title: Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy.
abstract: BACKGROUND
  Contralateral prophylactic mastectomy (CPM) rates have been increasing in the US, and although high levels of satisfaction with CPM have been reported, few studies have evaluated the long-term effects on body image, comparing CPM with breast-conserving surgery (BCS) and unilateral mastectomy (UM).
  
  
  METHODS
  We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n = 1176). Among women who underwent mastectomy, we examined satisfaction with the mastectomy decision, as well as variation in the use of reconstruction and experience of complications. Five survey items, evaluated individually and as a summed total score, were used to compare body image across surgery types (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction).
  
  
  RESULTS
  Participants were, on average, 3.6 years post-diagnosis at the time of survey (standard deviation 1.7). The majority of women (97% of CPM, 89% of UM) were satisfied with their mastectomy decision. Reconstruction was more common after CPM than after UM (70 vs. 47%), as were complications (28 vs. 19%). Body image scores were significantly worse among women who underwent CPM than among women who underwent BCS, with the lowest scores among women who underwent CPM without reconstruction.
  
  
  CONCLUSIONS
  In our sample, most women were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lower among those who underwent CPM than among those who underwent BCS. Our findings may inform decisions among women considering various courses of surgical treatment.
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Islam
authors.affiliation: Social and Scientific Systems, Inc., Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Elizabeth Hodgson
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez
authors.affiliation: Department of Plastic Surgery, School of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Clara N
authors.initials: CN
authors.lastname: Lee
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. hazel.nichols@unc.edu.
authors.forename: Hazel B
authors.initials: HB
authors.lastname: Nichols
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010549:Personal Satisfaction; D011379:Prognosis; D000072036:Prophylactic Mastectomy / Q000523:psychology*; D019651:Plastic Surgery Procedures; D011795:Surveys and Questionnaires
keywords: Body image; Breast cancer; Contralateral prophylactic mastectomy