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BREAST

Satisfaction with Prophylactic Mastectomy


Breast Reconstruction in Genetically
and
Predisposed Women
Paula J. C. Bresser, M.A.
Background:
Prophylactic mastectomy with breast reconstruction is a risk-reducCaroline Seynaeve, M.D.,
ing strategy for women at increased risk of breast cancer. It remains a very radical
Ph.D.
intervention, and long-term data on satisfaction are insufficiently available. In the
Arthur R. Van Gool, M.D.
present follow-up study, the authors assess satisfaction with prophylactic mastectomy
Cecile T. Brekelmans, Ph.D.
and breast reconstruction and its impact on sexual relationships.
Hanne Meijers-Heijboer,
Methods:
The authors conducted a retrospective study using a short self-report
M.D., Ph.D.
questionnaire administered to 114 genetically predisposed women who underwent
Albert N. van Geel, M.D., prophylactic mastectomy and breast reconstruction mainly by subpectorally imPh.D.
planted silicone prostheses performed at one institution.
Marian B. Menke-Pluijmers,
Results:
The median follow-up time between prophylactic mastectomy/breast reM.D., Ph.D.
construction and completion of the questionnaire was 3 years. Sixty percent of all
Hugo J. Duivenvoorden, participants were satisfied with the result of prophylactic mastectomy/breast reconstruction.
Ph.D.
Satisfaction was significantly and negatively correlated with perceived
Jan G. M. Klijn, M.D., Ph.D. lack of information, experienced complications, ongoing complaints, whether or
Aad Tibben, Ph.D. not the reconstructed breasts feel like your own, and not choosing this type of
breast reconstruction again. Adverse effects in the patients sexual relationship were
Rotterdam and Leiden,
strongly correlated with perceived lack of information, discrepant expectations,
The Netherlands
ongoing complaints and limitations, whether or not the reconstructed breasts feel
like your own, altered feelings of femininity, partners negative perception on
femininity and sexuality, and not choosing this type of breast reconstruction again.
Conclusions:
A majority of women would choose the procedure again, but adverse
effects and untoward changes in the perception of the sexual relationship need to
be addressed in the counselling of women at high risk, to optimize an informed
choice and enable adequate adjustmentpostoperatively.
Plast.
( Reconstr. Surg.
117:
1675, 2006.)

5
omen identified with a
BRCA1/2 muta48 to 64 percent.
At this moment,
bilateral or
tion have a cumulative lifetime risk of
contralateral prophylactic mastectomy is the
39 to 85 percent for breast cancer and
most effective, although radical, strategy to re11 to 63 percent for ovarian cancer at age 70
duce the risk of breast cancer in high-risk
6 , 7 Family Cancer Clinic of the
years. 1 4 Furthermore, the lifetime risk of conwomen.
At the
tralateral breast cancer for genetically predisErasmus Medical CentreDaniel den Hoed Canposed women after a history of breast cancer is
cer Centre in Rotterdam, between 35 and 51
percent of the identified mutation carriers opt
From the Departments of Medical Psychology and Psychotherapy,
for prophylactic mastectomy with breast
Medical Oncology, Surgical Oncology, Psychiatry, and Clinical reconstruction.
6, 8
Satisfaction
with prophylactic
Genetics, the Daniel den Hoed Cancer Center, and the Family
mastectomy
has
reported
tomastectomy
vary
between
www.plasreconsurg.org
1675
present
construction
reconstruction
were
the
ever,
longer
study,
that
major
70satisfaction
not
investigated
percent
term
awe
limitations
after
primary
after
assessed
inbeen
prophylactic
114
prophylactic
infocus
with
awomen
and
of
satisfaction
small
the
immediate
of
nearly
published
the
subsample.In
mastectomy
at
increased
study
100
with
breast
or
percent.
studies
breast
itHowwas
risk
the
rein
Cancer
Human
Received
21,
Presented
Aspects
2003,
sium,
Copyright
DOI:
2005.
10.1097/01.prs.0000217383.99038.f5
in
and
Clinic,
and
of
San
for
at
the
2006
Hereditary
Clinical
Antonio,
the
publication
26th
Erasmus
Eighth
by
Annual
Genetics,
the
Texas,
Cancer,
International
Medical
American
January
San
December
in
Leiden
Antonio
Barcelona,
Center;
26,
Society
2005;
Meeting
University
5,
Breast
and
2003.
ofrevised
Spain,
Plastic
the
on
Cancer
Medical
Psycho-Social
Department
November
March
Surgeons
SympoCenter.
of
14,
9,10

