Prophylactic Mastectomy: Does It Improve Quality of Life?

Growing numbers of women with breast cancer in one breast are choosing to have preventive double mastectomies despite there being little evidence that the surgery actually improves quality of life for those women.

Growing numbers of women with breast cancer in one breast are choosing to have preventive double mastectomies despite there being little evidence that the surgery actually improves quality of life (QOL) for those women.

Researchers at the Duke University Cancer Institute, led by E. Shelley Hwang, MD, MPH, surveyed nearly 4000 women who had undergone single or double mastectomy for cancer in one breast about their self-reported levels of well-being. The authors reported in Journal of Clinical Oncology that women who had double mastectomies were more satisfied with how their breasts looked and felt (P = .046). This result occurred primarily among women whose mastectomies were followed by reconstructive surgery.

However, the size of these effects might be too small to be clinically meaningful, said Dr Hwang. She notes that the findings support what has concerned many breast cancer surgeons: that women are not benefiting as greatly from undergoing double mastectomies as they expect they will.

“Unless a woman has a gene mutation that places her at significantly increased risk of a new cancer in the other breast, contralateral prophylactic mastectomy doesn’t prolong life, and our study shows that it doesn’t make for a notably better quality of life,” Dr Hwang said in a statement.

Women who had double mastectomies also reported marginally higher psychosocial well-being (feelings of confidence, emotional health, and acceptance of their bodies). Women who decided to have double mastectomies were generally younger, had higher incomes, and were at an earlier stage of breast cancer. After adjusting for these factors, the investigators found that the group electing to have double mastectomies reported slightly higher breast satisfaction compared with women who had single mastectomies.

However, breast reconstruction was found to have a much greater impact on QOL. Breast reconstruction resulted in much higher psychosocial well-being, breast satisfaction, and sexual well-being than double mastectomy provides.

Dr Hwang and her coauthors concluded that these findings are important to consider when counseling women who are considering double mastectomies as part of their breast cancer treatment so they have a clear understanding of all their options and recognize the tradeoffs of each. Even though women imagine they will be much happier after having a double mastectomy, Dr Hwang said, the study found that these patients’ experiences were not greatly different from those of patients undergoing single mastectomy.

Double mastectomy “does not appear to translate into a much better quality of life in the way that breast reconstruction does,” she said.