Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy.

Area of Science:

• Oncology
• Surgical Oncology
• Plastic and Reconstructive Surgery

Background:

• Rising rates of Contralateral Prophylactic Mastectomy (CPM) in the US.
• High reported satisfaction with CPM, but limited data on long-term body image effects.
• Need for comparative studies on body image after CPM versus breast-conserving surgery (BCS) and unilateral mastectomy (UM).

Purpose of the Study:

• To evaluate the long-term effects of CPM on body image.
• To compare body image outcomes across different surgical approaches: BCS, UM, and CPM.
• To assess patient satisfaction and complication rates associated with mastectomy decisions.

Main Methods:

• Analysis of survey responses from 1176 women in the Sister Study with personal/family history of breast cancer.
• Examination of mastectomy decision satisfaction, reconstruction use, and complication experiences.
• Comparison of body image scores using five survey items across BCS, UM (with/without reconstruction), and CPM (with/without reconstruction).

Main Results:

• High satisfaction with mastectomy decisions reported by 97% of CPM and 89% of UM patients.
• Reconstruction was more frequent after CPM (70%) than UM (47%), with higher complication rates (28% vs. 19%).
• Significantly worse body image scores were observed in women undergoing CPM compared to BCS, particularly those without reconstruction.

Conclusions:

• Most women, including those choosing CPM, express high satisfaction with their surgical decisions.
• Body image is demonstrably lower in patients who undergo CPM compared to BCS.
• Findings can inform shared decision-making for women considering surgical treatment options for breast cancer.