12 ,113
1
0,,115
16
6

Plastic and Reconstructive Surgery May 2006

of contralateral breast cancer caused by a


tomy and breast reconstruction. Sixteen questions
BRCA1/2 mutation or a supposed genetic predis- covered four domains: (1) general and prophyposition.
lactic mastectomy/breast reconstructionspecific
satisfaction (three questions); (2) feeling informed
about the procedure and its possible conPATIENTS AND METHODS
sequences (two questions); (3) perioperative and
Participants
postoperative complications, physical complaints,
From the database of a follow-up study on the and limitations attributable to prophylactic masmedical effects of prophylactic mastectomy in ge- tectomy/breast reconstruction (three questions);
netically predisposed and high-risk women, we apand (4) effects on body image and sexuality (eight
proached all women ( n
136) who underwent
questions). All questions addressed breast reconbilateral or contralateral prophylactic mastecto- struction specifically. Three questions concerning
my/breast reconstruction at our institution bebody image and sexuality addressed the perceptween 1994 and 2002. Prophylactic mastectomy/ tion of the women about their partners satisfacbreast reconstruction was performed because of
tion.
an increased risk of a new breast cancer caused by
Answers were rated on a five-point scale, as
either a BRCA1 or a BRCA2 mutation, orfollows:
a 50 Yes!, Yes, ? (neutral), No, or No!
percent risk carrier status in women from hered- Questions that implicated the presence of a partitary breast/ovarian cancer families. All women
ner could also be scored as not applicable.
were from families with cancer following an autosomal dominant pattern of inheritance and
Procedure
were offered genetic testing before undergoing
The questionnaire was mailed to all patients
prophylactic mastectomy. Some of these women
remain at increased risk of breast and/or ovarian who met the inclusion criteria. Two patients apparently moved without giving notice of their new
cancer without the possibility that this risk can be
address. Eighty-four percent of the womenn(
specified further. They may, however, opt for pro114) completed and returned the questionnaire
phylactic mastectomy. Reconstruction was perby mail.
formed by means of subpectorally implanted silicone prostheses, as has been described in detail
elsewhere. 1 7
Statistical Analysis
A history of breast cancer was not an exclusion We present the frequencies and percentages
criterion. Women who had previously undergonefor the responses on the questionnaire. Given that
unilateral mastectomy for a primary breast cancer women with a history of breast cancer may have
( n 9) underwent reconstruction at that side withhad different priorities when considering prophyanother technique.
lactic mastectomy with breast reconstruction, we
Follow-up was performed at the Family Cancer
performed analyses not only on the complete samClinic of the Erasmus Medical CentreDaniel denple but also on women with and without previous
Hoed Cancer Centre in Rotterdam. The institu- breast cancer separately. Furthermore, logistic retional review board approved the study. Written gression analyses were performed with (1) satisinformed consent from participants was obtained. faction and (2) adverse effects in the sexual relaSixty-five women also underwent a prophylactionship as outcome variables. Hereto, we
tic bilateral salpingo-oophorectomy, which was dichotomized the original five-point scale by comperformed either before, simultaneously with, orbining the Yes! and Yes answers, on the one hand,
after prophylactic mastectomy/breast reconstruc-and the ?, No, and No! answers, on the other hand,
tion. Bilateral salpingo-oophorectomy was not
for the outcome variables alone. This type of dinecessarily performed at our institute. Thirty-one chotomization was performed to study more spe1676
time
Questionnaire
based
and
follow-up
women
We
on
during
on
questionnaires
used
with
developed
clinical
studies,
the
the
hormone
follow-up
outcome
experience
to
a brief
measure
that
replacement
of
self-report
period.
areprophylactic
with
the
currently
satisfaction
high-risk
therapy
questionnaire
used
mastecwomen
atin
of
any
objective
ical
come
intion;
cifically
these
other
satisfied)
differences,
ofvariable
(2)
prophylactic
women
was
questions
years
theto
patients.
satisfied
was
elapsed
investigate
we
irrespective
of
investigated.
adjusted
mastectomy/breast
the
The
versus
since
questionnaire
influence
the
for
of
prophylactic
the
level
interpersonal
(1)
Because
remaining
age
of
of satisfaction
reconstruceach
on
atour
the
mastectheof
(nonmedmain
time
outthe

