Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-2026004826-en
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Mastectomia redutora de risco com reconstrução imediata: estudo exploratório do bem-estar psicossocial e sexual por meio do BREAST-Q™

Risk-reducing mastectomy with immediate reconstruction: an exploratory study of psychosocial and sexual well-being using the BREAST-QTM

Isabela Chaves Monteiro Soares; Enilze Maria de Souza Fonseca Ribeiro; Guilherme Batalha; Michelli Esteves de Souza; Flávia Kuroda Yamanishi; Iris Rabinovic

http://dx.doi.org/10.1590/0100-6991e-2026004826-en RCBC, vol.53, e2026004826, 2026
PDF Português
PDF English
SciELO
Downloads: 0
Views: 10

Resumo

Introdução: A mastectomia redutora de risco reduz significativamente a incidência de câncer de mama em mulheres com predisposição genética. Entretanto, seus impactos sobre o bem-estar psicossocial e sexual ainda são pouco explorados, especialmente em pacientes sem diagnóstico prévio da doença.

Objetivo: Avaliar o bem-estar psicossocial e sexual de mulheres submetidas à mastectomia redutora de risco com reconstrução imediata.

Métodos: Estudo observacional, transversal, com coleta retrospectiva de dados clínicos, realizado em centro especializado. Foram incluídas mulheres >18 anos, sem histórico de câncer de mama, submetidas à mastectomia bilateral redutora de risco com reconstrução imediata com implantes, entre 2018 e 2023. Os domínios de bem-estar psicossocial e sexual foram avaliados por meio do BREAST-Q™, com escores padronizados de 0 a 100. Foram realizadas análises descritivas, correlação de Spearman e testes não paramétricos, adotando-se P < 0,05.

Resultados: Foram incluídas 28 pacientes, com média de idade de 41,8 + 9,6 anos na cirurgia e 45,5 + 9,4 anos na avaliação. Os escores médios foram de 68,5 + 20,4 para bem-estar psicossocial e 55,4 + 17,8 para bem-estar sexual. Observou-se forte correlação entre os domínios (ρ = 0,81; p < 0,001). Complicações pós-operatórias precoces e necessidade de reoperações associaram-se a piores escores em ambos os domínios. Maior escolaridade associou-se a melhores escores de bem-estar sexual. As demais variáveis não apresentaram associação significativa.

Conclusão: A mastectomia redutora de risco com reconstrução imediata está associada a desfechos psicossociais e sexuais variáveis, influenciados principalmente por complicações pós-operatórias e reoperações. Esses achados reforçam a importância de incorporar a avaliação de qualidade de vida no aconselhamento e no seguimento dessas pacientes.

Palavras-chave

Breast Implants; Patient Reported Outcome Measures; Prophylactic Mastectomy; Quality of Life; Sexuality; Síndrome Hereditária de Câncer de Mama e Ovário

Abstract

Introduction: Risk-reducing mastectomy significantly decreases the incidence of breast cancer in women with a genetic predisposition. However, its effects on psychosocial and sexual well-being remain insufficiently explored, particularly among women without a previous diagnosis of breast cancer.

Objective: To evaluate the psychosocial and sexual well-being of women undergoing risk-reducing mastectomy with immediate breast reconstruction.

Methods: This observational, cross-sectional study involved the retrospective collection of clinical data and was conducted at a specialized center. Women aged >18 years, with no history of breast cancer, who underwent bilateral risk-reducing mastectomy with immediate implant-based reconstruction between 2018 and 2023 were included. Psychosocial and sexual well-being domains were assessed using the BREAST-Q™, with standardized scores ranging from 0 to 100. Descriptive analyses, Spearman’s correlation, and nonparametric tests were performed, adopting a significance level of P < 0.05.

Results: Twenty-eight patients were included. The mean age was 41.8 ± 9.6 years at the time of surgery and 45.5 ± 9.4 years at the time of assessment. Mean scores were 68.5 ± 20.4 for psychosocial well-being and 55.4 ± 17.8 for sexual well-being. A strong correlation was observed between the two domains (ρ = 0.81; p < 0.001). Early postoperative complications and the need for reoperations were associated with lower scores in both domains. Higher educational attainment was associated with better sexual well-being scores. No significant associations were found for the remaining variables.

Conclusion: Risk-reducing mastectomy with immediate reconstruction is associated with variable psychosocial and sexual outcomes, primarily influenced by postoperative complications and reoperations. These findings highlight the importance of incorporating quality-of-life assessment into the counseling and follow-up of these patients.

Keywords

Breast Implants; Hereditary Breast and Ovarian Cancer Syndrome; Patient-Reported Outcome Measures; Prophylactic Mastectomy; Quality of Life; Sexuality

Referências

1 Kim J, Harper A, McCormack V, Sung H, Houssami N, Morgan E, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat Med. 2025 Apr 24;31(4):1154-62. DOI: 10.1038/s41591-025-03502-3.

2 Fernando J, Oliveira P, Borges L, Souza L De, Chagas P, Vasconcelos GM De, et al. Perfil Epidemiológico da Incidência de Câncer no Brasil e Regiões : Estimativas para o Triênio 2026-2028. 2026;72(2):1-12. DOI: 10.32635/2176-9745.rbc.2026v72n2.5587.

