Breast Cancer Research and Treatment

, Volume 163, Issue 2, pp 273–279 | Cite as

The impact of mastectomy type on the Female Sexual Function Index (FSFI), satisfaction with appearance, and the reconstructed breast’s role in intimacy

  • K. Rojas
  • M. Onstad
  • C. Raker
  • MA Clark
  • A. Stuckey
  • J. Gass
Clinical trial



As mastectomy rates increase and overall survival for early breast cancer improves, a better understanding of the long-term consequences of mastectomy is needed. We sought to explore the correlation of specific mastectomy type with the Female Sexual Function Index (FSFI), body image satisfaction, and the reconstructed breast’s role in intimacy.


This study is a secondary analysis of a cross-sectional survey including a retrospective chart review. Patients at least one year from primary surgery were invited to complete the survey between 2012 and 2014. Baseline characteristics and survey responses were compared between three mastectomy groups: total/modified radical (TMRM), skin-sparing (SSM), and nipple-sparing (NSM). All patients underwent reconstruction.


Of 453 invited, 268 (59%) completed the survey. Sixty underwent mastectomy with reconstruction: 16 (27%) TMRM, 36 (60%) SSM, and 8 (13%) NSM. There were no significant differences in median total FSFI scores between groups, yet median FSFI scores for the NSM group indicated sexual dysfunction. After adjusting for receipt of chemotherapy and/or radiation, NSM had the lowest median desire score. There was a trend for the NSM group to be the least satisfied with postoperative appearance, but also more likely to report that the chest was “often” caressed during intimacy. However, nearly 40% of the NSM group reported that caress of the reconstructed breast was unpleasant.


NSM offers patients the greatest opportunity for preservation of their native skin envelope and potentially enhanced cosmetic outcome, but our results did not demonstrate superior sexual function or body image outcomes in this group. By highlighting surgical consequences of mastectomy preoperatively, surgeons may better set realistic patient expectations regarding both aesthetic and functional outcomes after breast cancer surgery. With clearer expectations, patients will have a better opportunity for improved surgical decision-making.


Breast cancer Mastectomy Sexuality Survivorship Intimacy Nipple sparing Mastectomy 



We would like to thank all of the patients who participated in our study, as well as Sara Fogarty D.O., Sarah Pesek M.D., and Rebecca Kwait M.D. for their contribution to the study. We would also like to thank the dedicated employees of Women & Infants Breast Health Center.

Compliance with ethical standards

Conflict of interest

The authors have no financial relationships related to this manuscript to disclose.


