title: Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study.
abstract: BACKGROUND
  Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM.
  
  
  METHODS
  This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998-2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year.
  
  
  RESULTS
  In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM.
  
  
  CONCLUSIONS
  The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients. Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM.
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Dmytro
authors.initials: D
authors.lastname: Unukovych
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; ; Department of Oncology, Karolinska University Hospital Solna, Stockholm, Sweden.
authors.forename: Hemming
authors.initials: H
authors.lastname: Johansson
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Brandberg
keywords: Breast cancer; body image; breast reconstruction; prophylactic mastectomy; quality of life, sexuality; risk-reducing mastectomy (RRM)