Background: For women at elevated risk of breast cancer, prophylactic mastectomy involves a complex surgical decision-making as well as substantial psychological and behavioural demands. Cancer-related worry, distress associated with perceived risk, anxiety about surgery and complications, and uncertainty about recovery may impact coping, help-seeking and engagement in health behaviours before and after surgery. However, pre-operative care appears to emphasise surgical and biomedical outcomes, with limited integration of psycho-oncological perspectives.
Aims: To review strategies and interventions aimed at optimising outcomes in risk-reducing breast surgery and assess the extent to which behavioural and psychological experience and support are incorporated.
Methods: A systematic review or reviews using PubMed was used to identify relevant meta-analyses and reviews between 2020-2026. Inclusion criteria involved English-language human studies with full-text availability. Following synthesisation of relevant studies, a preliminary search found 16 systematic reviews and meta-analyses. Included reviews examined interventions and outcomes relating to lymphoedema management, breast reconstruction techniques, infection preventions and cancer recurrence. Evidence relating to patient-reported outcomes, symptom burden, treatment satisfaction and long-term safety were also reviewed.
Results: Preliminary findings indicate that the evidence is weighed toward surgical, rehabilitative and biomedical outcomes. Benefits for lymph node transfer, innovative therapies (e.g., stem cell), compression therapy and acupuncture for post-surgical symptom management and some reconstruction techniques were associated with improved pain and satisfaction outcomes. However, psychosocial and behavioural interventions were rarely addressed for pre- and post-surgery. Limited attention was given to cancer-related distress, anxiety around surgery and complications, emotional preparedness and coping, or the impact of risk perception on treatment engagement and recovery behaviours.
Conclusions: Prophylactic mastectomy care may benefit from greater inclusion of psycho-oncological components. Pre-operative psychological and behavioural interventions may aid in addressing distress, support coping and decision-making, and promote behaviours that optimise recovery and longer-term wellbeing.