmented one tone darker than skin tone, and positioned in the middle of the vertical axis and laterally on the horizontal axis on round breasts or inferolaterally on teardrop-shaped breasts.