title: Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes.
abstract: Bilateral prophylactic mastectomy (BPM) is effective in reducing the risk of breast cancer in women with a well-defined family history of breast cancer or in women with BRCA 1 or 2 mutations. Evaluating patient-reported outcomes following BPM are thus essential for evaluating success of BPM from patient's perspective. Our systematic review aimed to: (1) identify studies describing health-related quality of life (HRQOL) in patients following BPM with or without reconstruction; (2) assess the effect of BPM with or without reconstruction on HRQOL; and (3) identify predictors of HRQOL post-BPM.
  
  
  
  We performed a systematic review of literature using the PRISMA guidelines. PubMed, Embase, PsycINFO, Web of Science, Scopus and Cochrane databases were searched.
  
  
  
  The initial search resulted in 1082 studies; 22 of these studies fulfilled our inclusion criteria. Post-BPM, patients are satisfied with the outcomes and report high psychosocial well-being and positive body image. Sexual well-being and somatosensory function are most negatively affected. Vulnerability, psychological distress and preoperative cancer distress are significant negative predictors of quality of life and body image post-BPM.
  
  
  
  There is a paucity of high-quality data on outcomes of different HRQOL domains post-BPM. Future studies should strive to use validated and breast-specific PRO instruments for measuring HRQOL. This will facilitate shared decision-making by enabling surgeons to provide evidence-based answers to women contemplating BPM.
authors.affiliation: Plastic and Reconstructive Surgical Service, 1275 York Avenue, MRI 1007, New York, NY, 10065, USA. razdans@mskcc.org.
authors.forename: Shantanu N
authors.initials: SN
authors.lastname: Razdan
authors.affiliation: Weil Cornell Medical College, New York, NY, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Patel
authors.affiliation: Memorial Sloan Kettering Cancer Center Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jewell
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, MRI-1007, New York, NY, 10065, USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D001828:Body Image / Q000523:psychology; D001943:Breast Neoplasms / Q000517:prevention & control; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D000072036:Prophylactic Mastectomy / Q000523:psychology*; D011788:Quality of Life; D020018:Sexual Dysfunctions, Psychological / Q000523:psychology
keywords: Bilateral prophylactic mastectomy; Patient-reported outcomes; Quality of life; Risk reducing mastectomy; Systematic review