title: Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy.
abstract: BACKGROUND
  Prophylactic mastectomy is a preventive option for women who wish to reduce their risk of breast cancer. There has been concern about possible negative psychological sequelae following this procedure. However, few data are available regarding long-term satisfaction and psychological and social function following this procedure.
  
  
  OBJECTIVE
  To evaluate patients' long-term satisfaction and psychological and social function following prophylactic mastectomy.
  
  
  METHODS
  Descriptive study of all women known to be alive (n = 609) who had a family history of breast cancer and elected to undergo bilateral prophylactic mastectomy at a large, tertiary US health care clinic between 1960 and 1993, 94% (n = 572) of whom completed a study questionnaire.
  
  
  METHODS
  Satisfaction with procedure and effects on psychological and social function, based on responses to the study-specific questionnaire.
  
  
  RESULTS
  Mean time from prophylactic mastectomy to last follow-up was 14.5 years. Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, the most striking finding was that 74% reported a diminished level of emotional concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), level of stress (58%/28%), self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity (67%/8%). Forty-eight percent reported no change in their level of satisfaction with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative effects in these 6 variables, respectively.
  
  
  CONCLUSIONS
  This study suggests that positive outcomes following prophylactic mastectomy include decreased emotional concern about developing breast cancer and generally favorable psychological and social outcomes. These must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and occurrence of adverse psychological and social outcomes in some women. JAMA. 2000;284:319-324
authors.affiliation: Division of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Frost
authors.forename: D J
authors.initials: DJ
authors.lastname: Schaid
authors.forename: T A
authors.initials: TA
authors.lastname: Sellers
authors.forename: J M
authors.initials: JM
authors.lastname: Slezak
authors.forename: P G
authors.initials: PG
authors.lastname: Arnold
authors.forename: J E
authors.initials: JE
authors.lastname: Woods
authors.forename: P M
authors.initials: PM
authors.lastname: Petty
authors.forename: J L
authors.initials: JL
authors.lastname: Johnson
authors.forename: D L
authors.initials: DL
authors.lastname: Sitta
authors.forename: S K
authors.initials: SK
authors.lastname: McDonnell
authors.forename: T A
authors.initials: TA
authors.lastname: Rummans
authors.forename: R B
authors.initials: RB
authors.lastname: Jenkins
authors.forename: J A
authors.initials: JA
authors.lastname: Sloan
authors.forename: L C
authors.initials: LC
authors.lastname: Hartmann
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D012919:Social Behavior; D018709:Statistics, Nonparametric