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Contralateral prophylactic mastectomy patients reported confidence with decision

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November 5, 2014

Most patients with breast cancer who underwent contralateral prophylactic mastectomy report long-term satisfaction with their decision, according to findings.

However, patients who chose to have reconstruction entailing reoperations noted lower levels of satisfaction with the procedure, the researchers wrote.

“When we’re counseling women considering having the other breast removed, it’s a very complex and multilayered discussion,” researcher Judy Boughey, MD, a breast surgeon at the Mayo Clinic, said in a press release. “Obviously, the risk of developing a new cancer in that breast has to be part of that discussion, but the literature shows that the risk for the other breast is really not that high, and that from a medical standpoint we don’t need to recommend that approach.”

In the study, researchers identified a previously established cohort of 621 women with unilateral breast cancer and a family history of breast cancer. These women underwent contralateral prophylactic mastectomy (CPM) between 1960 and 1993, and the researchers followed up with questionnaires pertaining to quality of life and satisfaction with CPM. The surveys were administered at two time points: the first, at 10 years after CPM, and the second at approximately 10 years later.

The researchers used medical record review to collect demographic, clinical and procedural variables, and to document follow-up information about subsequent surgeries. The reasons for reoperation were classified as: immediate postoperative complications, issues pertaining to implants, cosmetic/aesthetic concerns, nodule removal and other.

Five hundred eighty-three women responded to the first follow-up questionnaire, which was administered at a median of 10.7 years after CPM. Of these, 403 women (69%) opted to undergo reconstruction, whereas 180 (31%) did not. Those choosing to undergo reconstruction were generally younger (mean age, 47 years for women who chose construction vs. 53 years for non-construction; P=.01) and were more likely to be married (85% who underwent construction vs. 78% for non-construction; P=.048).

According to study results, the majority of the women expressed satisfaction with CPM (83%) and would choose to have the procedure again. Among reconstruction patients, 73% said they would make the same choice, but patients reported significantly lower satisfaction (P=.0001), and a smaller percentage said they would opt for reconstruction again (P<.0001).

The second questionnaire, administered a median of 18.4 years after CPM, was completed by 269 respondents. At this time point, 92% of women said they would choose CPM again. At this follow-up, a smaller percentage of women (about 10% of reconstruction patients and 16% of non-reconstruction patients) reported that they would change their decision regarding reconstruction.

“It’s also important to note that much of what drives removal of the other breast is patient anxiety, which feeds into patient quality of life, and it also important to consider breast symmetry from a cosmetic standpoint,” Boughey said in the release.

Disclosure: The researchers report no relevant financial disclosures.

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