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

Abstract

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.

A Retrospective Analysis of Outcomes Using Three Common Methods for Immediate Breast Reconstruction

“…1 In particular, poor cosmetic results or complications have correlated with patient dissatisfaction. 2,3 Prior studies of breast reconstruction methods have produced somewhat conflicting results in terms of outcomes. Some studies have shown higher satisfaction rates for autologous tissue reconstruction compared with implant reconstruction.…”

Discussion: Patient Satisfaction in Unilateral and Bilateral Breast Reconstruction [Outcomes Article]

“…3,6 Despite the well-known finding of increased complications and the potential for decreased aesthetic outcomes in patients receiving postmastectomy radiation therapy after both implant and autologous reconstruction, the authors report similar general and aesthetic patient satisfaction between the unilateral and bilateral reconstruction groups. 7-10 Regardless of the increased complications seen in irradiated patients undergoing breast reconstruction, patient satisfaction scores have been reported by this group and others to be equivalent to those of nonradiated patients.…”

“…Preoperative psychosocial functioning, body image, and physical activity levels have been shown to influence patient satisfaction with breast reconstruction. [3][4][5] Patients who are relatively satisfied preoperatively generally are pleased postoperatively, regardless of whether or not a reconstruction is performed. Prospective satisfaction assessments and evaluation of satisfaction over time are imperative to support the authors' conclusions.…”

Postmastectomy radiotherapy: Indications and implications

“…They concluded that radiotherapy was beneficial for patients with a T1N1 tumour and a lymphnode ratio of >0.08, and patients with a T2N1 tumour and a lymphnode ratio of >0. 25.…”

“…Studies have shown that reconstruction post-mastectomy can improve the psychosocial outcomes of these patients. 3,24,25 A randomized controlled trial conducted in 1983 showed that psychological morbidity is reduced by immediate reconstruction in patients undergoing mastectomy for breast carcinoma. 3 It is important to note that this study was methodologically flawed, and the lack of patient control over timing and method of reconstruction is "concerning", as alluded to in a Cochrane review 26 in which this study is included.…”