More women with cancer in one breast are opting to have both breasts removed to reduce their risk of future cancer. New research shows that in the long term, most have no regrets. Researchers surveyed 621 women with breast cancer who underwent double mastectomy between 1960 and 1993 and found that nearly all would make the same choice again.

The study, conducted by Mayo Clinic researchers in Rochester, Minnesota, made a surprising finding. While most women were satisfied with their decision whether they followed it with breast reconstruction or not, patients who decided against reconstructive surgery were likelier to say they would choose to have both breasts removed again. In the reconstructive surgery group, women who needed additional procedures due to complications, breast implant-related issues, or other reasons were likelier to regret their prophylactic mastectomy, though overall, most women with breast reconstructions were satisfied with their choices.

“I think what this study does is adds some literature to the hands of the people counseling patients to say, ‘Whatever decision you make, you’re very likely to be happy with that in the long run, so listen to yourself, and make the decision that’s best for you,’” said lead author Judy Boughey, MD, a Mayo breast surgeon. The study was published in Annals of Surgical Oncology (2014; doi:10.1245/s10434-014-4053-3).

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Most of those who skipped reconstruction said they felt the same about themselves and their femininity in the long run as they did before their mastectomies and would make the same choices today. Many of those with reconstructive surgery also felt the same about themselves as they did before their mastectomies, but some reported more satisfaction with their appearance, higher self-esteem, and feeling more feminine.

Although double mastectomy substantially reduces the risk of cancer developing in the other breast, past studies have found that many women who pursued it did not actually have a high risk of developing cancer in their other breast. There is mixed data on whether breast cancer patients who underwent a double mastectomy live longer than those who do not choose that option, though most studies show they do not. Physician advice and a desire for peace of mind tend to play key roles in mastectomy patients’ decision, the researchers noted.

“When we’re counseling women considering having the other breast removed, it’s a very complex and multilayered discussion,” Boughey said. “Obviously the risk of developing a new cancer in that breast has to be part of that discussion, but the literature shows that the risk for the other breast is really not that high, and that from a medical standpoint we don’t need to recommend that approach.”

“But it’s also important to note that much of what drives removal of the other breast is patient anxiety, which feeds into patient quality of life, and it is also important to consider breast symmetry from a cosmetic standpoint,” Boughey added.

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