Women’s experience of decision-making regarding prophylactic mastectomy

Literature review: A systematic review of the existing literature was conducted, eliciting ten studies which met the inclusion criteria examining psychosocial predictors of prophylactic mastectomy in women with a confirmed BRCA gene alteration. Narrative synthesis identified that results coalesced around temporal, familial and other factors including conceptualisation of cancer and perceived risk. The relative scarcity of published research, and an accompanying dominant biomedical focus, highlight that further exploration of psychosocially predictive factors, particularly those which are modifiable, is needed. Research report: Interpretative Phenomenological Analysis (IPA) was utilised to explore five women’s experience and sense-making of their decision to opt for prophylactic mastectomy, and how they experienced the period between opting for preventative surgery and waiting for this to occur. Four superordinate themes were identified: ‘It’s a no-brainer’ illuminated how women approached and made sense of their decision; ‘good breast/bad breast’ reflected women’s experience of simultaneously holding conflicting views towards their breasts; ‘big B on my shoulder’ highlighted worry held in relation to geneticised identity; and ‘the preciousness of life’ illustrated the impact of familial and existential experience. Findings emphasised the importance of clinicians remaining mindful to experiential, emotional and systemic motivations for surgery and to recognise and support women with the potential tension they may still hold as they debate and navigate prophylactic mastectomy. Critical appraisal: A reflective account is presented to support the consolidation of personal and professional learning points and reflections made during the research process.