Abstract
Purpose
Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR.
Patients and Methods
Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient’s charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL.
Results
SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care.
Conclusion
Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.
Abbreviations
BRCA, Breast cancer gene; BRRM, Bilateral risk-reducing mastectomy; BMI, Body mass index; HRQoL, Health-related quality of life play; JMD, Jugular-mammillary distance; NAC, Nipple-areolar complex; PALB2, Partner and Localizer of BRCA2.
Data Sharing Statement
Raw and analyzed data are available from the corresponding author on reasonable request.
Ethical Approval
All procedures were in accordance with the ethical standards of the local ethics committee of the University of Leipzig (021/17-ek) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study has been registered at the German clinical study register (DRKS00024043).
Informed Consent
The participants provided written informed consent for participation in this study, and for the publication of all data and accompanying images.
Disclosure
Dr Susanne Briest reports honoraria for presentations or participation and aboard or support for travelling to conferences from Pfizer, Genomic Health, Eisai, Lilly, Daiichi Sankyo, Amgen, Pierre Fabre, Roche, AstraZeneca, Janssen, Novartis, and Teva, outside the submitted work. The other authors declare that they have no conflicts of interest in this work.