Women's regrets after bilateral prophylactic mastectomy

Background: Primary prevention strategies such as chemopreventive agents (e .g., tamoxifen) and bilateral prophylactic mastectomy (PM) have received in creasingly more attention as manage ment options for women at high risk of developing breast cancer. Methods: A total of 370 women, who had registered in the Memorial Sloan-Ket tering Cancer Center National Prophylactic Mastectomy Registry, reported ha ving undergone a bilateral PM. Twenty-one of these women expressed regrets about their decision to have a PM. A psychiatrist and psychologist intervie wed 19 of the women about their experiences with the PM. Results: A physician-initiated rather than patient-initiated discussion abo ut the PM represented the most common factor in these women. Psychological distress and the unavailability of psychological and rehabilitative support throughout the process were. the most commonly reported regrets. Additiona l regrets about the PM related to cosmesis, perceived difficulty of detecti ng breast cancer in the remaining breast tissue, surgical complications, re sidual pain, lack of education about the procedure, concerns about conseque nt body image, and sexual dysfunction. Conclusions: Although a PM statistically reduces the chances of a woman dev eloping breast cancer, the possibility of significant physical and psycholo gical sequelae remains. Careful evaluation, education, and support both bef ore and after the procedure will potentially reduce the level of distress a nd dissatisfaction in these women. We discuss recommendations for the appro priate surgical and psychiatric evaluation of women who are considering a P M as risk-reducing surgery.