A comparison of patient satisfaction (using the BREAST-Q questionnaire) with bilateral breast reconstruction following risk-reducing or therapeutic mastectomy
Abstract:This study highlights the need for clinicians to take into account the indication for surgery as a major psychological factor in patients' perception of self and experience of surgery. It demonstrates that bilateral immediate reconstruction patients report similar physical symptoms irrespective of indication for mastectomy, but the decision-making process in terms of risk-balancing and diagnosis influences satisfaction with self and surgery. It underlines the importance of preoperative management of expectatio… Show more
“…Studies demonstrated that worse overall health status among survivors negatively influences satisfaction with breast reconstruction [ 40 ]. Therefore, it is conclusive that previvors had a significantly higher satisfaction in psychosocial well-being, sexual well-being, and physical well-being (chest) compared to survivors and is in accordance with previous data [ 41 ]. One might have expected otherwise while therapeutic mastectomies are accepted as a core component of cancer treatment and CRRM is in context with the cancer-affected breast surgery and therefore could be considered unavoidable.…”
Risk-reducing mastectomy (RRM) is the most efficient form of breast cancer (BC) risk reduction in BRCA1/2 pathogenic variant (pV) carriers. However, this intervention in physical integrity is associated with significant morbidity. We assessed long-term perception of satisfaction and health-related quality of life (QoL) after bilateral RRM and reconstruction using the validated BREAST-Q. We searched the prospective database of the Center for Hereditary Breast and Ovarian Cancer Cologne for previvors and survivors who underwent bilateral RRM from 1994 to 2015 and evaluated the results of their BREAST-Q scores. The study enrolled 43 previvors and 90 survivors after a mean follow-up of 46.3 ± 45.3 months after RRM. Satisfaction and QoL were independent of the technique of RRM or type of reconstruction but depended on the time of RRM. Compared to survivors, previvors had significantly higher mean satisfaction scores in their psychosocial, sexual, and physical well-being (chest) in both modules. Among previvors and survivors, higher psychological well-being correlated with a higher satisfaction with information and higher satisfaction with outcome. As psychological well-being correlated with satisfaction with information and outcome, we developed decision aids to improve shared decision making and long-term satisfaction with the decision and the postoperative outcome.
“…Studies demonstrated that worse overall health status among survivors negatively influences satisfaction with breast reconstruction [ 40 ]. Therefore, it is conclusive that previvors had a significantly higher satisfaction in psychosocial well-being, sexual well-being, and physical well-being (chest) compared to survivors and is in accordance with previous data [ 41 ]. One might have expected otherwise while therapeutic mastectomies are accepted as a core component of cancer treatment and CRRM is in context with the cancer-affected breast surgery and therefore could be considered unavoidable.…”
Risk-reducing mastectomy (RRM) is the most efficient form of breast cancer (BC) risk reduction in BRCA1/2 pathogenic variant (pV) carriers. However, this intervention in physical integrity is associated with significant morbidity. We assessed long-term perception of satisfaction and health-related quality of life (QoL) after bilateral RRM and reconstruction using the validated BREAST-Q. We searched the prospective database of the Center for Hereditary Breast and Ovarian Cancer Cologne for previvors and survivors who underwent bilateral RRM from 1994 to 2015 and evaluated the results of their BREAST-Q scores. The study enrolled 43 previvors and 90 survivors after a mean follow-up of 46.3 ± 45.3 months after RRM. Satisfaction and QoL were independent of the technique of RRM or type of reconstruction but depended on the time of RRM. Compared to survivors, previvors had significantly higher mean satisfaction scores in their psychosocial, sexual, and physical well-being (chest) in both modules. Among previvors and survivors, higher psychological well-being correlated with a higher satisfaction with information and higher satisfaction with outcome. As psychological well-being correlated with satisfaction with information and outcome, we developed decision aids to improve shared decision making and long-term satisfaction with the decision and the postoperative outcome.
“…In five studies satisfying our inclusion criteria, but with limited information or missing data, we contacted the authors with additional questions or a request to provide us with the missing or additional data. [15][16][17][18][19] Otherwise, we used the data of three studies [15][16][17] as presented and discussed possible consequences of missing data. Two studies were excluded because the missing data could not be retrieved.…”
Section: Data Extraction and Risk-of-bias Assessmentmentioning
Breast cancer is recognized as the most frequently diagnosed cancer in female patients worldwide. 1 Surgical intervention including mastectomy is considered an integral part of and often is essential to favorable therapeutic
“…Patient satisfaction with mastectomy and immediate reconstruction is shown to differ between those undergoing therapeutic mastectomy due to cancer as opposed to unaffected women with BRCA mutation having RRM. Physical well-being is the same but psychosocial and sexual well-being was lower in unaffected BRCA mutation carriers [ 73 ]. Indicators for a patient to be likely of having a genetic mutation linked to breast cancer.…”
Section: Who Should We Test For Brca Mutation and At What Time?mentioning
Germ-line mutation in BRCA (BReast CAncer gene) 1 or BRCA2 are found in 3–4% of all women with breast cancer. These patients have a significant increased risk of breast and ovarian cancer. They are often younger when diagnosed with the mutation, and the possible breast cancer they get is often aggressive with inferior outcome. There are risk reducing strategies, and the most powerful strategy is risk reducing surgery, both risk reducing bilateral mastectomy (RRM) and risk reducing bilateral salpino-oophorectomy (PBSO). This review is meant to address breast surgery in patients with germline BRCA mutation. The guidelines and techniques applied is under continuous change and it is important for the clinicians to be well informed to provide the patient with the information needed for them to make an informed decision on what risk strategy to choose.
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