Women's Impression of the Expected Breast Appearance and its Association with Breast Cancer Operations

Significant concern exists from clinicians in all fields that rates of bilateral mastectomy and prophylactic mastectomy are increasing. This study was performed to evaluate women's perception of breast appearance and its association with breast cancer operations.

From April 2012 to May 2013, all women attending a breast clinic were shown two breast pictures, "natural" and "augmented," and asked which photograph represented the current expected appearance of breasts. Among breast cancer patients, the choice of breast cancer operation was correlated with picture selection.

Of 1,177 consecutive women, mean age was 45 years. Overall, 70 % of patients felt that the augmented appearance is expected. This impression was seen in all racial/ethnic groups: non-Hispanic White 65 %, African American 67 %, Hispanic 71 %, and other groups 70 %. Younger age was strongly associated with the augmented appearance (p < 0.0001). Patients older than age 60 years selected the augmented appearance only 51 % of the time. This percentage increased with each younger decade with patients younger than 40 years selecting the augmented appearance in 85 %. Among breast cancer patients, augmented appearance selection was more likely for patients who underwent reconstruction (92 %; p < 0.001), as well as for those undergoing bilateral mastectomy (74 %; p = 0.057) compared with mastectomy alone (49 %).

Most women felt that the augmented appearance of breasts is currently expected, and this impression was more common in young women. This impression may be another factor contributing to the current trend of more extensive breast cancer operations and implant-based reconstructions.