  1. 1.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232CrossRefPubMedGoogle Scholar
  3. 3.
    Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA (2015) Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 150(1):9–16CrossRefPubMedGoogle Scholar
  4. 4.
    Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL (2014) Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA 312(9):902–914CrossRefPubMedGoogle Scholar
  5. 5.
    Rosenberg S (2013) Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Breast 24(Suppl 2):S154Google Scholar
  6. 6.
    Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC (2011) Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol 18(11):3110–3116CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gilbert E, Ussher JM, Perz J (2010) Sexuality after breast cancer: a review. Maturitas 66:397–407CrossRefPubMedGoogle Scholar
  8. 8.
    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16(2):501–514CrossRefPubMedGoogle Scholar
  9. 9.
    Archibald S, Lemieux S, Byers ES, Tamlyn K, Worth J (2006) Chemically induced menopause and the sexual functioning of breast cancer survivors. Women Ther 29(1/2):83–106CrossRefGoogle Scholar
  10. 10.
    Burwell SR, Case DL, Kaelin C, Avis NE (2006) Sexual problems in younger women after breast cancer surgery. J Clin Oncol 24(18):2815–2821CrossRefPubMedGoogle Scholar
  11. 11.
    Bertero C (2007) Breast cancer diagnosis and its treatment affecting the self: a meta-synthesis. Cancer Nurs 30(3):194–202CrossRefPubMedGoogle Scholar
  12. 12.
    Wilmoth MC (2001) The aftermath of breast cancer: an altered sexual self. Cancer Nurs 24(4):278–286CrossRefPubMedGoogle Scholar
  13. 13.
    Ussher J, Perz J, Gilbert E (2012) Changes to sexual well-being and intimacy after breast cancer. Cancer Nurs 35(6):456–465CrossRefPubMedGoogle Scholar
  14. 14.
    Broeckel J, Thors C, Jacobsen P, Small M, Cox C (2002) Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy. Breast Cancer Res Treat 75(3):241–248CrossRefPubMedGoogle Scholar
  15. 15.
    Rosenberg S, Tamimi R, Gelber S et al (2014) Treatment-related amenorrhea and sexual function in young breast cancer survivors. Cancer 120(15):2264–2271CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Schover LR (2008) Premature ovarian failure and its consequences: vasomotor symptoms, sexuality, and fertility. J Clin Oncol 26(5):753–758CrossRefPubMedGoogle Scholar
  17. 17.
    Beckjord E, Compas BE (2007) Sexual quality of life in women with newly diagnosed breast cancer. J Psychosoc Oncol 25(2):19–36CrossRefPubMedGoogle Scholar
  18. 18.
    Markopoulos C, Tsaroucha AK, Kouskos E, Mantas D, Antonopoulou Z, Karvelis S (2009) Impact of breast cancer surgery on the self-esteem and sexual life of female patients. J Int Med Res 37:182–188CrossRefPubMedGoogle Scholar
  19. 19.
    Aerts L, Christiaens M, Enzlin P, Neven P, Amant F (2014) Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. The Breast 23:629–636CrossRefPubMedGoogle Scholar
  20. 20.
    Pozo C, Carver CS, Noriega V et al (1992) Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol 10:1292–1298CrossRefPubMedGoogle Scholar
  21. 21.
    Kwait R, Pesek S, Onstad M, Edmonson D, Clark M, Raker C, Stuckey A, Gass J (2016) Influential forces in breast cancer surgical decision making and the impact on body image and sexual function. Ann Surg Oncol 10:3403–3411CrossRefGoogle Scholar
  22. 22.
    Schultz W, Van de Wiel H (2003) Sexuality, intimacy, and gynaecological cancer. J Sex Marital Ther 29:121–128CrossRefPubMedGoogle Scholar
  23. 23.
    Didier F, Radice D, Gandini S et al (2009) Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image, and sexuality? Breast Cancer Res Treat 118(3):623–633CrossRefPubMedGoogle Scholar
  24. 24.
    Baser R, Li Y, Carter J (2012) Psychometric validation of the female sexual function index (FSFI) in cancer survivors. Cancer 118(18):4606–4618CrossRefPubMedGoogle Scholar
  25. 25.
    Rowland J, Desmond K, Meyerowitz B, Belin W, Wyatt G, Ganz P (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429CrossRefPubMedGoogle Scholar
  26. 26.
    Nano MT, Gill PG, Kollias J et al (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75(11):940–947CrossRefPubMedGoogle Scholar
  27. 27.
    Boquieren V, Esplen M, Wong J, Toner B, Warner E, Malik N (2015) Psycho-oncology 25(1):66–76CrossRefGoogle Scholar
  28. 28.
    Henson HJ (2002) Breast cancer and sexuality. Sex Disabil 20:261–275CrossRefGoogle Scholar
  29. 29.
    Fallbjork U, Rasmussen BH, Karlsson S, Salander P (2013) Aspects of body image after mastectomy due to breast cancer- a two-year follow-up study. Eur J Oncol Nurs 17(3):340–345CrossRefPubMedGoogle Scholar
  30. 30.
    Neto MS, de Aguiar Menezes MV, Moreira JR, Garcia EB, Abla LE, Ferreira LM (2013) Sexuality after breast reconstruction post mastectomy. Aesthetic Plast Surg 37(3):643–647CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.The Program in Women’s Oncology, Women & Infants Hospital Breast Health CenterWarren Alpert School of Medicine/Brown UniversityProvidenceUSA
  2. 2.Department of Gynecologic OncologyMD Anderson Cancer CenterHoustonUSA
  3. 3.Division of ResearchWomen and Infants’ Hospital of Rhode IslandProvidenceUSA
  4. 4.Center for Health Policy and Research, Department of Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA

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