Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

• Published in: Annals of surgical oncology Vol. 24; no. 9; pp. 2502 - 2508
• Main Authors: McCarthy, Colleen M., Hamill, Jennifer B., Kim, Hyungjin Myra, Qi, Ji, Wilkins, Edwin, Pusic, Andrea L.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2017; Springer Nature B.V
• Subjects: Anxiety; Breast cancer; Breast carcinoma; Breast Oncology; Consortia; Decision making; Mastectomy; Medicine; Medicine & Public Health; Oncology; Quality of life; Risk factors; Surgery; Surgical Oncology; Womens health; Numeric Pain Rating Scale (NPRS); Individualized Treatment Decisions; Postmastectomy Reconstruction; Bilateral Prophylactic Mastectomy (BPM); Breast Cancer
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-5915-2

Background
Although bilateral prophylactic mastectomy (BPM) can reduce the risk of breast cancer, the decision to proceed surgically can have significant consequences and requires careful deliberation. To facilitate decision making for women at high risk for breast carcinoma, the risks and benefits of BPM should be well-elucidated. We sought to determine the effects of BPM and immediate reconstruction on health-related quality-of-life outcomes among a multisite cohort of women at high risk for breast carcinoma.
Methods
Patient-reported outcome data were prospectively collected as part of the Mastectomy Reconstruction Outcomes Consortium Study, and data on a subgroup of 204 high-risk women who elected to have BPM and immediate reconstruction were evaluated. Baseline scores were compared with scores at 1 or 2 years after reconstruction.
Results
Satisfaction with breasts and psychosocial well-being were significantly higher at both 1 and 2 years (
p
 < 0.01); however, anxiety was significantly lower at 1 or 2 years (
p
 < 0.01) and physical well-being of the chest and upper body was significantly worse at 1 year (
p
 < 0.01).
Conclusion
Our results highlight the impact of BPM and immediate reconstruction on health-related quality-of-life outcomes in this setting. BPM and reconstruction can result in significant, positive, lasting changes in a woman’s satisfaction with her breasts, as well as her psychosocial well-being. Furthermore, presurgery anxiety was significantly reduced by 1 year post-reconstruction and remained reduced at 2 years. With this knowledge, women at high risk for breast carcinoma, and their providers, will be better equipped to make the best individualized treatment decisions.