Skip to main content

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

Breast Cancer Research and Treatment volume 163, pages 273–279 (2017)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Netherlands)

Fig. 1

References

  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):1233–1241

    Article  PubMed  Google Scholar 

  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):1227–1232

    Article  PubMed  Google Scholar 

  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):9–16

    Article  PubMed  Google Scholar 

  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):902–914

    Article  CAS  PubMed  Google Scholar 

  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):S154

    Google Scholar 

  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):3110–3116

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gilbert E, Ussher JM, Perz J (2010) Sexuality after breast cancer: a review. Maturitas 66:397–407

    Article  PubMed  Google Scholar 

  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):501–514

    Article  CAS  PubMed  Google Scholar 

  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):83–106

    Article  Google Scholar 

  10. Burwell SR, Case DL, Kaelin C, Avis NE (2006) Sexual problems in younger women after breast cancer surgery. J Clin Oncol 24(18):2815–2821

    Article  PubMed  Google Scholar 

  11. Bertero C (2007) Breast cancer diagnosis and its treatment affecting the self: a meta-synthesis. Cancer Nurs 30(3):194–202

    Article  PubMed  Google Scholar 

  12. Wilmoth MC (2001) The aftermath of breast cancer: an altered sexual self. Cancer Nurs 24(4):278–286

    Article  CAS  PubMed  Google Scholar 

  13. Ussher J, Perz J, Gilbert E (2012) Changes to sexual well-being and intimacy after breast cancer. Cancer Nurs 35(6):456–465

    Article  PubMed  Google Scholar 

  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):241–248

    Article  PubMed  Google Scholar 

  15. Rosenberg S, Tamimi R, Gelber S et al (2014) Treatment-related amenorrhea and sexual function in young breast cancer survivors. Cancer 120(15):2264–2271

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schover LR (2008) Premature ovarian failure and its consequences: vasomotor symptoms, sexuality, and fertility. J Clin Oncol 26(5):753–758

    Article  PubMed  Google Scholar 

  17. Beckjord E, Compas BE (2007) Sexual quality of life in women with newly diagnosed breast cancer. J Psychosoc Oncol 25(2):19–36

    Article  PubMed  Google Scholar 

  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 37:182–188

    Article  CAS  PubMed  Google Scholar 

  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 23:629–636

    Article  CAS  PubMed  Google Scholar 

  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 10:1292–1298

    Article  CAS  PubMed  Google Scholar 

  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 10:3403–3411

    Article  Google Scholar 

  22. Schultz W, Van de Wiel H (2003) Sexuality, intimacy, and gynaecological cancer. J Sex Marital Ther 29:121–128

    Article  PubMed  Google Scholar 

  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):623–633

    Article  CAS  PubMed  Google Scholar 

  24. Baser R, Li Y, Carter J (2012) Psychometric validation of the female sexual function index (FSFI) in cancer survivors. Cancer 118(18):4606–4618

    Article  PubMed  Google Scholar 

  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):1422–1429

    Article  CAS  PubMed  Google Scholar 

  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):940–947

    Article  PubMed  Google Scholar 

  27. Boquieren V, Esplen M, Wong J, Toner B, Warner E, Malik N (2015) Psycho-oncology 25(1):66–76

    Article  Google Scholar 

  28. Henson HJ (2002) Breast cancer and sexuality. Sex Disabil 20:261–275

    Article  Google Scholar 

  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):340–345

    Article  PubMed  Google Scholar 

  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):643–647

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. The Program in Women’s Oncology, Women & Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA

    K. Rojas, A. Stuckey & J. Gass

  2. Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, USA

    M. Onstad

  3. Division of Research, Women and Infants’ Hospital of Rhode Island, Providence, RI, USA

    C. Raker

  4. Center for Health Policy and Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    MA Clark

Authors
  1. K. Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Onstad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Raker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. MA Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Stuckey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Gass
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Rojas.

Ethics declarations

Conflict of interest

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rojas, K., Onstad, M., Raker, C. et al. The impact of mastectomy type on the Female Sexual Function Index (FSFI), satisfaction with appearance, and the reconstructed breast’s role in intimacy. Breast Cancer Res Treat 163, 273–279 (2017). https://doi.org/10.1007/s10549-017-4174-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-017-4174-z

Keywords

  • Breast cancer
  • Mastectomy
  • Sexuality
  • Survivorship
  • Intimacy
  • Nipple sparing
  • Mastectomy