3 NCCN. Breast Cancer Risk Reduction The University of Texas. Natl Compr Cancer Netw Clin Parctise Guidel Oncol. 2025;1-59.

4 Urban LABD, Chala LF, Paula IB de, Bauab S di P, Schaefer MB, Oliveira ALK, et al. Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Radiol Bras. 2023;56(4):207-14. DOI: 10.1590/0100-3984.2023.0064.

5 Comeaux JG, Culver JO, Lee JE, Dondanville D, McArthur HL, Quinn E, et al. Risk-reducing mastectomy decisions among women with mutations in high- and moderate- penetrance breast cancer susceptibility genes. Mol Genet Genomic Med. 2022;10(10):1-11. DOI: 10.1002/mgg3.2031.

6 Karlan BY. Genetic / Familial High-Risk Assessment : Breast , Ovarian , Pancreatic , and Prostate. 2026;

7 Pikler V, Winterowd C. Racial and body image differences in coping for women diagnosed with breast cancer. Heal Psychol Off J Div Heal Psychol Am Psychol Assoc. 2003 Nov;22(6):632-7. DOI: 10.1037/0278-6133.22.6.632.

8 Faria BM, Rodrigues IM, Marquez L V, Pires UDS, de Oliveira S V. The impact of mastectomy on body image and sexuality in women with breast cancer: A systematic review. Psicooncologia. 2021;18(1):91-115. DOI: 10.1007/s00520-021-06153-5.

9 Duarte TP, Andrade ÂN de. Enfrentando a mastectomia: análise dos relatos de mulheres mastectomizadas sobre questões ligadas à sexualidade. Estud Psicol. 2003;8(1):155-63. DOI: 10.1590/s1413-294x2003000100017.

10 Goldenberg M. Gênero e corpo na cultura brasileira. Psicol Clínica. 2005;17(2):65-80. DOI: 10.1590/s0103-56652005000200006.

11 Rocco N, Montagna G, Criscitiello C, Nava MB, Privitera F, Taher W, et al. Nipple sparing mastectomy as a risk-reducing procedure for brca-mutated patients. Vol. 12, Genes. MDPI AG; 2021. p. 1-7. DOI: 10.3390/genes12020253.

12 Winters ZE, Benson JR, Pusic AL. A systematic review of the clinical evidence to guide treatment recommendations in breast reconstruction based on patient-reported outcome measures and health-related quality of life. Ann Surg. 2010;252(6):929-42. DOI: 10.1097/SLA.0b013e3181e623db.

13 Pusic, Andrea L.; Klassen, Anne F.; Cano SJ. The BREAST-Q(r) Version 2.0: Mastectomy Module - Portuguese (Brazil) Translation. 2017;1-32.

14 Geiger AM, Nekhlyudov L, Herrinton LJ, Rolnick SJ, Greene SM, West CN, et al. Quality of life after bilateral prophylactic mastectomy. Ann Surg Oncol. 2007 Feb;14(2):686-94.

15 Gahm J, Wickman M, Brandberg Y. Bilateral prophylactic mastectomy in women with inherited risk of breast cancer - Prevalence of pain and discomfort, impact on sexuality, quality of life and feelings of regret two years after surgery. Breast [Internet]. 2010;19(6):462-9. Available from: https://www.embase.com/search/s?subaction=viewrecord&id=L50936763&from=export DOI: 10.1016/j.breast.2010.05.003.

16 Metcalfe KA, Narod SA. Breast Cancer Risk Perception Among Women Who Have Undergone Prophylactic Bilateral Mastectomy. JNCI J Natl Cancer Inst [Internet]. 2002 Oct 16;94(20):1564-9. Available from: https://doi.org/10.1093/jnci/94.20.1564 DOI: 10.1093/jnci/94.20.1564.

17 Srinivasa DR, Clemens MW, Qi J, Hamill JB, Kim HM, Pusic AL, et al. Obesity and Breast Reconstruction: Complications and Patient-Reported Outcomes in a Multicenter, Prospective Study. Plast Reconstr Surg. 2020;145(3):481E-490E. DOI: 10.1097/PRS.0000000000006543.

18 Cai L, Momeni A. The Impact of Reconstructive Modality and Postoperative Complications on Decision Regret and Patient-Reported Outcomes following Breast Reconstruction. Aesthetic Plast Surg. 2022 Apr 29;46(2):655-60. DOI: 10.1007/s00266-021-02660-2.

19 Harvey KL, Johnson L, Sinai P, Mills N, White P, Holcombe C, et al. Patient-reported outcomes 3 and 18 months after mastectomy and immediate prepectoral implant-based breast reconstruction in the UK Pre-BRA prospective multicentre cohort study. Br J Surg [Internet]. 2025;112(2):1-9. DOI: 10.1093/bjs/znaf032.

20 Raman S, Powell LE, Andersen ES, Lauren ;, Nigro C. One Size Does Not Fit All; Patient Preference for Breast Reconstruction. 2022.
 

Submetido em:
27/04/2026

Aceito em:
06/07/2026

6ab170bfa9539517d379d542 rcbc Articles
1809-4546 (Eletrônico) 0100-6991 (Impresso)
RCBC ©2026 Todos os direitos reservados sobre o conteúdo deste website. Os artigos seguem suas próprias licenças.

RCBC

Share this page
Page Sections