Volume 117, Number 6 Satisfaction with Prophylactic Mastectomy

tomy/breast reconstruction; (3) history of breast As is shown in Table 2, 68 women (60 percent)
cancer; (4) bilateral salpingo-oophorectomy; andwere satisfied with the result of prophylactic mas(5) hormone replacement therapy. Each predic- tectomy and breast reconstruction. One hundred
tor variable was tested on the outcome variable six women (95 percent) would opt for prophylacseparately, including the variables that were ad- tic mastectomy again, should they have to choose
justed for. A value of
p
0.05 (two-tailed) wasagain; 89 women (80 percent) would choose to
considered statistically significant.
undergo the same type of breast reconstruction
again; and 95 women (85 percent) felt sufficiently
RESULTS
informed.
Sample Characteristics
Forty-eight women (43 percent) reported periOf the 136 women who received the question- operative and/or postoperative complications
naire, 114 participated in this study (84 percent). and 35 women (32 percent) mentioned that they
Two-thirds of these women (
n
77) were unafexperienced ongoing physical complaints in one
fected BRCA1/2 mutation carriers ( n
63) or 50 or both reconstructed breasts. Twenty-eight
percent risk carriers (
n
14); 22 women had women (25 percent) reported limitations in acpreviously been treated for breast cancer by either
tivities of daily life attributable to the aftermath of
breast-conserving therapy ( n
13) or unilateralprophylactic mastectomy/breast reconstruction.
mastectomy ( n
9). Fifteen women elected to
The sensation of the breasts was altered in
undergo bilateral mastectomy with reconstruction
nearly all women (97 percent), 58 women (51
when breast cancer was diagnosed. None of these
percent) rated their breasts as
feeling like
not
women experienced a recurrence of breast cancer
in the years after surgery until time of assessment. their own, and 32 (29 percent) women reported
altered feelings of femininity after prophylactic
Thirteen of 37 women with a history of breast
cancer were proven BRCA1/2 mutation carriers.mastectomy/breast reconstruction, whereas only
eight women (8 percent) thought their partners
Some women did not answer all questions,
resulting in different totals. Median follow-up af- found them less feminine. Ten women (13 perter surgery for the complete sample was 3 years cent) experienced positive changes in their sexual
relationship resulting from prophylactic mastec(range, 2 months to 8 years). Respondents and
tomy/breast reconstruction. Forty women (44 pernonrespondents ( n
22) did not differ demographically. Characteristics of the participants are cent) reported an adverse change in their sexual
presented in Table 1.
relationship resulting from prophylactic mastectomy/breast reconstruction. Finally, 10 of the
Overall Evaluation
partners (13 percent) were thought to have experienced a positive change in the sexual relaWomen with and without a history of breast
cancer did not differ significantly in responses on tionship, whereas 27 partners (35 percent) were
the questionnaire. Therefore, we performed the thought to have experienced an adverse change in
analyses on the total sample.
the sexual relationship.
Table 1. General Characteristics of 114 Participants Who Underwent
Reconstruction
from 1994 and
to 2002
Prophylactic Mastectomy
Breast
Unaffected Women*
(n
77)
Median age, years (range) 41 (2559) 46 (3065) 44 (2565)
Median age at time of PM/BR, years (range) 38 (2355) 43 (2659) 40 (2359)
PM,
prophylactic
mastectomy;
BR, breast
reconstruction;
PBSO, prophylactic bilateral salpingoMedian
follow-up,
years (range)
3 (08)
4 (08) 3 (08)
Living
Risk
Additional
BRCA1/2
Women
PBSO,
HRT,
status,
with
%a%at
%
a48
partner,
mutation
risk
17
(46)
14
68breast
(18)
(90)
65
63
(57)
24
32(82)
(65)
(86)
38
100
(35)
(33)
(88)
76 (67)
oophorectomy;
*Women
therapy.
Women
Based
on
with
without
family
a50%
HRT,
history
a(62)
history
history
hormone
of%carriers
breast
of
suggestive
replacement
cancer.
cancer.
for
a 13
breast/ovarian
cancer syndrome.30 (39) 1 (2) 31 (27)

