title: Long-Term Psychosocial Functioning in Women with Bilateral Prophylactic Mastectomy: Does Preservation of the Nipple-Areolar Complex Make a Difference?
abstract: BACKGROUND
  Nipple-sparing prophylactic mastectomy (PM) is an option for women at high-risk for breast cancer, and may offer better cosmetic results than a skin-sparing PM where the nipple-areolar complex (NAC) is removed. However, there may be residual breast cancer risk due to the maintained NAC. It is unclear if sparing the NAC with PM impacts on psychosocial functioning, including cancer-related distress and body image after PM.
  
  
  METHODS
  This was a cross-sectional survey study of women who had undergone bilateral PM (no previous breast cancer) recruited through surgical or cancer genetics clinics. All women completed standardized questionnaires assessing cancer-related distress, anxiety, depression, satisfaction with decision, decision regret, and health-related quality of life related to breast surgery. Outcomes were compared between women with nipple-areola-sparing PM (NAC-PM) and skin-sparing PM (SS-PM).
  
  
  RESULTS
  Overall, 137 women completed the study; 53 (39%) had NAC-PM and 84 (61%) had SS-PM. The mean age of the study population was 41.5 years [standard deviation (SD) 8.8] and the mean time between PM and questionnaire completion was 50 months (SD 31). On the BREAST-Q, we found that women with NAC-PM had significantly higher levels of satisfaction with breasts (p = 0.01), satisfaction with outcome (p = 0.02), and sexual well-being (p < 0.001) compared with SS-PM. No statistically significant differences in total cancer-related distress (p = 0.89), anxiety (p = 0.86), or depression (p = 0.93) were observed between the two groups.
  
  
  CONCLUSIONS
  Overall, women with NAC-PM had better body image and sexual functioning compared with women with SS-PM, while both groups had comparable levels of cancer-related distress and perception of breast cancer risk.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada, Kelly.metcalfe@utoronto.ca.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
authors.forename: Tulin D
authors.initials: TD
authors.lastname: Cil
authors.forename: John L
authors.initials: JL
authors.lastname: Semple
authors.forename: Lucy Dong Xuan
authors.initials: LD
authors.lastname: Li
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Sophia
authors.initials: S
authors.lastname: Virani
authors.forename: Steven
authors.initials: S
authors.lastname: Narod
authors.forename: Tuya
authors.initials: T
authors.lastname: Pal
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D059351:Organ Sparing Treatments; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011379:Prognosis; D013315:Stress, Psychological; D013997:Time Factors; D055815:Young Adult