Psychological Reactions to Prophylactic Mastectomy Synchronous with Contralateral Breast Reconstruction

Goin, Marcia Kraft; Goin, John M.

doi:10.1097/00006534-198209000-00011

Cited by 54 publications

(18 citation statements)

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“…Obviously, the gain in life expectancy is greater if mastectomy is performed in younger women [17]. As a matter of fact, most women reported a high satisfaction after surgery, with a small proportion of negative effects on psychological status or on sexual activity [114][115][116]. However, both options of intensive screening, including CE-MR imaging and bilateral mastectomy, could be combined for BRCA mutation carriers; the intensive screening could be used until an invasive breast cancer is diagnosed; afterwards, bilateral mastectomy could be offered as a tool for both treating the newly diagnosed cancer and to prevent as much as possible similar events in the future.…”

Section: Open Problems and Future Perspectivesmentioning

confidence: 99%

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

2006

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In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.

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Section: Open Problems and Future Perspectivesmentioning

confidence: 99%

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

2006

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“…Breast reconstruction after mastectomy has been shown to have positive psychological benefits. 9,10 The use of saline-filled implants and the use of autogenous tissue for reconstruction of the breast mound are thought to enhance cosmetic results and have an acceptable complication rate. Prophylactic mastectomy is often performed with immediate reconstruction (at the same time and under the same anesthetic as the mastectomy).…”

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confidence: 99%

Satisfaction with Breast Reconstruction in Women with Bilateral Prophylactic Mastectomy: A Descriptive Study

Metcalfe

Semple

Narod

2004

Plastic and Reconstructive Surgery

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Prophylactic bilateral mastectomy is an option for women who are at an increased risk of developing breast cancer. Prophylactic mastectomy is often performed with immediate reconstruction (i.e., at the same time and under the same anesthetic as the mastectomy). Satisfaction with reconstruction has been described previously for women with mastectomy for breast cancer. However, the authors know of no previous research that has reported on satisfaction with reconstruction in patients who have electively sought mastectomy for the prevention of breast cancer. Women in the province of Ontario who had undergone prophylactic bilateral mastectomy plus breast reconstruction between 1991 and 2000 were asked to rate their level of satisfaction with the cosmetic results of their mastectomy and reconstruction and their overall satisfaction with their decision to have prophylactic mastectomy. Women were also asked whether they experienced complications associated with their surgery and what types of complications they experienced. Thirty-seven women completed questionnaires for this study, and all of them had immediate breast reconstruction after prophylactic mastectomy. The majority of women (70.3 percent) reported being satisfied or extremely satisfied with the cosmetic results of their breast reconstruction. Women with self-reported postsurgical complications (16.2 percent) were significantly less satisfied with reconstruction than those who did not report complications (p = 0.009). Personal subjective risk of breast cancer before prophylactic mastectomy was negatively correlated with satisfaction with reconstruction (r = -0.38, p = 0.024) and with subjective risk estimation after prophylactic surgery (r = -0.54, p = 0.001). Women who did not worry about developing breast cancer after prophylactic mastectomy had significantly higher levels of satisfaction with breast reconstruction than those who continued to worry (p < 0.001). Women who reported an improved body image after reconstruction were significantly more likely to report higher levels of satisfaction than those who reported a diminished body image (p = 0.007). The majority of women were satisfied with the cosmetic results of breast reconstruction after prophylactic mastectomy. Women who overestimated their breast cancer risk had lower satisfaction levels. Correcting overestimation of breast cancer risk in women who have prophylactic mastectomy may improve satisfaction with reconstruction following prophylactic mastectomy.

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“…Advantages of immediate reconstruction include the psychological benefit to the patient, minimization of hospital stays, decreased use of general anesthesia, decreased costs, and increased ease of surgical techniques, with more skin available for reconstruction. [43][44][45][46][47][48] The advantages of immediate reconstruction must, however, be weighed against any potential effects on complication rates, cosmesis, and oncologic safety. Table 4 some studies suggesting delayed reconstruction is better, and others suggesting that immediate reconstruction is equivalent to delayed.…”

Section: Discussionmentioning

confidence: 99%

Local???Regional Radiation Therapy After Breast Reconstruction: What Is the Appropriate Target Volume?

Hazard

Miercort

Gaffney

et al. 2004

American Journal of Clinical Oncology

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The oncologic safety and cosmetic outcome of immediate breast reconstruction in breast cancer patients requiring radiation therapy remains ill-defined. Between 1980 and 1998, 18 patients were treated at the University of Utah Medical Center with mastectomy, immediate breast reconstruction, and adjuvant radiation therapy delivered via an electron arc technique. A case-control study was performed matching reconstructed patients in a 1:2 ratio with patients undergoing mastectomy without reconstruction, using number of lymph nodes and tumor size. Median follow-up was 61 months for the reconstructed group. Five-year local-regional control, disease-free survival, and overall survival rates were 87%, 58%, and 74% respectively in the reconstructed group, versus 88%, 57%, and 67% respectively in the matched control group. Cosmesis was good/excellent in 11 of 13 living patients (85%). Significant capsular contraction occurred in 18% of prosthetic reconstruction patients, and revisional surgery was required in 24% of prosthetic reconstruction patients. Utilizing the electron arc technique, the median radiation dose to the chest wall at the midlevel of the ribs was 20% of the prescribed dose, and no patient failed deep to the implant. These results suggest that in appropriately selected patients, structures deep to the reconstruction are not at high risk for local-regional recurrence, and immediate breast reconstruction yields comparable local-regional control, disease-free survival, and overall survival rates to nonreconstructed patients, with acceptable cosmetic results.

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Psychological Reactions to Prophylactic Mastectomy Synchronous with Contralateral Breast Reconstruction

Cited by 54 publications

References 0 publications

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

Satisfaction with Breast Reconstruction in Women with Bilateral Prophylactic Mastectomy: A Descriptive Study

Local???Regional Radiation Therapy After Breast Reconstruction: What Is the Appropriate Target Volume?

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