Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: Analysis of 60 consecutive cases in a specialist breast unit

INTRODUCTION: Although controversial, use of contralateral risk-reducing mastectomy (CRRM) is increasing. It is not clear whether reduction of objective breast cancer risk or other factors determine decisions for CRRM. We aimed to identify factors that influence these decisions by scrutinising how decisions were made in one centre. METHODS: We reviewed a consecutive series of 60 patients considered for CRRM in one centre. Data sources, analysed using qualitative methods, were records of routine psychological assessment, surgeon letters, case-notes and interviews with four surgeons. RESULTS: Perceptions of objective risk did not generally drive patients' requests or surgeons' decisions. Instead, CRRM appeared to be mainly performed for psychological reasons: to reduce patients' cancer worry and to achieve cosmetic benefits. CONCLUSION: Routine use of the term 'risk-reducing' surgery masks a clinical decision which usually reflects influences other than risk. As CRRM is often carried out for psychological reasons it follows that evidence about its psychosocial outcomes is needed.