Bilateral prophylactic mastectomy often adversely affects sexuality: 'didn't feel like my own'.(News)

SAN ANTONIO -- Long-term satisfaction with the decision to undergo bilateral prophylactic mastectomy with immediate breast reconstruction is frequently diminished by unanticipated changes in body image and the sexual relationship, Paula J.C. Bresser, Ph.D., reported.

This is an aspect of preoperative patient counseling that clearly warrants far greater emphasis. As part of the decision-making process, women contemplating this radical preventive surgery need to fully understand that there is a good chance changes in sexual functioning are in store, Dr. Bresser said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

She reported on 114 women who completed a detailed questionnaire on the effects of bilateral prophylactic mastectomy with immediate breast reconstruction via subpectoral implants a median of 3 years after undergoing the surgery at Erasmus Medical Center, Rotterdam, the Netherlands.

All of the women were genetically predisposed to breast cancer; one-third had already been diagnosed with it. Fifty-seven percent also underwent bilateral prophylactic salpingo-oophorectomy, and 27% were on hormone therapy for at least part of the follow-up period.

The practice at Erasmus is to provide women at high genetic risk for breast or ovarian cancer with nondirective counseling regarding prevention options. "A woman's decision is a personal decision," explained Dr. Bresser of the medical center.

This nondirective counseling approach requires that patients receive comprehensive information so they make an informed choice. In this regard, Dr. Bresser and her colleagues were gratified to find 95% of survey participants indicated they would opt for bilateral prophylactic mastectomy if they had it to decide over again, and 79% would chose the same type of immediate breast reconstruction.

On the downside, nearly one-third of women ...