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Long-Term Psychosocial Functioning in Women with Bilateral Prophylactic Mastectomy: Does Preservation of the Nipple-Areolar Complex Make a Difference?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Nipple-sparing prophylactic mastectomy (PM) is an option for women at high-risk for breast cancer, and may offer better cosmetic results than a skin-sparing PM where the nipple-areolar complex (NAC) is removed. However, there may be residual breast cancer risk due to the maintained NAC. It is unclear if sparing the NAC with PM impacts on psychosocial functioning, including cancer-related distress and body image after PM.

Methods

This was a cross-sectional survey study of women who had undergone bilateral PM (no previous breast cancer) recruited through surgical or cancer genetics clinics. All women completed standardized questionnaires assessing cancer-related distress, anxiety, depression, satisfaction with decision, decision regret, and health-related quality of life related to breast surgery. Outcomes were compared between women with nipple-areola-sparing PM (NAC-PM) and skin-sparing PM (SS-PM).

Results

Overall, 137 women completed the study; 53 (39 %) had NAC-PM and 84 (61 %) had SS-PM. The mean age of the study population was 41.5 years [standard deviation (SD) 8.8] and the mean time between PM and questionnaire completion was 50 months (SD 31). On the BREAST-Q, we found that women with NAC-PM had significantly higher levels of satisfaction with breasts (p = 0.01), satisfaction with outcome (p = 0.02), and sexual well-being (p < 0.001) compared with SS-PM. No statistically significant differences in total cancer-related distress (p = 0.89), anxiety (p = 0.86), or depression (p = 0.93) were observed between the two groups.

Conclusions

Overall, women with NAC-PM had better body image and sexual functioning compared with women with SS-PM, while both groups had comparable levels of cancer-related distress and perception of breast cancer risk.

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References

  1. Hartmann LC, Schaid D, Sellers T, et al. Bilateral prophylactic mastectomy in BRCA1/2 mutation carriers. American Association for Cancer Research, 2000.

  2. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–85.

    Article  CAS  PubMed  Google Scholar 

  3. Semple J, Metcalfe KA, Lynch HT, et al. International rates of breast reconstruction after prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol. 2013;20:3817–22.

    Article  PubMed  Google Scholar 

  4. Baltzer HL, Alonzo-Proulx O, Mainprize JG, et al. MRI volumetric analysis of breast fibroglandular tissue to assess risk of the spared nipple in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol. 2014;21:1583–8.

    Article  PubMed  Google Scholar 

  5. Yao K, Liederbach E, Tang R, et al. Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol. 2015;22:370–6.

    Article  PubMed  Google Scholar 

  6. Peled AW, Duralde E, Foster RD, et al. Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72 Suppl 1:S48–52.

    PubMed  Google Scholar 

  7. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118:623–33.

    Article  CAS  PubMed  Google Scholar 

  8. Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.

    Article  CAS  PubMed  Google Scholar 

  9. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  CAS  PubMed  Google Scholar 

  10. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res. 1997;42:17–41.

    Article  CAS  PubMed  Google Scholar 

  11. Bjelland I, Dahl AA, Haug TT, et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  12. Brehaut JC, O’Connor AM, Wood TJ, et al. Validation of a decision regret scale. Med Decis Making. 2003;23:281–92.

    Article  PubMed  Google Scholar 

  13. Goel V, Sawka CA, Thiel EC, et al. Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. Med Decis Making. 2001;21:1–6.

    Article  CAS  PubMed  Google Scholar 

  14. Sheehan J, Sherman KA, Lam T, et al. Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology. 2007;16:342–51.

    Article  PubMed  Google Scholar 

  15. Sheehan J, Sherman KA, Lam T, et al. Regret associated with the decision for breast reconstruction: the association of negative body image, distress and surgery characteristics with decision regret. Psychol Health. 2008;23:207–19.

    Article  PubMed  Google Scholar 

  16. Holmes-Rovner M, Kroll J, Schmitt N, et al. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996;16:58–64.

    Article  CAS  PubMed  Google Scholar 

  17. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–53.

    Article  CAS  PubMed  Google Scholar 

  18. Klassen AF, Pusic AL, Scott A, et al. Satisfaction and quality of life in women who undergo breast surgery: a qualitative study. BMC Womens Health. 2009;9:11.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Brandberg Y, Sandelin K, Erikson S, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol. 2008;26:3943–9.

    Article  PubMed  Google Scholar 

  20. Gopie JP, Mureau MA, Seynaeve C, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer. 2013;12:479–87.

    Article  PubMed  Google Scholar 

  21. Metcalfe KA, Esplen MJ, Goel V, et al. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psychooncology. 2004;13:14–25.

    Article  PubMed  Google Scholar 

  22. Lodder LN, Frets PG, Trijsburg RW, et al. One year follow-up of women opting for presymptomatic testing for BRCA1 and BRCA2: emotional impact of the test outcome and decisions on risk management (surveillance or prophylactic surgery). Breast Cancer Res Treat. 2002;73:97–112.

    Article  CAS  PubMed  Google Scholar 

  23. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22:1055–62.

    Article  PubMed  Google Scholar 

  24. Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93:1633–7.

    Article  CAS  PubMed  Google Scholar 

  25. Metcalfe KA, Mian N, Enmore M, et al. Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening. Breast Cancer Res Treat. 2012;133:735–40.

    Article  CAS  PubMed  Google Scholar 

  26. Graves KD, Vegella P, Poggi EA, et al. Long-term psychosocial outcomes of BRCA1/BRCA2 testing: differences across affected status and risk-reducing surgery choice. Cancer Epidemiol Biomarkers Prev. 2012;21:445–55.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Kelly A. Metcalfe RN, PhD

  2. Women’s College Research Institute, Toronto, ON, Canada

    Kelly A. Metcalfe RN, PhD, John L. Semple MD, FRCPC, Lucy Dong Xuan Li BSc, Sophia Virani MSc & Steven Narod MD, FRCPC

  3. Women’s College Hospital, Toronto, ON, Canada

    Tulin D. Cil MD, FRCPC, MEd & John L. Semple MD, FRCPC

  4. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Lucy Dong Xuan Li BSc

  5. University Health Network, Toronto, ON, Canada

    Shaghayegh Bagher MSc & Toni Zhong MD, MHS, FRCSC

  6. Moffitt Cancer Center, Tampa, FL, USA

    Tuya Pal MD

Authors
  1. Kelly A. Metcalfe RN, PhD
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  2. Tulin D. Cil MD, FRCPC, MEd
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  3. John L. Semple MD, FRCPC
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  4. Lucy Dong Xuan Li BSc
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  5. Shaghayegh Bagher MSc
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  6. Toni Zhong MD, MHS, FRCSC
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  7. Sophia Virani MSc
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  8. Steven Narod MD, FRCPC
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  9. Tuya Pal MD
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Corresponding author

Correspondence to Kelly A. Metcalfe RN, PhD.

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Metcalfe, K.A., Cil, T.D., Semple, J.L. et al. Long-Term Psychosocial Functioning in Women with Bilateral Prophylactic Mastectomy: Does Preservation of the Nipple-Areolar Complex Make a Difference?. Ann Surg Oncol 22, 3324–3330 (2015). https://doi.org/10.1245/s10434-015-4761-3

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  • DOI: https://doi.org/10.1245/s10434-015-4761-3

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