Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women.
BACKGROUND
Prophylactic mastectomy with breast reconstruction is a risk-reducing strategy for women at increased risk of breast cancer. It remains a very radical intervention, and long-term data on satisfaction are insufficiently available. In the present follow-up study, the authors assess satisfaction with prophylactic mastectomy and breast reconstruction and its impact on sexual relationships.


METHODS
The authors conducted a retrospective study using a short self-report questionnaire administered to 114 genetically predisposed women who underwent prophylactic mastectomy and breast reconstruction mainly by subpectorally implanted silicone prostheses performed at one institution.


RESULTS
The median follow-up time between prophylactic mastectomy/breast reconstruction and completion of the questionnaire was 3 years. Sixty percent of all participants were satisfied with the result of prophylactic mastectomy/breast reconstruction. Satisfaction was significantly and negatively correlated with perceived lack of information, experienced complications, ongoing complaints, whether or not the reconstructed breasts feel "like your own," and not choosing this type of breast reconstruction again. Adverse effects in the patient's sexual relationship were strongly correlated with perceived lack of information, discrepant expectations, ongoing complaints and limitations, whether or not the reconstructed breasts feel "like your own," altered feelings of femininity, partner's negative perception on femininity and sexuality, and not choosing this type of breast reconstruction again.


CONCLUSIONS
A majority of women would choose the procedure again, but adverse effects and untoward changes in the perception of the sexual relationship need to be addressed in the counselling of women at high risk, to optimize an informed choice and enable adequate adjustment postoperatively.
Bresser
Paula J C
PJ
Department of Medical Psychology, The Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, The Netherlands. p.bresser@erasmusmc.nl
Seynaeve
Caroline
C
Van Gool
Arthur R
AR
Brekelmans
Cecile T
CT
Meijers-Heijboer
Hanne
H
van Geel
Albert N
AN
Menke-Pluijmers
Marian B
MB
Duivenvoorden
Hugo J
HJ
Klijn
Jan G M
JG
Tibben
Aad
A
D000203:Activities of Daily Living; D000328:Adult; D001828:Body Image; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D020249:Hormone Replacement Therapy; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000517:prevention & control; D010052:Ovariectomy; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology; D011795:Surveys and Questionnaires