Anderson Chelsea, Islam Jessica Y, Elizabeth Hodgson M, Sabatino Susan A, Rodriguez Juan L, Lee Clara N, Sandler Dale P, Nichols Hazel B
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Social and Scientific Systems, Inc., Durham, NC, USA.
Ann Surg Oncol. 2017 Jun;24(6):1499-1506. doi: 10.1245/s10434-016-5753-7. Epub 2017 Jan 5.
Contralateral prophylactic mastectomy (CPM) rates have been increasing in the US, and although high levels of satisfaction with CPM have been reported, few studies have evaluated the long-term effects on body image, comparing CPM with breast-conserving surgery (BCS) and unilateral mastectomy (UM).
We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n = 1176). Among women who underwent mastectomy, we examined satisfaction with the mastectomy decision, as well as variation in the use of reconstruction and experience of complications. Five survey items, evaluated individually and as a summed total score, were used to compare body image across surgery types (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction).
Participants were, on average, 3.6 years post-diagnosis at the time of survey (standard deviation 1.7). The majority of women (97% of CPM, 89% of UM) were satisfied with their mastectomy decision. Reconstruction was more common after CPM than after UM (70 vs. 47%), as were complications (28 vs. 19%). Body image scores were significantly worse among women who underwent CPM than among women who underwent BCS, with the lowest scores among women who underwent CPM without reconstruction.
In our sample, most women were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lower among those who underwent CPM than among those who underwent BCS. Our findings may inform decisions among women considering various courses of surgical treatment.
在美国，对侧预防性乳房切除术（CPM）的比例一直在上升，尽管有报道称对CPM的满意度较高，但很少有研究评估其对身体形象的长期影响，并将CPM与保乳手术（BCS）和单侧乳房切除术（UM）进行比较。
我们分析了参加姐妹研究的有乳腺癌个人和家族史的女性（n = 1176）的调查回复。在接受乳房切除术的女性中，我们检查了对乳房切除术决定的满意度，以及重建使用情况和并发症经历的差异。使用五个调查项目，分别评估并作为总分，来比较不同手术类型（BCS、未进行重建的UM、未进行重建的CPM、进行重建的UM和进行重建的CPM）的身体形象。
在调查时，参与者平均在确诊后3.6年（标准差1.7）。大多数女性（CPM的97%，UM的89%）对她们的乳房切除术决定感到满意。CPM后进行重建比UM后更常见（70%对47%），并发症也是如此（28%对19%）。接受CPM的女性的身体形象得分明显低于接受BCS的女性，未进行重建的CPM女性得分最低。
在我们的样本中，大多数女性对她们的乳房切除术决定非常满意，包括那些选择接受CPM的女性。然而，接受CPM的女性的身体形象低于接受BCS的女性。我们的研究结果可能为考虑各种手术治疗方案的女性提供决策参考。
