An Analysis of the Decisions Made for Contralateral Prophylactic Mastectomy and Breast Reconstruction
Plastic and Reconstructive Surgery
Buchanan PJ et al
Background: Little is known about the role breast reconstruction plays
in decisions made for contralateral prophylactic mastectomy. This study
explores factors critical to patient medical decision-making for
contralateral prophylactic mastectomy and reconstruction among women
with early stage, unilateral breast cancer.
Methods: A mixed methods approach was used to gain an understanding of
patients’ choices and experiences. Patients with stage 0 to III
unilateral breast cancer who underwent reconstruction were recruited,
and semistructured interviews were conducted. Patient-reported outcomes
were evaluated using the Concerns About Recurrence Scale and the
BREAST-Q.
Results: Thirty patients were enrolled; 13 (43 percent) underwent
unilateral mastectomy and 17 (57 percent) underwent contralateral
prophylactic mastectomy. Three broad categories emerged from patient
interviews: medical decision-making, quality of life after mastectomy,
and breast reconstruction expectations. Patients who chose contralateral
prophylactic mastectomy made the decision for mastectomy based
primarily on worry about recurrence. Quality of life after mastectomy
was characterized by relief of worry, especially in patients who chose
contralateral prophylactic mastectomy [n = 14 (82.4 percent)]. Patients’
desires for symmetry, although not the primary reason for contralateral
prophylactic mastectomy, played a role in supporting decisions made.
Levels of worry after treatment were similar in both groups (72.7
percent). Patients with contralateral prophylactic mastectomy had higher
mean scores for satisfaction with breast (82.4 versus 70.6) and
satisfaction with outcome (89.9 versus 75.2).
Conclusions: The choice for contralateral prophylactic mastectomy is
greatly influenced by fear of recurrence, with desires for symmetry
playing a secondary role in decisions made.
