The psycho-social impact of contralateral risk reducing mastectomy (CRRM) on women: a rapid review

OBJECTIVES: For women who have been diagnosed with unilateral breast cancer there is an increasing trend for them to request removal of the contralateral healthy breast, so called contralateral risk reducing mastectomy (CRRM). The current literature is only just beginning to identify patient-reported reasons for undergoing CRRM and associated patient reported outcomes. It is also unclear whether women at moderate/high risk of developing a subsequent primary contralateral breast cancer report similar outcomes to those considered to be at low/average risk. This lack of knowledge provides the rationale for this review. METHODS: A rapid review methodology was undertaken to identify and explore the published research literature focused on the longer term (>5 years) psychosocial impacts on women who undergo CRRM. RESULTS: 15 studies were identified. No UK studies were identified. High satisfaction and psychosocial wellbeing was consistently reported across all studies. Reducing the risk of a subsequent CBC and therefore reducing cancer related anxiety, and satisfaction with cosmesis, were key themes running across all studies explaining satisfaction. Dissatisfaction was associated with adverse effects such as poor cosmesis, body image changes, femininity, sexual relationships, re-operations for acute and longer term complications and reconstructive problems CONCLUSIONS: Satisfaction and psychological wellbeing following CRRM was consistently high across all studies. However, the findings suggest women need to be more fully informed of the risks and benefits of CRRM and/or immediate/delayed reconstruction in order to support informed decision making.