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JAMA: Most satisfied with prophylactic mastectomy CHICAGO - Most women at high risk for breast cancer who undergo mastectomy as a prophylactic (preventive) option are satisfied with the procedure and experience generally favorable outcomes, according to an article in the July 19 issue of The Journal of the American Medical Association (JAMA). Marlene H. Frost, R.N., Ph.D., and colleagues from the Mayo Clinic and Mayo Foundation, Rochester, Minn., analyzed survey data from 572 women who underwent bilateral prophylactic mastectomy between 1960 and 1993.  The researchers wanted to evaluate the patients’ long-term satisfaction, and find out how preventive breast tissue removal affected psychological and social function. According to background information, data from the Mayo Clinic shows prophylactic mastectomy lowers the incidence of breast cancer by approximately 90 percent among women with a family history of breast cancer.  The authors note that even though it is the preferred option for a minority of women at high risk for breast cancer, only 9 percent to 17 percent of women who express an interest in prophylactic mastectomy actually proceed with the surgery.  The researchers received completed questionnaires from 572 women. They found that 70 percent of the women were satisfied or very satisfied with prophylactic mastectomy.  “At a mean of 14.5 years after surgery, the majority of women reported satisfaction, a diminished level of emotional concern about developing breast cancer, and that they would likely choose the procedure again,” the researchers write.  “Additionally, the majority of women reported favorable effects or no change in self-esteem, satisfaction with body appearance, feelings of femininity, sexual relationships, level of stress in life and overall emotional stability,” they continue.  Women who said they were satisfied or very satisfied with prophylactic mastectomy most often cited these reasons:  peace of mind, good health since undergoing the mastectomy or no problems with the procedure, satisfaction with body image, and risk reduction or enhanced detection of cancer.  In contrast, 19 percent of patients said they were dissatisfied or very dissatisfied with the procedure. “Women who were dissatisfied or very dissatisfied with prophylactic mastectomy most frequently reported adverse symptoms or complications including implant concerns, adverse body image and sequelae and insufficient information or support,” the authors write. The researchers found that women who did not have breast reconstructive surgery were more satisfied than those who did.  “In our study, women who chose not to have reconstructive surgery compared with women who chose to have immediate reconstructive surgery reported fewer adverse outcomes with feelings of femininity (17 percent and 28 percent respectively) and body appearance (26 percent and 37 percent, respectively),” they write.  “Moreover, women who did not have reconstruction would not have been exposed to concerns about implants and other problems with reconstructive surgery.” The authors assert that the positive outcomes following prophylactic mastectomy must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and the adverse psychological and social outcomes  experienced by some women.  “While the majority of women are satisfied with prophylactic mastectomy and would choose it again, there are some women who are neutral in their response or dissatisfied with this procedure,” the authors write. “Our role as health care professionals is to provide a woman with a family history of breast cancer the best available information and encourage her to take time to consider all the options now available,” they conclude.