Less correspondence between expectations before and cosmetic results after risk- reducing mastectomy in women who are mutation carriers: A prospective study Y. Brandberg a,b, * , B. Arver a,b , H. Johansson b , M. Wickman c,e , K. Sandelin d,e , A. Liljegren a,b a Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden b Department of Oncology, Karolinska University Hospital, Stockholm, Sweden c Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden d Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden e Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Accepted 10 October 2011 Available online 26 October 2011 Abstract Purpose: The primary aim was to describe satisfaction with the cosmetic results six months and one year after risk-reducing mastectomy (RRM) with immediate breast reconstruction. Another aim was to ascertain associations between ratings on “correspondence between the overall results and expectations before RRM” and age, mutation carrier status, salpingo-oophorectomy (SOE) before RRM, body image, and with sexual pleasure and discomfort. Methods: 91/100 women who underwent RRM between 1997 and 2005 were included. Assessments were made six and twelve months after RRM with questionnaires regarding satisfaction with the cosmetic results, sexuality (SAQ), and body image (BIS). Results: At both assessment points, >70% of the women considered the overall results of RRM to correspond to their expectations. Over 80% were satisfied with the size of their breasts, but 49% indicated at the one-year assessment that at least one breast was too hard and 73% indicated that they had no or only minor sensitivity in the breasts. In the univariate analyses, associations between “correspondence between the overall results and expectations before RRM” and mutation carrier status ( p ¼ 0.039) and SOE ( p ¼ 0.025) were found, but only mu- tation carrier status remained in the multivariate analysis (0.037). Conclusion: The majority of the women reported that the results of RRM corresponded to their expectations, with lower levels of corre- spondence in mutation carriers than in non-carriers. Overall satisfaction with the cosmetic result was high, but a majority of the women were unsatisfied with the softness of the reconstructed breasts. These results can be useful when informing patients about RRM. Ó 2011 Elsevier Ltd. All rights reserved. Keywords: Breast cancer; Prophylactic mastectomy; Cosmetic result; Sexuality; Hereditary risk; Satisfaction; Body image Introduction Risk-reducing mastectomy (RRM), including immediate breast reconstruction, is performed as a means to reduce breast cancer incidence in women from families with a well-defined history of breast cancer, and in women with BRCA1 or BRCA2 mutations. 1e4 In a retrospective study of 572 women who underwent RRM from 1960 to 1993, 70% were satisfied with the re- sults. 5 A retrospective study of 75 women after RRM from 1991 to 2000 showed a high level (72%) of satisfac- tion with the cosmetic results. 6,7 In another retrospective study, 84% of patients reported excellent or acceptable re- sults. 8 However, in a review of nine studies assessing psy- chosocial outcomes, the majority reported variable satisfaction with the cosmetic results. 9 In a retrospective in- terview study of 13 women 10 years after RRM at the Kar- olinska University Hospital, Stockholm, the majority were satisfied with the cosmetic results (n ¼ 10), but five of them reported that their relationship with their partner had been negatively affected by the RRM. 10 This negative outcome was partly due to a decreased sensation in the re- constructed breasts, and a changed body appearance. In summary, the majority of the published studies report high levels of satisfaction with the cosmetic results of * Corresponding author. Department of Oncology-Pathology, Karolinska Institutet, Radiumhemmet, Karolinska University Hospital, S 171 76 Stockholm, Sweden. Tel.:þ46 851772422; fax: þ46 8 32 61 13. E-mail address: yvonne.brandberg@ki.se (Y. Brandberg). 0748-7983/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2011.10.010 Available online at www.sciencedirect.com EJSO 38 (2012) 38e43 www.ejso.com