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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

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

Authors: Kelly A. Metcalfe, RN, PhD, Tulin D. Cil, MD, FRCPC, MEd, John L. Semple, MD, FRCPC, Lucy Dong Xuan Li, BSc, Shaghayegh Bagher, MSc, Toni Zhong, MD, MHS, FRCSC, Sophia Virani, MSc, Steven Narod, MD, FRCPC, Tuya Pal, MD

Published in: Annals of Surgical Oncology | Issue 10/2015

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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.
Literature
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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
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.CrossRefPubMed
8.
Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.CrossRefPubMed
9.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
12.
Brehaut JC, O’Connor AM, Wood TJ, et al. Validation of a decision regret scale. Med Decis Making. 2003;23:281–92.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.PubMedCentralCrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
21.
Metcalfe KA, Esplen MJ, Goel V, et al. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psychooncology. 2004;13:14–25.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.PubMedCentralCrossRefPubMed
Metadata
Title
Long-Term Psychosocial Functioning in Women with Bilateral Prophylactic Mastectomy: Does Preservation of the Nipple-Areolar Complex Make a Difference?
Authors
Kelly A. Metcalfe, RN, PhD
Tulin D. Cil, MD, FRCPC, MEd
John L. Semple, MD, FRCPC
Lucy Dong Xuan Li, BSc
Shaghayegh Bagher, MSc
Toni Zhong, MD, MHS, FRCSC
Sophia Virani, MSc
Steven Narod, MD, FRCPC
Tuya Pal, MD
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4761-3

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