Previous studies regarding body image after bilateral prophylactic mastectomy with breast reconstruction have reported a risk of reduced satisfaction with body image and adverse effects on sexual life. The aim of this retrospective study was to find areas for future surgical improvements to optimize patient satisfaction with the aesthetic result after bilateral prophylactic mastectomy and immediate breast reconstruction with implants. Nipple-areola complexes were reconstructed. Twenty-four consecutive and standardized operated women were included. The follow-up time was an average of 5.4 (range: 2.4-10.2) years. The outcome in terms of breast symmetry, size, and firmness were measured with objective and subjective methods, and results were compared to those from a control group of 24 women. Patient satisfaction was evaluated with a questionnaire. Main findings were that the overall aesthetic result was regarded as good in both objective and subjective evaluations and that breast symmetry in patients was as common as in the control group, but reconstructed breasts were firmer. Twenty of 24 patients thought that the aesthetic result exceeded their expectations, and 22/24 would recommend this kind of breast reconstruction to another woman. In contrast with the predictions of plastic surgeons, patients were most dissatisfied with the nipple-areola reconstruction. Conclusions: The overall aesthetic result after bilateral prophylactic mastectomy and immediate breast reconstruction with implants was good and symmetrical. Patient satisfaction with nipple-areola reconstruction was only moderate. The results emphasize the importance of a preoperative discussion with the patient regarding whether to keep or reconstruct the nipple-areola complex while planning a prophylactic mastectomy. © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
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