Anxiety and Depressive Symptomatology and Body Image After Risk-Reducing Mastectomy in Women with Increased Risk of Breast Cancer: A Longitudinal Study

Abstract

Introduction: Risk-reducing mastectomy (RRM) is an effective preventive strategy for women at high risk of developing breast cancer, particularly those with BRCA1/2 mutations or a strong family history. However, the psychological consequences of this procedure, including anxiety, depressive symptomatology, and body image concerns, remain insufficiently explored in the long term. Objective: To analyze the levels and differences in anxiety, depressive symptomatology, and body image in women at increased risk of breast cancer assessed before surgery, shortly after surgery, and at long-term follow-up following risk-reducing mastectomy. Method: Fifty-five women at increased risk of breast cancer due to BRCA1/2 mutations or significant family history participated in this longitudinal study. Some participants had a previous breast cancer diagnosis. Anxiety and depressive symptomatology were assessed using the Hospital Anxiety and Depression Scale (HADS), and body image was measured with the Body Image Scale (BIS). Assessments were conducted 15–30 days before surgery, 15–30 days after surgery, and at long-term followup (mean = 5.24 years post-surgery). Results: A significant main effect of time was observed for anxiety and depressive symptomatology, with higher levels reported at long-term follow-up. Body image scores also worsened significantly over time, particularly at follow-up. No significant time × group interaction effects were found, suggesting similar trajectories across groups. Conclusions: These findings suggest a potential worsening in anxiety, depressive symptomatology, and body image over time following risk-reducing mastectomy, highlighting the importance of long-term psychological monitoring.