Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy

Context Prophylactic mastectomy is a preventive option for women who wish t o reduce their risk of breast cancer. There has been concern about possible negative psychological sequelae following this procedure. However, few dat a are available regarding long-term satisfaction and psychological and soci al function following this procedure. Objective To evaluate patients' long-term satisfaction and psychological an d social function following prophylactic mastectomy. Design, Setting, and Participants Descriptive study of all women known to b e alive (n=609) who had a family history of breast cancer and elected to un dergo bilateral prophylactic mastectomy at a large, tertiary US health care clinic between 1960 and 1993, 94% (n = 572) of whom completed a study ques tionnaire. Main Outcome Measures Satisfaction with procedure and effects on psychologi cal and social function, based on responses to the study-specific questionn aire. Results Mean time from prophylactic mastectomy to last follow-up was 14.5 y ears. Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, t he most striking finding was that 74% reported a diminished level of emotio nal concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), lev el of stress (58%/28%), self-esteem (69%/ 13%), sexual relationships (73%/4 %), and feelings of femininity (67%/8%). Forty-eight percent reported no ch ange in their level of satisfaction with body appearance; 16% reported favo rable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative e ffects in these 6 variables, respectively. Conclusions This study suggests that positive outcomes following prophylact ic mastectomy include decreased emotional concern about developing breast c ancer and generally favorable psychological and social outcomes. These must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and occurrence of adverse psycho logical and social outcomes in some women.