Originally published as JCO Early Release 10.1200/JCO.2005.09.233 on October 3 2005

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Satisfaction After Contralateral Prophylactic Mastectomy: The Significance of Mastectomy Type, Reconstructive Complications, and Body Appearance

From the Divisions of Medical Oncology, Statistics, Plastic and Reconstructive Surgery, Internal Medicine, and Surgery and Surgical Specialties, Mayo Clinic, Rochester, MN; and Cancer Prevention and Control Division, Moffitt Cancer Center and Research Institute, Tampa, FL

Address reprint requests to Marlene H. Frost, RN, PhD, Mayo Clinic, 200 First St SW, Charlton 6, Rochester, MN 55905; e-mail: frost.marlene{at}mayo.edu

PURPOSE: Contralateral prophylactic mastectomy (CPM) is one option for reducing the risk of a second breast cancer in women with a personal and family history of breast cancer. Few data are available regarding satisfaction, psychological, and social function after CPM. The purpose of this research is to evaluate women’s long-term satisfaction with CPM, factors influencing satisfaction, and psychological and social function after CPM.

PATIENTS AND METHODS: This was a descriptive study of all women with a family history of breast cancer, known to be alive, who elected CPM at Mayo Clinic (Rochester, MN) between 1960 and 1993 (n = 621). Ninety-four percent of the women (n = 583) completed a study-specific questionnaire.

RESULTS: A mean of 10.3 years after the procedure, the majority of women (83%) were satisfied with their CPM. A smaller number were neutral (8%) or dissatisfied (9%). Women who had a subcutaneous mastectomy had more problems with reconstruction, and fewer of these women were satisfied than women with simple mastectomy. Decreased satisfaction with CPM was associated with decreased satisfaction with appearance, complications with reconstruction, reconstruction after CPM, and increased level of stress in life. The majority of women experienced no change or favorable effects in self-esteem (83%), level of stress in life (83%), and emotional stability (88%). Satisfaction with body appearance, feelings of femininity, and sexual relationships were the most adversely affected with 33%, 26%, and 23% of the women responding negatively.

CONCLUSION: Although most women are satisfied with CPM, each woman should weigh the benefits alongside the potential adverse effects.

Supported in part by Grant No. R01-80181 from the National Cancer Institute, Grant No. DAMD17-94-J-4216 from the Department of Defense, the Andersen Foundation, and Lonabelle "Kappie" Spencer.

Presented in part at the 39th Annual Meeting of the American Society for Clinical Oncology, Chicago, IL, May 31-June 3, 2003; and the 10th Annual Meeting of the International Society for Quality of Life Research, Prague, Czech Republic, November 12-17, 2003.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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