Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

Abstract

Background: Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM.Methods: This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998-2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year.Results: In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM. Conclusions:The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients.Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM.

Predictors of women's sexual outcomes after implant‐based breast reconstruction

“…A small body of literature focused on sexual outcomes after breast reconstruction specifically. [4][5][6][7][8][9][10][11][12][13][14][15] Sexuality is considered a biopsychosocial concept, and therefore is thought to be associated with both biological and psychosocial factors. Some studies emphasized sexuality and body satisfaction following breast reconstruction, 5 as well as femininity and attractiveness.…”

“…11 Two studies have reported an association between patient characteristics and sexual outcomes after breast reconstruction: older women reported higher sexual well-being than younger women, 12 whereas better preoperative quality of life and lower emotional distress predicted higher postoperative sexual well-being. 13 The partner also plays an important role in the process of breast reconstruction; couples greatly value partner involvement and joint surgical decisionmaking. 14 Partner intimacy after breast reconstruction was found to be related to couples' adjustment and communication styles, and individual expectations.…”

The Relationship Between Body Image and Sexuality After Surgical Treatment in Women With Breast Cancer

“…It is emphasized by scholars that the negative body image is one of the important factors that negatively affects sexual life of women. (6,8,10,22) Also, Fang et al (22) have been reported there is a relationship between body image and sexuality, and that there are more sexual problems in people with poor body image. In current study mean scores on prior sexual adjustment indicated that women were moderately satisfied with their sexual life preBC, but that their sexual adjustment worsened (Mean=-3.79) following mastectomy/lumpectomy.…”

“…Researchers have highlighted these problems should be identified and treated because they affect other areas of life. (10) However, when faced with serious disease such as cancer the health professionals are usually more concerned with assuring survival and restoring physical integrity. Therefore sexuality and body image assessments are not routinely provided in the oncology setting.…”

Body image: Integral aspect of psychosocial evaluation for patients undergoing breast reconstruction

“…As a result, patients may avoid social interaction, neglect self‐care, and develop clinically significant levels of depression or anxiety. The association between psychological distress and body image has been evaluated with age, 8 primary breast surgery (mostly mastectomy), 9 risk‐reducing surgery, 10 and post‐treatment either immediately postsurgery 11 or during survivorship 9 . Around 30% of breast cancer survivors expressed body image dissatisfaction after 4 years postbreast surgery and 25% had depression, while 53% had anxiety 9 …”