title: Long-term patient-reported satisfaction after contralateral prophylactic mastectomy and implant reconstruction.
abstract: OBJECTIVE
  To determine whether satisfaction and health-related quality of life (HR-QoL) differ between women who do and do not undergo contralateral prophylactic mastectomy (CPM) in the setting of implant reconstruction using the BREAST-Q, a validated patient-reported outcome instrument.
  
  
  METHODS
  From 2000 to 2007, a total of 3,874 patients with stage 0 to III unilateral breast cancer (BC) had mastectomy; 688 (18 %) pursued CPM within 1 year. Patients who completed the BREAST-Q reconstruction module as part of BREAST-Q validation studies or routine clinical care formed our study cohort. Comparisons were made between CPM and no-CPM patients using univariate analysis and multivariate models (MVA).
  
  
  RESULTS
  Of 294 patients with BREAST-Q data, 112 (38 %) had CPM. Median time from mastectomy to BREAST-Q was 52 months. CPM patients were younger (mean 47 vs. 50 years), more likely to be White (98 vs. 86 %), married (84 vs. 71 %), have a family history of BC (60 vs. 44 %), and to choose silicone implants (67 vs. 48 %). There were no differences in tumor or treatment characteristics between groups at the time of BREAST-Q. Patients with CPM had a higher mean score for Satisfaction with Breasts (64.4 vs. 54.9; p < 0.001) and Satisfaction with Outcome (74.8 vs. 67.7; p = 0.007); other HR-QoL domains did not differ. On MVA, CPM and the absence of lymphedema were significant predictors of Satisfaction with Breasts (CPM p = 0.005, lymphedema p = 0.039). CPM was not associated with improved Satisfaction with Outcome.
  
  
  CONCLUSIONS
  This study suggests that in the setting of implant reconstruction, CPM has a positive correlation with patient satisfaction with their breasts, but not with improvements in other HR-QoL domains.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Starr
authors.initials: S
authors.lastname: Koslow
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Pharmer
authors.forename: Amie M
authors.initials: AM
authors.lastname: Scott
authors.forename: Michelle
authors.initials: M
authors.lastname: Stempel
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Tari A
authors.initials: TA
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult