Perceptions of poor body image and other psychosocial factors persist long term (6 to 20 years) after undergoing risk-reduction mastectomy (RRM) to lower risk of hereditary breast cancer or to remove the contralateral breast after a diagnosis of breast cancer, according to results from a prospective, long-term, follow-up study published in Breast

Several previous prospective, short-term studies have shown that RRM had a negative impact on body image and sexuality in the first few years following surgery. Although a number of retrospective studies have shown long-term dissatisfaction with the effect of RRM on physical appearance, there is a paucity of long-term follow-up on health-related quality of life (HRQoL), anxiety/depressive symptoms, and perceptions of body image and sexuality in these women. 

This study involved 298 women who underwent RRM at a university hospital in Sweden between March 1997 and September 2010: 188 women without breast cancer underwent bilateral RRM; 110 women with breast cancer underwent RRM of the contralateral breast at a time after initial breast cancer surgery. Approximately 95% of these women underwent immediate breast reconstruction. Data related to perceptions of body image, sexuality, and anxiety/depression collected 1 year following surgery were available for 200 women.

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In 2016/2017, these 200 women were contacted by mail and asked to complete and return the Body Image Scale, the Sexuality Activity Questionnaire, the Hospital Anxiety and Depression Scale, and the Swedish Short Term-36 Health Survey.  

Of the 146 (73%) women who completed the questionnaires, 99 did not have a previous diagnosis of breast cancer. Mean follow-up after RRM was 11.5 years.

Of note, no differences in HRQoL and anxiety/depressive symptoms were observed at the long-term follow-up compared with 1 year postop, or between the 2 groups of women. Although long-term persistence of negative body image perceptions was seen in both groups, women with a previous diagnosis of breast cancer reported increased rates of sexual discomfort (=.016), disease treatment/surgery-related symptoms (P=.006), and problems with sexuality (P=.031) when compared with women without a cancer diagnosis.  

The study authors concluded that poor body image persists after RRMregardless of whether the woman received a cancer diagnosis. These results are clinically significant when counseling women who are considering prophylactic bilateral RRM or contralateral RRM after a breast cancer diagnosis.


Bai L, Arver B, Johansson H, Sandelin K, Wickman M, Brandberg Y. Body image problems in women with and without breast cancer 6-20 years after bilateral risk-reducing surgery — a prospective follow-up study. Breast. 2019;44:120-127.