Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

Gopie, Jessica P.; Mureau, Marc A.M.; Seynaeve, Caroline; Kuile, Moniek M. ter; Menke-Pluymers, Marian B. E.; Timman, Reinier; Tibben, Aad

doi:10.1007/s10689-012-9588-5

Cited by 104 publications

(101 citation statements)

References 49 publications

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“…Although RRSO has not previously been shown to negatively impact body image [37], past research has concluded that women who undergo RRM report worse body image after surgery [21,10,22]. We considered whether the high rate of reconstruction in our sample may explain these differences; however, 95-100% of participants in these previous studies had also undergone reconstruction.…”

Section: Discussionmentioning

confidence: 94%

“…Early studies found no evidence of a negative sexual impact in 79 women who opted for RRM up to 18 months post-surgery [19] and only minor deteriorations in body image in 76 women who had RRM up to three years prior [20]. In contrast, Brandberg et al [21] reported significant reductions in body image and sexual pleasure in 90 unaffected women one year after RRM, and more recent findings suggest these negative impacts continue at least up to two years following RRM [15,22].…”

Section: Introductionmentioning

confidence: 98%

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Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

et al. 2014

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Purpose: To prospectively investigate long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO).Methods: Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret three years post-surgery. Outcomes were compared to age-and risk-matched controls.Results: Participants (N=233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM+RRSO (30 controls). Women who underwent RRM and those who underwent RRM+RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Conclusions:Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.3

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 98%

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

et al. 2014

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“…Active coping and seeking social support were predictive of lower levels of body image problems at the long-term follow up. In another prospective study from the Netherlands of 48 healthy BRCA1/2 mutation carriers, body image decreased 6 months after BRRM (7). Two years postoperatively, both body image and satisfaction with sexual relationship tended to be lower as compared to baseline.…”

Section: Introductionmentioning

confidence: 94%

“…We did not investigate the perception of the couple relationship, which has been demonstrated to be the most important variable for sexual functioning (7,24,26). It is plausible that satisfaction with the relationship at baseline may be associated with sexual functioning two years after RMM.…”

Section: Bismentioning

confidence: 99%

Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

Unukovych¹,

Johansson²,

Brandberg³

2017

Gland Surg.

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Background: Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM.Methods: This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998-2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year.Results: In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM. Conclusions:The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients.Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM.

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“…One study found that even after completion of reconstruction, 37 % of women reported that their breasts felt unpleasant, 29 % were not satisfied with their breast appearance, and 21 % felt embarrassed for their naked bodies. 27 In addition, breast stimulation is an important component of sexual arousal for some women that is severely impaired or lost altogether after mastectomy. 28 In summary, bilateral risk-reducing mastectomy significantly reduces near-term breast cancer risk in BRCA gene mutation carriers.…”

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confidence: 99%

Risk-Reducing Mastectomy for BRCA Gene Mutation Carriers

Euhus

2015

Ann Surg Oncol

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A family history of early-onset breast cancer in multiple relatives is an important breast cancer risk factor that should prompt efforts to define and manage cancer risk. Genetic testing is the most powerful tool we have for precisely determining who in these families is at increased risk and who is not. With the advent of massive parallel sequencing or next-generation sequencing and the commercialization of multigene panels, we have incrementally expanded the proportion of families that can be understood and managed from a genetic perspective. Nevertheless, BRCA1 and BRCA2 remain the most commonly identified genes affected by deleterious mutations. The next largest fraction includes PALB2, CHEK2, and ATM, but it is estimated that even with whole-genome sequencing, we are explaining only about 35 % of apparent inherited breast cancer predisposition. 1The first task after receiving a ''deleterious'' or ''likely deleterious'' genetic test result is to estimate cancer risks. This requires knowledge about the mutated gene, about the specific mutation, and about the extended cancer family history. It is common, but not accurate, to see a BRCA1 mutation and immediately assume that the lifetime breast cancer risk is 80 %. Slight differences in the way we code for other genes (polymorphisms) can influence the cancer probabilities associated with mutations in major predisposition genes. Different families have different risk profiles, even with the same mutation. This has been observed for BRCA1 for which lifetime breast cancer risk has been estimated at 26-87 % depending on the associated family history. It also is true for the newer ''modest penetrance'' genes such as ATM, for which the lifetime risk appears to be as high as 60 % in some families.2 Attention to the three-generation cancer family history during post-test counseling cannot be emphasized enough. Once cancer risks have been estimated, the focus shifts to developing a risk management strategy that considers the magnitude of the risk, the risks and effectiveness of possible interventions, and individual risk tolerance and preferences. The options to consider include lifestyle interventions, enhanced surveillance, chemoprevention, and risk-reducing surgery.The meta-analysis by De Felice and colleagues reported in this Annals of Surgical Oncology issue contributes to this discussion by attempting to quantify the breast cancer risk reduction afforded by bilateral risk-reducing mastectomy for BRCA gene mutation carriers. Their analysis included four prospective studies and estimated a 93 % reduction in breast cancer risk. Is this the number we should quote to our BRCA gene mutation carriers? A careful look at the studies included (or excluded) in this analysis will help to calibrate our confidence in the result.De Felice and colleagues were interested in prospective English-language studies describing bilateral prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers with no diagnosis of breast cancer by the time of mastectomy.

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Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

Cited by 104 publications

References 49 publications

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

Risk-Reducing Mastectomy for BRCA Gene Mutation Carriers

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