This study evaluates the impact of hyaluronic acid (HA) injection for nipple projection following mastectomy, as a complement to areola micropigmentation. While micropigmentation is standard in nipple-areola complex (NAC) reconstruction, HA use remains novel, with limited data on psychosocial, sexual, and aesthetic outcomes.
A sequential explanatory mixed-methods design will be used. In Phase 1, a randomized controlled trial will compare two groups: one receiving NAC micropigmentation alone (control) and the other receiving micropigmentation plus HA-based nipple projection (intervention). A total of 138 participants will be recruited at the Areolar Micropigmentation Unit of Germans Trias i Pujol University Hospital (Barcelona) over 36 months. Outcomes will include psychosocial and sexual well-being, satisfaction with breast and nipple appearance, and nipple projection, measured using the Spanish BREAST-Q, a custom satisfaction tool, and calipers.
Phase 2 will involve a qualitative phenomenological study using semi-structured interviews with a purposive sample from the intervention group. Thematic analysis will explore body image, emotional and social well-being, and overall satisfaction, using NVivo software.
This is the first study assessing HA nipple reconstruction by advanced practice nurses using validated patient-reported outcomes. While the BREAST-Q is appropriate, it may not fully capture emotional nuances, justifying qualitative exploration. HA durability is estimated at 6-9 months, but residual volume and satisfaction over time remain underexplored. HA's aesthetic footprint may allow reduced dosages in future applications.
This minimally invasive technique may reduce the need for surgical nipple reconstruction. Conducting the procedure in a nurse-led setting is novel and may enhance patient-centered care and the role of nursing in post-mastectomy recovery.
The study complies with the Declaration of Helsinki and Spanish biomedical regulations. Ethical approval was obtained. Participants will provide informed consent, and data will be anonymized and securely stored.
Quantitative Phase
None
Parallel
Areola Micropigmentation
Procedure/SurgeryAreola micropigmentation performed by trained nurses
Hyaluronic Acid Filler Injection
DeviceSubcutaneous injection of cross-linked hyaluronic acid filler (Juvederm®) for nipple projection.
Satisfaction with Nipple Reconstruction
Patient-reported satisfaction with nipple reconstruction, measured using the "Satisfaction with Nipple" scale of the Spanish version of the BREAST-Q questionnaire. This scale ranges from 0 to 100, with higher scores indicating greater satisfaction."
Psychosocial Well-being
Psychosocial well-being assessed using the 'Psychosocial Well-being' domain of the Spanish version of the BREAST-Q questionnaire. This scale ranges from 0 (lowest well-being) to 100 (highest well-being), with higher scores indicating better psychosocial outcomes.
Sexual Well-being
Sexual well-being assessed using the 'Sexual Well-being' domain of the Spanish version of the BREAST-Q questionnaire. This scale ranges from 0 (lowest sexual well-being) to 100 (highest sexual well-being), with higher scores indicating better outcomes.
Satisfaction with Breasts
Satisfaction with breast appearance, measured using the 'Satisfaction with Breasts' subscale of the Spanish version of the BREAST-Q questionnaire. This scale ranges from 0 (lowest satisfaction) to 100 (highest satisfaction), with higher scores indicating better outcomes.
Satisfaction with Micropigmentation
Patient-reported satisfaction with areola micropigmentation, measured using a custom satisfaction questionnaire. Higher scores indicate better satisfaction outcomes.
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