What Affects Intimacy & Satisfaction After Prophylactic Mastectomy & Breast Reconstruction
Does prophylactic mastectomy and breast reconstruction impact patients’ intimacy?
With growing knowledge of genetic mutations and their association with an increased risk of breast cancer, more women are choosing to undergo risk reducing mastectomy and breast reconstruction. This growing trend led researchers to examine what factors influence a patient’s intimate life and overall satisfaction with their breast reconstruction outcomes.
Choosing to undergo a prophylactic mastectomy is a major life-changing decision and can be a good option for patients who are at high risk of developing breast cancer. In certain situations, prophylactic mastectomy can reduce the risk of breast cancer by 90%-95%.
Breast reconstruction is also an option following preventative mastectomy and can be performed using implants or the patient’s own tissue. Regardless of the reconstructive procedure performed, changes in breast sensation and appearance may impact a patient’s intimate life and overall satisfaction with their final results.
A study published in the International Journal of Behavioral Medicine took a closer look at what factors influenced patients’ satisfaction with their reconstructed breasts and intimacy following bilateral prophylactic mastectomy.
The study followed 26 women and concluded satisfaction appeared to be influenced by realistic outcome expectations and communication with others. Women who liked their breasts pre-surgery appeared less satisfied with their reconstructed breasts post-surgery, and women who disliked their breasts before surgery were more satisfied with their reconstructed breasts. Women with unrealistic expectations concerning the look and feel of their reconstructed breasts were often unhappy with their reconstructed breasts and felt they did not meet their expectations
So, what’s the take home message?
It is crucial for surgeons and patients to have honest discussions regarding patient wishes and realistic expectations. This is called Shared Decision Making and we believe it is the most important aspect of patient centered health care! Patients and their doctors should work together to make the decisions for individualized care. Time should be taken to discuss ALL options and the pros and cons of each before creating a surgery plan. It is our belief at PRMA that each patient is unique, and as such, no two breast reconstruction journeys will be alike.
Although reconstructive techniques have come a long way, it is important for patients to understand final results will not always look or feel like what mother nature provided. For example, during the prophylactic mastectomy, nerves supplying feeling to the breast will be cut. This results in a lack of sensation or numbness to the breast. For patients choosing to have tissue-based reconstruction (like the DIEP flap), sensory nerve reconstruction can be performed and can help restore sensation to the breast. Unfortunately, this is not an option for implant reconstruction patients at this time.
Regardless of the procedure being performed, patients should know more than one procedure is typically required for optimal cosmetic results. Referred to as the “Revision Stage” or “Stage 2,” this procedure is designed to fine-tune the reconstructed breast(s) in order to improve the overall cosmetic appearance.
Women undergoing prophylactic mastectomy and breast reconstruction have many options available to them today. By understanding patient needs and discussing realistic expectations, overall satisfaction with reconstruction results and intimacy can be achieved.
Author: Dr. Minas Chrysopoulo and Courtney Floyd
A study published in Plastic and Reconstructive Surgery examined the abdominal recovery rates and patient satisfaction after breast reconstruction with different abdominal flaps: the DIEP, SIEA and muscle-sparing free TRAM.
I had the DIEP procedure. At the time, 2006, there was no talk of nerve reconstruction. Would that be a consideration now? Are the nerves still in there and could they be connected?
Great question Mary. Sadly, after the tissue has been transplanted to the chest, further sensory nerve reconstruction cannot be performed at this time.