Affected Women
Total Group
(n
37)
114)
n(

1677

Plastic and Reconstructive Surgery May 2006


Table 2. Womens Experience with Prophylactic Mastectomy and Breast
Reconstruction*
Answers No. Yes! and Yes (%) ? (Neutral) (%) No and No! (%)

Being satisfied with result of PM/BR 113 68 (60) 13 (12) 32 (28)


Would opt for PM again 112 106 (95) 5 (5) 1 (1)
Would opt for BR again 112 89 (80) 12 (11) 11 (10)
Feeling sufficiently informed 112 95 (85) 1 (1) 16 (14)
Surgery did not meet expectations 112 35 (31) 8 (7) 69 (62)
Complications 113 48 (43) 2 (2) 63 (56)
Ongoing complaints 111 35 (32) 5 (5) 71 (64)
Limitations in daily life 112 28 (25) 6 (5) 78 (70)
Change in feeling of the breasts 114 111 (97) 0 (0) 3 (3)
Breasts do not feel like your own 113 58 (51) 7 (6) 48 (43)
Changes in femininity attributable to PM/BR 111 32 (29) 4 (4) 75 (68)
Partners perception of lessened femininity
attributable to PM/BR 100 8 (8) 3 (3) 89 (89)
Positive effects in sexuality attributable to PM/BR 77 10 (13) 11 (14) 56 (73)
Adverse effects in sexuality attributable to PM/BR 90 40 (44) 9 (10) 41 (46)
Partners perception of positive effects in sexuality
attributable to PM/BR 79 10 (13) 11 (14) 58 (73)
Partners perception of adverse effects in sexuality
attributable to PM/BR 77 27 (35) 10 (13) 40 (52)
PM, prophylactic mastectomy; BR, breast reconstruction.
*Row totals deviating from
n
114 indicate missing data.
Sample size; number of women who had a response on this item.
Self-reported complications, including secondary reconstructive surgery.

Satisfaction
tients and Methods. Significant differences were
found
between satisfied patients and nonsatisfied
We dichotomized the total group into satisfied
patients, as shown in Table 3.
patients ( n
68) and nonsatisfied patients (
n
Nonsatisfied
patients felt significantly less in45) based on the following question: Are you
formed than satisfied patients0.02).
( Nonp
satisfied with the result of breast reconstruction?
The answers were analyzed taking into account satisfied patients reported significantly more comvarious confounders as described above under Paplications ( p0.01) and more physical
Table 3. Relationship between Satisfaction and Womens Experience with
Breast
Reconstruction*
Prophylactic
Mastectomy and
Nonsatisfied Patients
(n
45)
Reported Experience No. No. (%) No. No. (%)
Feeling insufficiently informed 43 10 (23) 68 6 (9) 0.02
Surgery did not meet expectations 45 17 (38) 67 18 (27) 0.08
Complications 44 23 (52) 68 24 (35) 0.01
Complaints 42 26 (62) 68 9 (13) 0.001
Limitations in daily life 43 13 (30) 68 15 (22) 0.33
Change in feeling of the breasts 45 45 (100) 68 65 (96) 0.75
Breasts do not feel like your own 44 28 (64) 68 30 (44) 0.02
Change in feelings of femininity 44 14 (32) 66 17 (26) 0.53
Partners perception of decrease in his wifes
femininity 37 4 (11) 62 4 (7) 0.94
PM,
*Logistic
prophylactic
regression
mastectomy;
analysis,
adjusted
BR,
breast
for reconstruction;
age 26
at the
time 50
of
PBSO,
PM/BR;
prophylactic
years since
bilateral
PM/BR;
salpingohistory of breast
Positive
effects
on
the sexual
relationship
5 (19)
5 (10)
0.70
1678
Adverse
Partners
Would
relationship
not
effects
perception
opt
for
28
26
on
6BR
13
PM
the
(21)
of
(50)
again
again
sexual
positive
adverse
50504replacement
43
44
14
(8)
relationship
10
effect
1effect
(28)
0.07
(2)
(23)
0.06
67
on
on
0sexual
sexual
(0)
32
1 (2)
18
0.28
0.01
(56)
57item.
22significant.
(39) 0.31
oophorectomy;
therapy.
cancer;
Sample
A
valuePBSO;
size;
of
pnumber
and
HRT,
0.05
HRT.
hormone
of
(two-tailed)
women
who
was
had
considered
a68
response
statistically
on
this

