Original articleBody image problems in women with and without breast cancer 6–20 years after bilateral risk-reducing surgery – A prospective follow-up study
Introduction
Risk-reducing breast/ovarian surgery is offered to women with increased hereditary risk of breast/ovarian cancer or confirmed BRCA1/BRCA2 mutation. The demands on outcome after risk-reducing mastectomy (RRM) with immediate breast reconstruction (IBR) are equally high for asymptomatic individuals as for those with previous breast cancer diagnosis. RRM should fulfil the goals of safety, retained body image, and health-related quality of life (HRQoL). Though bilateral RRM shows a risk-reduction of approximately 90% for developing breast cancer in asymptomatic individuals [[1], [2], [3], [4]], the need for reoperations, due to postoperative complications and/or revisions to achieve satisfying cosmetic results after implant-based reconstruction, still exists [5,6].
Previous prospective short-term follow-up studies have shown high overall cosmetic satisfaction six months and one year post-RRM, corresponding to the women's expectations, and no negative impact on anxiety/depressive symptoms, or HRQoL [7,8]. Body image and sexuality were negatively affected the first years after surgery [[9], [10], [11], [12]]. Long-term effects of risk-reducing surgery have been studied retrospectively, indicating high procedure satisfaction, but decreased levels of satisfaction with the physical appearance [[13], [14], [15], [16], [17]]. There is, however, a lack of long-term prospective psychosocial follow-up studies [17].
This prospective follow-up study aimed to investigate women's perceptions of the cosmetic outcome of their breast reconstruction, body image, sexuality, anxiety/depressive symptoms, and HRQoL, 6–20 years post-RRM. Differences between women with or without previous breast cancer at follow-up, as well as changes over time from the one-year assessment to follow-up, were evaluated.
Section snippets
Patients and procedure
Between March 1997 and September 2010, 298 women underwent RRM at Karolinska University Hospital in Stockholm, Sweden due to increased hereditary risk for breast cancer. Individual risk for breast cancer was based on BRCA tests/family history of breast cancer. A total of 188 (63%) ‘women without cancer’ underwent bilateral RRM, while 110 (37%) ‘women with (previous breast) cancer’ underwent complementary/contralateral RRM (depending on if they previously had breast conservation or mastectomy).
Results
The Consort diagram (Fig. 1) presents the 148 (74%) women who returned the envelopes, of whom 146 (73%) (99 without previous breast cancer; 47 with previous breast cancer) completed the questionnaires. Demographic/clinical data for 136 (68%) women who consented to data collection from medical records are presented in Table 1. For the women who completed the questionnaires without giving permission to extract data from their medical records, some missing data were replaced using the research
Discussion
This is, to our knowledge, the furthermost prospective long-term follow-up study about psychosocial outcomes for women with increased hereditary risk for breast cancer post-RRM and IBR. HRQoL, anxiety/depressive symptoms appeared to remain rather unchanged in the long-term, with one exception. ‘General health’ decreased over time in both groups. Body image problems noted at the one-year assessment did not change at the long-term assessment, and there were no differences between the groups,
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2020, Sexual Medicine ReviewsCitation Excerpt :Because BRCA1/2 mutations are also associated with high risk of breast cancer, women are also advised to consider risk-reducing bilateral prophylactic mastectomy to reduce breast cancer risk by 90–95%.5 Although these surgeries are potentially lifesaving, there are more than 2 decades of research examining the persistent sexual sequelae associated with these surgeries, particularly the side effects of treatment-induced surgical menopause,6,7 changes in body image, and changes in appearance satisfaction.8,9 In one longitudinal study, more than one-third of women continued to struggle with body image almost 15 years after preventive bilateral mastectomies.10