Body Image in BRCA-Positive Young Women Following Bilateral Risk-Reducing Mastectomy: A Review of the Literature.

Christa Torrisi

doi:10.3389/fpsyg.2021.778484

Abstract

Background/Significance: The presence of a breast cancer (BRCA) gene mutation increases a woman’s lifetime risk of developing breast cancer. Bilateral risk-reducing mastectomy is a proactive treatment option which lowers that risk. However, breast removal can create a change in physical appearance. It is unclear if BRCA-positive women undergoing this surgery in young adulthood, a life stage where intimate relationships, families, and careers are being established, have the same experience with body image as women in later stages of life.Purpose: The aim of this literature review is to assess how bilateral risk-reducing mastectomy impacts body image in young BRCA-positive women less than 40 years of age, with no history of breast cancer.Methods: Database searches were performed, yielding 402 results. Studies were considered if participants had an increased lifetime breast cancer risk/BRCA-positive diagnosis and history of bilateral risk-reducing mastectomy, body image was evaluated, and mean age was less than 40 years. A total of three qualitative studies and three quantitative studies were identified as relevant for this review.Results: A dearth of information exists on body image in young women following bilateral risk-reducing mastectomy. It was found in this review that some women experienced a decline in body image following surgery, while in others body image was maintained or improved.Conclusion: Understanding factors that impact body image following this risk-reducing surgery will allow clinicians to support this unique population. Open and informative discussion should be encouraged with young women considering, or who have undergone, bilateral risk-reducing mastectomy.

Highlights

The presence of a breast cancer (BRCA) gene mutation is predicted to increase a woman’s lifetime risk of developing breast cancer to 72%, compared to the 12% lifetime risk of a woman without this gene mutation (Kuchenbaecker et al, 2017; McCarthy et al, 2017)
Searches were performed 06/16/2021, and 08/22/2021 utilizing a combination of the key terms of “risk-reducing mastectomy,” “BRCA,” “body image,” and “young.” CINAHL, PubMed, and Scopus databases were utilized in the review of literature
Studies selected for this review included those in which participants had previously undergone Bilateral risk-reducing mastectomy (BRRM), were BRCA-positive or had an increased familial risk of breast cancer, and those in which body image was addressed within the study

Summary

Introduction

The presence of a breast cancer (BRCA) gene mutation is predicted to increase a woman’s lifetime risk of developing breast cancer to 72%, compared to the 12% lifetime risk of a woman without this gene mutation (Kuchenbaecker et al, 2017; McCarthy et al, 2017). Women less than 40 years of age have accounted for a 15% increase in BRCA testing between 2003 and 2016 (Guo et al, 2020), emphasizing the importance of knowing and managing risk to this population. Bilateral risk-reducing mastectomy (BRRM), a surgical procedure in which healthy breasts are removed to prevent breast carcinoma, is the most effective proactive treatment option available for BRCA-positive women. Lifetime breast cancer risk is reduced by 90% following BRRM (Rebbeck et al, 2004). This procedure continues to increase in prevalence, with insurance claims database surveys between 2003 and 2016 displaying that BRCA-positive women undergoing BRRM had increased between 1.2 and 1.6% per month (Liede et al, 2018)

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Discussion

Conclusion