Satisfied Patients
(n 68)
p

Volume 117, Number 6 Satisfaction with Prophylactic Mastectomy

complaints ( p
0.001) than satisfied patients.
sexual relationship
0.001).
( Finally,
p
they were
Moreover, nonsatisfied patients reported signifi- more likely to report that they would not opt for
cantly more than satisfied patients that their
breast reconstruction again (
p 0.01).
breasts did not feel like they belonged to their
body ( p 0.02). Finally, nonsatisfied patients reDISCUSSION
ported significantly more often that they would
This is the first study that addresses the impact
not opt for breast reconstruction again (
p of
0.01).
both prophylactic surgery and breast reconstruction in a large sample of genetically predisposed
Impact on Perception of Sexual Relationship women. Prophylactic mastectomy/breast reconNearly half of the women who filled out the struction was not regretted by the vast majority of
questions about the sexual relationship (
n
90) women, which is in accordance with other
9, 1 11 5
reported that the result of prophylactic mastectostudies.
Nevertheless,
only 60 percent of the
my/breast reconstruction had negatively affectedwomen were satisfied with the results of the breast
their sexual relationship (44 percent). Therefore, reconstruction. This is less than observed in other
, 13, 16
we performed a logistic regression analysis with
studies.
Higher12distress
or cancer-related worry
the impact on the sexual relationship as an out- has been found in women opting for prophylactic
come variable. We adjusted for the same con- mastectomy compared with those who favoured surfounders as described above under Patients andveillance, although the distress had significantly de9, 14 ,1we
8
Methods.
creased 6 months after surgery.
Therefore,
Results are shown in Table 4. Women who speculate that relief from anxiety of developing a
reported adverse changes in their sexual relationnew breast cancer characterizes the short-term outship stated that they felt insufficiently informed come after prophylactic mastectomy. Thereafter,
about the procedure and its possible consethe growing awareness of the profound consequences ( p 0.01), that surgery had not met their
quences of the surgery might have affected the satexpectations ( p
0.001), and that they were exisfaction with the eventual results. Indeed, signifiperiencing more complaints ( p 0.01) and more
cantly more nonsatisfied women would not opt for
limitations in daily life ( p 0.01). They werebreast
also reconstruction again compared with satisfied
more likely to report that the reconstructed
women.
9
breasts did not feel like their own (
p 0.01) and
Frost
found
et in
al.their
study (mean followthat they experienced altered feelings of feminin- up, 14.5 years) that 80 percent of the surveyed
ity ( p
0.01) and a decrease in their partners women were satisfied with prophylactic mastecperception of his wifes femininity (
p
0.04).
tomy. However, they did not explicitly study the
They were more likely to perceive an adverse
satisfaction with breast reconstruction after prochange in the way the partner experienced their phylactic mastectomy. Moreover, the mean age of
Table 4. Relationship between Adverse Effects on the Sexual Relationship and
Prophylactic
Mastectomy
Womens Experience
withand Breast Reconstruction*
No Effect ( n

50) Adverse Effect (

n 40)

No. No. (%) No. No. (%)

