Context Prophylactic mastectomy is a preventive option for women who wish to
reduce their risk of breast cancer. There has been concern about possible
negative psychological sequelae following this procedure. However, few data
are available regarding long-term satisfaction and psychological and social
function following this procedure.
Objective To evaluate patients' long-term satisfaction and psychological and social
function following prophylactic mastectomy.
Design, Setting, and Participants Descriptive study of all women known to be alive (n = 609) who had a
family history of breast cancer and elected to undergo bilateral prophylactic
mastectomy at a large, tertiary US health care clinic between 1960 and 1993,
94% (n = 572) of whom completed a study questionnaire.
Main Outcome Measures Satisfaction with procedure and effects on psychological and social
function, based on responses to the study-specific questionnaire.
Results Mean time from prophylactic mastectomy to last follow-up was 14.5 years.
Most women (70%) were satisfied with the procedure; 11% were neutral; and
19% were dissatisfied. Among the psychological and social variables, the most
striking finding was that 74% reported a diminished level of emotional concern
about developing breast cancer. The majority of women reported no change/favorable
effects in levels of emotional stability (68%/23%), level of stress (58%/28%),
self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity
(67%/8%). Forty-eight percent reported no change in their level of satisfaction
with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%,
23%, 25%, and 36% reported negative effects in these 6 variables, respectively.
Conclusions This study suggests that positive outcomes following prophylactic mastectomy
include decreased emotional concern about developing breast cancer and generally
favorable psychological and social outcomes. These must be weighed against
the irreversibility of the decision, potential problems with implants and
reconstructive surgery, and occurrence of adverse psychological and social
outcomes in some women.