Sexual identity and prophylactic mastectomy

The psychological adjustment of women following prophylactic mastectomy with reconstruction has not been evaluated. This study reviews this problem in 9 women chosen at random from the practice of two surgeons. The sexual identity of the women and its effect upon the outcome of their surgery was of particular interest. The surgeon's perception of problems of adjustment and the difference in the patient's and surgeon's evaluation of operative results were considered. The study included interviews with a psychiatrist, a questionnaire for the surgeon, and a subjective evaluation of operative results by both patient and surgeon. A high degree of psychopathology, particularly depression, was encountered. Most women had a relatively weak sexual identity preoperatively. In most instances the surgeon was not alerted to the patient's troubled feelings. Though psychopathology was evident, it does not seem to indicate that the patient will have difficulty accepting the results of surgery. We suggest that women who deny their sexuality might adjust to this surgery more easily. Psychiatric consultation appears to aid patient management.