Does not feel sufficiently informed 50 2 (4) 40 12 (30) 0.01


Surgery did not meet expectations 48 9 (19) 40 18 (45) 0.001
Complications 49 18 (37) 40 20 (50) 0.34
Complaints 48 8 (17) 40 18 (45) 0.01
Limitations in daily life 50 7 (14) 39 18 (46) 0.01
PM,
prophylactic
mastectomy;
BR,the
breast
reconstruction;
Nonsatisfied
with
the result of
reconstruction
50 PBSO,
14 (28)prophylactic
40 18 (45) bilateral
0.07 salpingoChanged
Breasts
Change
Partners
Would
femininity
relationship
not
do
infeeling
perception
feelings
opt
not
50
for
feel
48at
1in6BR
PM
(2)
like
of
one
(13)
offemininity
36
again
again
decrease
adverse
your
or27
7both
(19)
20
50
49
own
(74)
0breasts
effect
00.04
in
49
(0)
(0)
50
his
0.001
918
39
39
on
(18)
50
(36)
7response
1sexual
(18)
(3)
49
3940
(98)
0.25
20
0.01
27
(51)
40
(68)
38
0.01
0.01
(95) 0.48
oophorectomy;
*Adjusted
therapy.
Sample
size;
for
age
number
HRT,
the
hormone
of
time
women
of
replacement
PM/BR;
who
had
years
awifes
since
PM/BR;
on
this
item.
history
of breast cancer; PBSO; and HRT.

1679

Plastic and Reconstructive Surgery May 2006

their group at the time of the study was much


of women had experienced untoward changes in
higher (57 years) than in our study. Although their relationship because of prophylactic mastec9
their findings suggest a positive adjustment in the
tomy. Frostfound
et al. that
prophylactic maslong term, our data suggest that a favorable out- tectomy could result in adverse effects on the sexcome of prophylactic mastectomy/breast reconual relationship (23 percent) and feelings of
struction and therefore persistent sexual attrac- femininity (25 percent), which is consistent with
tiveness may be more valued by younger women.
our findings. However, those studies did not focus
The level of satisfaction about prophylactic on breast reconstruction specifically. In our study,
mastectomy/breast reconstruction in our study though not related to satisfaction with prophylacwas associated with various factors, such as peri- tic mastectomy/breast reconstruction, nearly half
operative and postoperative complications of pro- of all women experienced untoward changes in
phylactic mastectomy/breast reconstruction and their sexual relationship because of prophylactic
ongoing physical complaints and limitations in
mastectomy/breast reconstruction. This finding
daily life. This has been found in previous
was significantly associated with perceived lack of
10
,
13
,1
9
,2
0
research.
Fewer women reported ongoinginformation, expectations that were not met, oncomplaints in our study, compared with the studygoing physical complaints and limitations in daily
by Bebbington Hatcher and Fallowfield. 1 5 Inlife,
theiraltered feelings of femininity and body image,
cohort, half of all women reported ongoing prob- and perception of the partners negative view of
lems attributable to surgery, even at 18 months
his wifes sexual attractiveness. Indeed, women
after the intervention. Because their study group
may have experienced pain or hindrance, and
was recruited from 20 different centers, the type
therefore the sexual relationship will not be as
of surgery or the experience of the surgeons may
uncomplicated as it was before surgery.
not have been similar for all women, which might
The absence of a relationship between satisexplain the different outcome. Moreover, our fol- faction with prophylactic mastectomy and breast
low-up period was longer, which may be an ex- reconstruction, on the one hand, and changes in
planation for our lower number of ongoing com- the sexual relationship, on the other hand, is noplaints.
ticeable. We speculate that satisfaction with the
Also, the feeling of the reconstructed breasts
result of prophylactic surgery in this group of highas belonging to ones body and the type of recon- risk women is complex and may be related to
struction clearly influence the womens satisfac- changes in the sexual relationship through as yet
tion with the procedure. As was pointed out by
unknown variables.
Contant et al., 1 9 the expectation of an unaltered
This study has several limitations. First, our
body image is often reported to be a motivation sample
for
was heterogeneous with respect to medical
undergoing breast reconstruction. When expec- history and treatment. We adjusted for the effect
tations considering body image are not met, this of demographic variables by using the method of
might well be the explanation for dissatisfactionlogistic regression analysis. Because of small subwith the outcomes of surgery. Unfortunately, the samples, we were not able to perform additional
design of this study is not such that it explores theanalyses. However, most demographic variables
womens presurgical attitudes. An ongoing studydo have an effect on the responses of this sample,
at our institution, relating the outcome of proand it is advisable that the importance of these
phylactic mastectomy/breast reconstruction as
variables in a larger population be investigated.
perceived by both women and a number of ex- Second, the questions of the questionnaire aimed
perts, will possibly provide more data on this issue. at prophylactic mastectomy/breast reconstrucMost studies on the psychological effects of tion and did not take into account the fact that it
prophylactic mastectomy reported few or no det- may be impossible to distinguish between breast
rimental
effects
onrelationship.
body
image
and
sexuality
in al.Third,
the
reconstruction
and
the
prophylactic
mastectomy.
1680
majority
did
ferences
tively
Two
prophylactic
tion
Oostrom
find
on
follow-up
and
the
some
in
of
etpostoperatively
sexual
body
women.
al.mastectomy
mastectomy/breast
effects,
studies
reported
found
and
concluded
that
sexuality
breast
Recently,
anot
reconstructhat
Lodder
preoperapercentagefound
the
van
effects
difet
to
of
made
underwent
plants)
other
musculocutaneous
between
method
was
the
formed
the
ofbreast
number
very
reconstruction.
level
(e.g.,
the
by
low,
reconstruction
ofoutcome
of
Fogarty
satisfaction
transverse
so
flap
women
noorIn
comparison
et
after
no
expander
in
aal.,
rectus
recent
differences
by
our
with
autologous
means
sample
these
abdominis
study
based
could
of
other
were
who
perand
imanbe
2 3image
1but
2,
1 5,and
1were
6,
18comparable
, 19
,reconstruction.
21high
,2 2attributable
1types
4 on
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Volume 117, Number 6 Satisfaction with Prophylactic Mastectomy


