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Ann Surg Oncol. 2017 Jun;24(6):1499-1506. doi: 10.1245/s10434-016-5753-7. Epub 2017 Jan 5.

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

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Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Social and Scientific Systems, Inc., Durham, NC, USA.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Department of Plastic Surgery, School of Medicine, The Ohio State University, Columbus, OH, USA.
Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.



Contralateral prophylactic mastectomy (CPM) rates have been increasing in the US, and although high levels of satisfaction with CPM have been reported, few studies have evaluated the long-term effects on body image, comparing CPM with breast-conserving surgery (BCS) and unilateral mastectomy (UM).


We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n = 1176). Among women who underwent mastectomy, we examined satisfaction with the mastectomy decision, as well as variation in the use of reconstruction and experience of complications. Five survey items, evaluated individually and as a summed total score, were used to compare body image across surgery types (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction).


Participants were, on average, 3.6 years post-diagnosis at the time of survey (standard deviation 1.7). The majority of women (97% of CPM, 89% of UM) were satisfied with their mastectomy decision. Reconstruction was more common after CPM than after UM (70 vs. 47%), as were complications (28 vs. 19%). Body image scores were significantly worse among women who underwent CPM than among women who underwent BCS, with the lowest scores among women who underwent CPM without reconstruction.


In our sample, most women were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lower among those who underwent CPM than among those who underwent BCS. Our findings may inform decisions among women considering various courses of surgical treatment.


Body image; Breast cancer; Contralateral prophylactic mastectomy

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