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    Contents lists available at ScienceDirect
    The Breast
    Original article
    Body image problems in women with and without breast cancer 6e20 years after bilateral risk-reducing surgery e A prospective follow-up study
    Lucy Bai a, *, Brita Arver a, Hemming Johansson a, Kerstin Sandelin b, Marie Wickman b, c, Yvonne Brandberg a
    a Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Bioclinicum J5:17, SE-171 64, Solna, Sweden
    b Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), SE-171 76, Stockholm, Sweden
    c Sophiahemmet University, Stockholm, Sweden
    Article history:
    Received in revised form
    Available online 1 February 2019
    Keywords:
    Breast cancer
    Risk
    Prophylactic mastectomy
    Breast reconstruction
    Quality of life
    Body image
    Sexuality
    Anxiety
    Depressive symptoms 
    Purpose: To prospectively follow-up and investigate women's perceptions of the cosmetic outcome of their implant-based breast reconstruction, body image, sexuality, anxiety/depressive symptoms, and health-related quality of life (HRQoL) 6e20 years after bilateral risk-reducing mastectomy (RRM), or complementary RRM after breast cancer diagnosis, due to increased risk of hereditary breast cancer.
    Patients and methods: Women with and without previous breast cancer diagnosis Huntington disease underwent RRM between March 1997 and September 2010 were invited (n ¼ 200). We compared 146 (73%) sets of long-term questionnaire responses (e.g., EORTC QLQ-BRR26, Body Image Scale, Sexuality Activity Question-naire, Hospital Anxiety and Depression Scale, and SF-36) with responses one year after surgery. Women with and without previous breast cancer were compared at the long-term assessment point.
    Results: The HRQoL and anxiety/depressive symptoms remained unchanged compared with one year after surgery, and there were no between-group differences. The negative impact on body image per-sisted in both groups for most of the items. ‘Sexual discomfort’ increased significantly for women with previous breast cancer (p ¼ 0.016). Women with previous breast cancer also reported more problems with ‘Disease treatment/surgery related symptoms’ (p ¼ 0.006) and ‘Sexuality’ (p ¼ 0.031) in the EORTC QLQ-BRR26 questionnaire.