Understanding The Experience and Psychosocial Impact of Bilateral Risk-Reducing Mastectomies on People at Moderate Risk of Breast Cancer

A bilateral risk-reducing mastectomy (BRRM) is a surgery removing the breast tissue from both breasts. It can reduce the risk of developing breast cancer by up to 94% in women at high risk (Marcinkute et al., 2021). Although people at moderate risk are not routinely offered a BRRM (NICE [CG164], 2023), many do seek, request, and receive this surgery. Research thus far has focused on the impact of BRRMs on those at high risk and has found a range of positive and negative psychosocial outcomes. It is unknown what the psychosocial impact of a BRRM is for people at moderate risk: this thesis aimed to fill this gap.

Using the principles of interpretative phenomenological analysis (IPA), this thesis interviewed three people at moderate risk of breast cancer who elected to have a BRRM, to understand the experience and psychosocial impact of this procedure. Five group themes were identified; breast cancer worry and post-surgery relief; effect of and adjustment to a post-BRRM body; the importance of feeling prepared; insufficient support and inconsistent services; the role of peer support.

The findings suggest that the psychosocial impact of a BRRM for people at moderate risk has many similarities to those at high risk, including reduced BC worry, and a period of adjusting to a changed body. The importance of preoperative counselling to help those pursuing a BRRM to make an informed decision and maintain realistic outcome expectations, was highlighted. The value of peer support in preparing for the long-term impact was also identified. This study therefore reiterates the importance of NICE guidance being routinely followed, such that all people pursuing a BRRM are offered preoperative counselling and have access to peer support.