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Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

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Abstract

The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, n = 48), at 6 months (T1, n = 44) and after finishing breast reconstruction (median 21 months, range 12–35) (T2, n = 36). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37 % of the women reported that their breasts felt unpleasantly, 29 % was not satisfied with their breast appearance and 21 % felt embarrassed for their naked body. Most body image issues remained unchanged in 30 % of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR.

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Notes

  1. Leiden University Medical Center (LUMC), Erasmus University Medical Center Rotterdam (Erasmus MC), Daniel den Hoed Cancer Centre, Haga Teaching Hospital (Haga), Admiraal de Ruyter Hospital Goes.

  2. Correlation coefficients with body image change scores were calculated for the following baseline psychological variables: sexual and partner relationship satisfaction, cancer distress and general mental and physical health.

  3. Dropout reasons: questionnaires were “too general” or “time consuming”, having had complications, “there was no cancer distress as there was no cancer”, and “not feeling psychologically stable”.

  4. Sexual and partner relationship satisfaction was only completed by women with a partner, therefore, N may be lower than 32 for these variables.

  5. The four women without a BRCA1/2 mutation preferred PM over surveillance and after multidisciplinary consultation, they were allowed to have surgery.

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Acknowledgments

We thank all women who participated in the study. We also thank the involved specialists for providing medical data: G. K. van Drunen, N. A. S. Posch, M. J. I. Braam and H. P. van Not at the participating centers LUMC, Haga Hospital and Admiraal de Ruyter Hospital Goes. We also thank Annelies Kleijne for data management. This study was supported by the Dutch Cancer Society (UL 2007-3726).

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Authors and Affiliations

  1. Center for Human and Clinical Genetics, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Jessica P. Gopie & Aad Tibben

  2. Department of Plastic and Reconstructive Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands

    Marc A. M. Mureau

  3. Department of Medical Oncology, Family Cancer Clinic, Erasmus MC, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

    Caroline Seynaeve

  4. Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands

    Moniek M. ter Kuile

  5. Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

    Marian B. E. Menke-Pluymers

  6. Department of Medical Psychology and Psychotherapy, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands

    Reinier Timman

  7. Department of Clinical Genetics, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands

    Aad Tibben

Authors
  1. Jessica P. Gopie
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  2. Marc A. M. Mureau
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  5. Marian B. E. Menke-Pluymers
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Correspondence to Jessica P. Gopie.

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Gopie, J.P., Mureau, M.A.M., Seynaeve, C. et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Familial Cancer 12, 479–487 (2013). https://doi.org/10.1007/s10689-012-9588-5

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