Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy

Abstract

Background Contralateral prophylactic mastectomy (CPM) rates have been increasing in the U.S. Though some studies have reported high overall satisfaction among women who undergo CPM, it is unclear how long-term satisfaction differs from that of women who undergo unilateral mastectomy (UM). Furthermore, few studies have assessed whether the effects of CPM on body image differ from those of breast conserving surgery (BCS) or UM. Methods We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n=1176). Among women who underwent mastectomy, satisfaction with mastectomy decision and reconstruction was compared between women who underwent CPM and UM. We also evaluated responses on 5 items related to body image according to surgery type (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction). Results Participants were, on average, 60.8 years old at diagnosis (SD=8.7) and 3.6 years post-diagnosis at the time of survey (SD=1.7). BCS was the most common surgical treatment reported (63%), followed by CPM (22%) and UM (15%). Satisfaction with mastectomy decision was reported by 97% of women who underwent CPM and 89% of those who underwent UM. Compared to other surgery types, women who underwent CPM without reconstruction reported feeling more self-conscious, less feminine, less whole, and less satisfied with the appearance of their breasts. Body image was consistently highest among women who underwent BCS. Conclusions In our sample of women with both a personal and family history of breast cancer, most were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lowest among women who underwent CPM without reconstruction. Our findings may inform decisions among women considering various courses of surgical treatment.

“I don't want to take chances.”: A qualitative exploration of surgical decision making in young breast cancer survivors

“…Several themes that emerged in this study reflected this complexity, particularly the tension between some of the emotions which were commonly expressed by women regarding their treatment. Consistent with other studies that have examined satisfaction with surgical decisions, most women in our study voiced confidence and satisfaction with their surgical choice. However, despite this confidence, some women said that, at times, they felt uncertain in some way about their decision.…”

Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015

“…Moreover, BLM has greater morbidity than unilateral mastectomy (ULM) or breast-conserving surgery with radiotherapy (breast conserving therapy [BCT]), in terms of complications, body image, recovery time, and impact on employment. [4][5][6][7][8] The choice to undergo BLM is complex. Although the probability of developing a contralateral second breast cancer has declined in the United States over time, 9 potentially due to the more widespread use of adjuvant endocrine therapy, 10 the majority of patients report that fear of a subsequent breast cancer was their primary motivation for choosing to undergo BLM.…”

Contralateral prophylactic mastectomy for unilateral breast cancer in women at average risk: Systematic review of patient reported outcomes

“…A total of 81 abstracts met eligibility criteria; 81 full‐text articles were reviewed, 63 were subsequently found to be ineligible, and one article was added following review of reference lists of eligible studies. A total of 19 studies were eligible for inclusion in the analysis 7,14‐32 …”

“…Four studies reported satisfaction with reconstruction and cosmesis 15,16,30,31 (Table 3). In two studies, satisfaction was high 15,31 .…”