Contralateral prophylactic mastectomy: Long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits

Purpose: This study aims to evaluate the long-term consistency of satisfaction with contralateral prophylactic mastectomy (CPM) and adverse psychosocial effects as well as to explore the effect of informed decision-making, personality traits, and quality of life (QOL) on satisfaction. Methods: A previously established cohort of women with unilateral breast cancer who had undergone CPM between 1960 and 1993 were surveyed using study-specific and standardized questionnaires at two follow-up time points. The first survey was a mean of 10.7 years and the second survey a mean of 20.2 years after CPM. Results:487 of the 583 women who responded to the first study were alive and resurveyed. Data from both surveys were available for 269 women. With longer follow-up, there was a small increase in the percentage of women satisfied (90%) and those who would choose CPM again (92%) (4% and 2% increase from first survey, respectively). Most adversely affected were body appearance (31%), feelings of femininity (24%), and sexual relationships (23%). Ninety-three percent of women felt they had made an informed decision. Perception of making an informed choice and current QOL were moderately associated with satisfaction with CPM (r = 0.37 and 0.37, respectively) while associations with trait anxiety and optimism were weak (r = 0.27 and 0.21, respectively). Conclusions: Long-term satisfaction and adverse effects remained remarkably stable. It is important that women fully understand the benefits and adverse effects associated with CPM.