Long-Term Patient-Reported Satisfaction after Contralateral Prophylactic Mastectomy and Implant Reconstruction

Abstract

To determine whether satisfaction and health-related quality of life (HR-QoL) differ between women who do and do not undergo contralateral prophylactic mastectomy (CPM) in the setting of implant reconstruction using the BREAST-Q, a validated patient-reported outcome instrument. From 2000 to 2007, a total of 3,874 patients with stage 0 to III unilateral breast cancer (BC) had mastectomy; 688 (18%) pursued CPM within 1year. Patients who completed the BREAST-Q reconstruction module as part of BREAST-Q validation studies or routine clinical care formed our study cohort. Comparisons were made between CPM and no-CPM patients using univariate analysis and multivariate models (MVA). Of 294 patients with BREAST-Q data, 112 (38%) had CPM. Median time from mastectomy to BREAST-Q was 52months. CPM patients were younger (mean 47 vs. 50years), more likely to be White (98 vs. 86%), married (84 vs. 71%), have a family history of BC (60 vs. 44%), and to choose silicone implants (67 vs. 48%). There were no differences in tumor or treatment characteristics between groups at the time of BREAST-Q. Patients with CPM had a higher mean score for Satisfaction with Breasts (64.4 vs. 54.9; p<0.001) and Satisfaction with Outcome (74.8 vs. 67.7; p=0.007); other HR-QoL domains did not differ. On MVA, CPM and the absence of lymphedema were significant predictors of Satisfaction with Breasts (CPM p=0.005, lymphedema p=0.039). CPM was not associated with improved Satisfaction with Outcome. This study suggests that in the setting of implant reconstruction, CPM has a positive correlation with patient satisfaction with their breasts, but not with improvements in other HR-QoL domains.