Patient satisfaction with aesthetic outcome after bilateral prophylactic mastectomy and immediate reconstruction with implants

Gahm, Jessica; Jurell, Göran; Edsander-Nord, Åsa; Wickman, Marie

doi:10.1016/j.bjps.2008.11.014

Cited by 50 publications

(32 citation statements)

References 31 publications

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“…Four studies were designed as prospective cohort studies [15,23,28,31], and rest were case series [12-14,16-22,24-27,29,30,32,33]. Three studies by Metcalfe et al [16,17,19], two studies by Brandberg et al [23,28], two studies by Gahm et al [21,25] and another three studies by Gahm et al [26,27,32] were each based on same patient populations. Eight studies were from Sweden [21,23-28,32], 5 from the US [12-14,20,22], 3 each from Canada [16,17,19] and the Netherlands [18,30,31], and 1 each from UK [15], Turkey [29] and Norway [33].…”

Section: Resultsmentioning

confidence: 99%

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Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes

Razdan¹,

Patel

Jewell

et al. 2015

Qual Life Res

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Purpose Bilateral prophylactic mastectomy (BPM) is effective in reducing the risk of breast cancer in women with a well-defined family history of breast cancer or in women with BRCA 1 or 2 mutations. Evaluating patient-reported outcomes following BPM are thus essential for evaluating success of BPM from patient’s perspective. Our systematic review aimed to: (1) identify studies describing health-related quality of life (HRQOL) in patients following BPM with or without reconstruction; (2) assess the effect of BPM with or without reconstruction on HRQOL; and, (3) identify predictors of HRQOL post BPM. Methods We performed a systematic review of literature using the PRISMA guidelines. PubMed, Embase, PsycINFO, Web of Science, Scopus and Cochrane databases were searched. Results The initial search resulted in 1082 studies; 22 of these studies fulfilled our inclusion criteria. Post BPM, patients are satisfied with the outcomes and report high psychosocial well-being and positive body image. Sexual well-being and somatosensory function are most negatively affected. Vulnerability, psychological distress and preoperative cancer distress are significant negative predictors of quality of life and body image post BPM. Conclusion There is a paucity of high quality data on outcomes of different HRQOL domains post BPM. Future studies should strive to use validated and breast-specific PRO instruments for measuring HRQOL. This will facilitate shared decision-making by enabling surgeons to provide evidence-based answers to women contemplating BPM.

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Section: Resultsmentioning

confidence: 99%

“…Spear et al described that 100% of women (n=11) in their study were willing to undergo reconstruction again [22]. Gahm et al noted that 92% of patients (n=22) would recommend BPM to another woman at high risk for developing breast cancer [25]. …”

Section: Resultsmentioning

confidence: 99%

Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes

Razdan¹,

Patel

Jewell

et al. 2015

Qual Life Res

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“…A significantly higher percentage of patients in the NSM group underwent bilateral prophylactic mastectomy compared to the SSM group. Bilateral prophylactic mastectomy and reconstruction is generally associated with high patient satisfaction (26-28), however some studies have found negative effects on body image and sexuality in substantial numbers of patients (29-31). Our results did not show bilateral prophylactic mastectomy to impact psychosocial or sexual well-being (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction

et al. 2016

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Background Nipple-sparing mastectomy (NSM) is considered an oncologically safe option for select patients. As many patients are candidates for nipple-sparing or skin-sparing mastectomy (SSM), reliable patient-reported outcome data are crucial for decision-making. The objective of this study was to determine whether patient satisfaction and/or health-related quality of life (HRQOL) were improved by preservation of the nipple with NSM compared to SSM and nipple reconstruction. Methods Subjects were identified from a prospectively maintained database of patients who completed the BREAST-Q following mastectomy and breast reconstruction between March and October 2011 at Memorial Sloan Kettering Cancer Center. Fifty-two patients underwent NSM followed by immediate expander-implant reconstruction. A comparison group consisted of 202 patients who underwent SSM followed by immediate expander-implant reconstruction and later nipple reconstruction. HRQOL and satisfaction domains as measured by BREAST-Q scores were compared in multivariate linear regression analyses that controlled for potential confounding factors. Results NSM patients reported significantly higher scores in the psychosocial (p=0.01) and sexual well-being (p=0.02) domains compared to SSM patients. There was no significant difference in the BREAST-Q physical well-being, satisfaction with breast, or satisfaction with outcome domains between the NSM and SSM groups. Conclusions NSM is associated with higher psychosocial and sexual well-being compared to SSM and nipple reconstruction. Preoperative discussion of such HRQOL outcomes with patients may facilitate informed decision-making and realistic postoperative expectations.

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“…Skin sparing mastectomy and immediate breast reconstruction (SSM & IMR) has been proved to be oncologically safe, and is associated with high satisfaction rate and low morbidity[79,80]. More recently, there has been increasing interest in offering BRCA1/2 carriers SSM and IBR, either by using an autologous flap, implant or both.…”

Section: Resultsmentioning

confidence: 99%

Risk-reducing strategies for women carrying brca1/2 mutations with a focus on prophylactic surgery

2010

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BackgroundWomen who have inherited mutations in the BRCA1 or BRCA2 genes have substantially elevated risks of breast and ovarian cancer. Mutation carriers have various options, including extensive and regular surveillance, chemoprevention and risk-reducing surgery. The aim of this review is to provide an up-to-date analysis and to subsequently summarise the available literature in relation to risk-reducing strategies, with a keen focus on prophylactic surgery.MethodsThe literature review is facilitated by Medline and PubMed databases. The cross-referencing of the obtained articles was used to identify other relevant studies.ResultsProphylactic surgery (bilateral mastectomy, bilateral salpingo-oophorectomy or a combination of both procedures) has proved to be the most effective risk-reducing strategy. There are no randomised controlled trials able to demonstrate the potential benefits or harms of prophylactic surgery; therefore, the evidence has been derived from retrospective and short follow-up prospective studies, in addition to hypothetical mathematical models.Based on the current knowledge, it is reasonable to recommend prophylactic oophorectomy for BRCA1 or BRCA2 mutation carriers when childbearing is completed in order to reduce the risk of developing breast and ovarian cancer. In addition, women should be offered the options of rigorous breast surveillance, chemoprevention with anti-oestrogens--especially for carriers of BRCA2--or bilateral prophylactic mastectomy.ConclusionThe selection of the most appropriate risk-reducing strategy is not a straightforward task. The impact of risk-reducing strategies on cancer risk, survival, and overall quality of life are the key criteria considered for decision-making. Notably, various other factors should be taken into consideration when evaluating individual mutation carriers' individual circumstances, namely woman's age, morbidity, type of mutation, and individual preferences and expectations.Although prospective randomised controlled trials concerned with examining the various interventions in relation to the woman's age and type of mutation are needed, randomisation is extremely difficult and rather deemed unethical given the current available evidence from retrospective studies.

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Patient satisfaction with aesthetic outcome after bilateral prophylactic mastectomy and immediate reconstruction with implants

Cited by 50 publications

References 31 publications

Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes

Quality of life among patients after bilateral prophylactic mastectomy: a systematic review of patient-reported outcomes

Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction

Risk-reducing strategies for women carrying brca1/2 mutations with a focus on prophylactic surgery

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