Mastectomy to Prevent Cancer Reduces Women's Worries
Of the seven women who eventually developed breast cancer after having both breasts removed, six were still alive. "None of the women voiced dissatisfaction and five of the six said they 'definitely' or 'probably' would choose prophylactic mastectomy again," Frost says. Their reasons: "it was the best decision at the time ... they were comfortable with their body image, it provided peace of mind, and ... it provided risk reduction or enhanced detection of cancer." One woman, though, reported that the procedure gave her a false sense of security.
Satisfaction with breast reconstructive surgery was quite another issue. While 95% of the women surveyed chose reconstructive surgery, only 69% reported being either satisfied or very satisfied with the results.
For some women, the results of breast reconstruction are "not exactly what they expected," Alison Estabrook, MD, chief of breast surgery at St. Luke's-Roosevelt-Hospital Center's Comprehensive Breast Center in New York, tells WebMD.
"They are very happy that they have a decrease in breast cancer risk, ...If you ask them about medical health, they're probably happy they did what they did," says Estabrook. "But it changes their lives, and our experience is that a lot of women are pretty shocked about what they did. They did it for good reasons, but a lot have emotional trauma to go through, with readjustments to their bodies. And they're young, a lot of them are dancers, doing things that involve their bodies a lot. If you're looking at their psychosocial adjustment, it's a problem."
Hoffman agrees, telling WebMD, "They may have an idealized picture in their minds of what the breast will look like, which is not always possible, so they are unhappy with the results."
In Frost's study, the small number of women who did not elect to have breast reconstructive surgery showed greater satisfaction with their decision. Frost speculates that these women place less emphasis on their breasts as part of their self-image. In her study, those who decided against breast reconstruction had fewer negative feelings about their femininity and body appearance. Further, those women "would not have been exposed to concerns about implants and other problems with reconstructive surgery," Frost says.
Despite the high satisfaction rate reported by Frost, most women at high risk of breast cancer do not choose prophylactic mastectomy. "However, there's a great deal of interest in this fairly extreme option, so we have needed insights into the long-term sense of satisfaction with this choice," Robert A. Smith, PhD, director of cancer screening at the American Cancer Society, tells WebMD.
"This is not a decision to be made quickly. It's not a decision to be made without all the facts, and not without considerable degree of expert counseling, about what this may offer you. What's your underlying risk of breast cancer and death from breast cancer?