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Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study

Yvonne Brandberg, Kerstin Sandelin, Staffan Erikson, Göran Jurell, Annelie Liljegren, Annika Lindblom, Ann Lindén, Anna von Wachenfeldt, Marie Wickman, Brita Arver

From the Departments of Oncology-Pathology, Surgery, Reconstructive Plastic Surgery, and Molecular Medicine, Karolinska Institutet, Stockholm; and the Department of Surgery, Central Hospital, Västerås, Sweden

Corresponding author: Yvonne Brandberg, PhD, Department of Oncology-Pathology, Karolinska Institutet, Radiumhemmet, Karolinska University Hospital, S 171 76, Stockholm, Sweden; e-mail: yvonne.brandberg{at}onkpat.ki.se

Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives.

Patients and Methods A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM.

Results Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A substantial proportion of the women reported problems with body image 1 year after BPM (eg, self consciousness, 48%; feeling less sexually attractive, 48%; and dissatisfaction with the scars, 44%). Sexual pleasure was rated lower 1-year post-BPM as compared with before operation (P = .005), but no differences over time in habit, discomfort, or activity were found.

Conclusion No negative effects on anxiety, depression, and quality of life were found. Anxiety and social activities improved. Negative impact on sexuality and body image was reported.

Supported by grants from the Swedish Cancer Society, the Swedish Association for Cancer & Traffic Victims, and the Stockholm County Council.

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

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