Bilateral Risk-Reducing Mastectomy With Immediate Breast Reconstruction Lowers Concerns of Breast Cancer in Women With a High-Risk Genetic Predisposition for Breast Cancer Compared With a Radiological Imaging Surveillance Group

Background and Objectives: Women with a high-risk genetic predisposition for breast cancer are faced with the choice between bilateral risk-reducing mastectomy, often accompanied by immediate breast reconstruction, or radiological imaging surveillance. This study examined changes in mental well-being and health-related quality of life following surgery and compared outcomes with women adhering to surveillance. Additionally, surgical complications and regrets were assessed. Methods: Patients were recruited from multiple clinical departments across Denmark and stratified into surgery or surveillance groups. Patient-reported outcomes were measured using validated questionnaires, including the BREAST-Q, at baseline and 3, 12, and 24 months post-surgery or post-baseline. Results: A total of 35 and 37 patients were included in the surgery and surveillance groups, respectively. Surgery significantly reduced concerns about developing breast cancer but also led to lower physical well-being. Significant between-group differences were found at all post-baseline time points for these outcomes. Surgically and conservatively treated complications occurred in 14% and 23% of patients, respectively. No patients regretted the surgery. Conclusions: Risk-reducing mastectomy with immediate reconstruction effectively reduces breast cancer concerns in high-risk women in the short and long term but at the cost of reduced physical well-being and potential complications. These findings are essential for aligning preoperative expectations.