Paula J. C. Bresser, M.A.
nonautologous breast reconstructions, which is reDepartment
of
Medical
Psychology
and Psychotherapy
assuring. However, we realize that this issue should
Erasmus Medical Center
be further investigated. Fourth, the instrument we
P.O. Box 1738
developed has not been tested for reliability or
3000 DR Rotterdam, The Netherlands
p.bresser@erasmusmc.nl
validity. Its sole purpose was to provide insight into
possible determinants of nonsatisfaction with the
ACKNOWLEDGMENTS
results of prophylactic mastectomy/breast reconstruction, using one item per factor. Currently, a This study was supported by grant OG98-003 from The
Netherlands Organization for Health Research and Developprospective study is being conducted at our ment.
insti- The authors express their appreciation to Ann A. Claetution that investigates the motivations andssens,
impliresearch assistant, Family Cancer Clinic, Department of
cations of prophylactic surgery and breast Medical
recon- Oncology, Erasmus Medical CenterDaniel den Hoed
struction.
Cancer Center, Rotterdam, The Netherlands, for her contri-

bution to this project.

CONCLUSIONS
Although other studies have shown that prophylactic mastectomy/breast reconstruction obviously serves to decrease cancer-related anxiety in
the short term, the long-term impact on quality of
life and especially on the quality of the sexual
relationship should not be underestimated. Because the women in our group show few regrets
and most of them feel sufficiently informed, we
anticipate that the absence of regrets despite the
awareness of adverse consequences reflects that
the urge to reduce anxiety, remain healthy, and
survive supersedes any ambivalence regarding the
possible negative outcomes of prophylactic mastectomy/breast reconstruction in the long term.
Although physicians must inform their patients
extensively about the long-term ramifications of
prophylactic mastectomy/breast reconstruction,
they should be aware that this information is given
at the moment that the urge to survive predominates. Therefore, it is important to pay attention
to the way the information is processed and assimilated.
Careful exploration of the possible impact on
body image and the sexual relationship enables
the women at risk and their partners to recognize
the potential risk factors for inadequate coping. If
there are any such factors, additional professional
attention from a psychologist or social worker may
be of help to anticipate untoward experiences after
treatment.
If
needed,
follow-up
can
offered
construction.
which
maladjustment
jective
the
information
and
long
Finally,
correctly
women
well-being
after
termahas
prophylactic
assimilated.
if
subject
and/or
and
the
been
ofinadequate
presurgical
these
comprehensively
couples
worthy
mastectomy/breast
persons
of
are
coping.
counseling
further
atsupport
may
high
The
offered
study
benefit
risk
and
subrefor
isbe
in

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