Sexual Identity and Prophylactic Mastectomy

Romm, Sharon; Hutzler, Jeffrey; Berggren, Ronald B.

doi:10.1097/00000637-198107000-00005

Cited by 8 publications

(4 citation statements)

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“…During the first postoperative year, about half of the 25 patients available for follow-up noted mood impairment, increased anxiety, and tension-related symptoms, and one fourth of the patients reported taking antianxiety drugs regularly after the surgery. In a retrospective study of nine patients following prophylactic mastectomy, Romm et al 53 noted psychopathology ranging from depression to hysterical personality in seven (78 percent). Information on preexisting psychiatric illness was not available for patients in either of these studies.…”

Section: Prophylactic Mastectomymentioning

confidence: 99%

“…53 Women with previous psychiatric treatment or with insufficient social support must be identified, as they are more likely to have psychologic problems postoperatively. 51 Preoperative psychologic assessment is useful to help examine a woman's motives for prophylactic surgery, address issues of sexuality and femininity following surgery, and identify women at risk for psychologic morbidity in the postoperative period.…”

Section: Prophylactic Mastectomymentioning

confidence: 99%

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The woman at increased risk for breast cancer: evaluation and management strategies

Bilimoria

Morrow

1995

CA: A Cancer Journal for Clinicians

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Section: Prophylactic Mastectomymentioning

confidence: 99%

Section: Prophylactic Mastectomymentioning

confidence: 99%

The woman at increased risk for breast cancer: evaluation and management strategies

Bilimoria

Morrow

1995

CA: A Cancer Journal for Clinicians

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“…Little is known about women's views of cosmetic, sexual or psychological outcomes of BPM and studies to date have often been carried out on small (and, therefore, possibly unrepresentative) samples (Romm et al, 1981;Goin and Goin, 1982;Meyer and Ringberg, 1986). In a single case report , the patient revealed that surgery resulted in marked loss of femininity and sexuality with considerable pain over a long recovery period.…”

mentioning

confidence: 99%

Clinical follow-up after bilateral risk reducing (?prophylactic?) mastectomy: mental health and body image outcomes

et al. 2000

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Background: In Manchester, approximately 120 women at ≥1: 4 lifetime risk of breast cancer have considered preventative surgery since 1992. Women treated within the Manchester protocol receive two genetic counselling sessions, a psychological assessment and a surgical consultation pre‐operatively and annual follow‐up post‐operatively. The vast majority of women have breast reconstruction. Methods: Since 1996, mental health and body image have been assessed in women attending annual follow‐up using self‐report questionnaires: the 28‐item General Health Questionnaire (GHQ) and 10‐item Body Image Scale (BIS). Women with high scores are assessed by clinical interview together with a proportion who have no significant problems. Results: Between 1995 and 1999, 76 women completed surgery. Ten were awaiting post‐operative review and 60 (91%) attended for follow‐up of whom 45 (75%) were interviewed. Questionnaire data were available for 52 (79%) women, mean age 40.8 years (range 27–58). Six women were gene mutation carriers and of these three had had breast cancer. One additional patient was affected but had not been genetically tested. Eight (17%) of 47 women with assessments in the first post‐operative year scored in the ‘caseness’ range on the GHQ: the mean GHQ score was 3.8 (S.D. 6.7), range 0–25. Results were comparable with those for women attending the Family History Clinic for risk assessment. The mean score on the BIS was 5.1 (S.D. 5.5), range 0–25, comparable with scores for women undergoing conservative surgery for breast cancer. Twenty‐one percent of women reported no negative change in body image following surgery (i.e. zero questionnaire summary scores) and the majority of changes reported were of minor degree (item scores 0 or 1). The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self‐consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over time. A minority of women had more serious psychological or body image concerns, usually in relation to surgical complications: they received further psychiatric intervention. Conclusions: For the majority of women there is no evidence of significant mental health or body image problems in the first 3 years following Bilateral Prophylactic Mastectomy (BPM), but women who have complications warrant additional psychological help. Careful pre‐operative preparation and long‐term monitoring are advocated in this new field of cancer prevention. Copyright © 2000 John Wiley & Sons, Ltd.

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“…The potential adverse psychological impact of prophylactic mastectomy on sexual identity and emotional well-being have been well-documented in the literature. 38,39 Stefanek et al 40 surveyed 164 high-risk women from The Johns Hopkins University and found that those who had undergone multiple past biopsies, or who had an excessive fear of breast cancer, were most likely to be interested in prophylactic mastectomy.…”

Section: Prophylactic Mastectomymentioning

confidence: 99%

Educational Review: Role of the Surgeon in Hereditary Breast Cancer

et al. 2001

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Up to 10% of the breast cancers detected in the United States are related to an inherited germline mutation, usually in the BRCA1 or BRCA2 genes, and the majority of these patients will at some point require surgical evaluation and/or treatment. Women who harbor a genetic predisposition for breast cancer face an increased risk for early onset disease, bilateral tumors, and other non-breast malignancies, such as ovarian cancer. These issues raise questions regarding the appropriate surveillance regimen, and the potential efficacy of risk reduction strategies that should be considered. Once a breast cancer diagnosis has been established, the prognosis appears to be similar to stage-controlled sporadic breast cancer, despite an increased prevalence of adverse primary tumor features. However, the role of breast conservation therapy for these patients and the optimal means of addressing the substantially increased risk for contralateral tumors is not yet defined. The reported literature in this area, including a discussion of the value of genetic counseling and genetic testing, is reviewed.

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Sexual Identity and Prophylactic Mastectomy

Cited by 8 publications

References 0 publications

The woman at increased risk for breast cancer: evaluation and management strategies

The woman at increased risk for breast cancer: evaluation and management strategies

Clinical follow-up after bilateral risk reducing (?prophylactic?) mastectomy: mental health and body image outcomes

Educational Review: Role of the Surgeon in Hereditary Breast Cancer

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