The odds of developing emotional and physical problems after treatment are increased in women receiving a mastectomy for breast cancer vs procedures that preserve breast tissue, such as a lumpectomy, according to data presented at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago, Illinois, from October 4 to October 7, 2025.1
Worse sexual health, body image, and other physical and emotional symptoms were reported in women undergoing mastectomy. According to the study authors, this highlights a need to screen women before they receive a mastectomy.
Key takeaways:
- Women undergoing mastectomy report worse body image, sexual health, and emotional outcomes than those receiving breast-conserving surgery.
- Fifteen of 20 studies showed poorer psychosocial outcomes after mastectomy, highlighting consistent quality-of-life concerns.
- No standardized approach currently exists for evaluating post-surgical quality of life in breast cancer patients.
- Researchers call for a validated screening tool to better assess and support women before undergoing mastectomy.
- Lifestyle strategies—including a plant-based diet, regular exercise, limited alcohol use, and healthy weight maintenance—may reduce breast cancer risk and improve long-term well-being.
“As surgeons, we often focus on the medical side of care. There is no universal or standardized approach to counseling women on the full range of physical and emotional outcomes after mastectomy,” said Lauren Raymond-King, MD, lead author and surgical resident at Yale School of Medicine.
Quality-of-life differences reported
There were 20 studies included in the analysis that included women with stages 1 through 3 of breast cancer. These trials evaluated the changes in quality of life, sexual health, and physiological well-being in women following mastectomy. Exclusion criteria included participants with stage 4 breast cancer or who elected for a prophylactic mastectomy.
Worse psychosocial outcomes in at least 1 domain were reported for patients undergoing mastectomy in 15 of the 20 studies. Additionally, no standardized approach to evaluating post-surgical quality of life was identified.
Of trials:
- 55% assessed body image
- 50% assessed sexual health or sexual function in 50%,
- 45% assessed pain or physical function
- 40% assessed quality of life.
Significantly less assessment was reported for psychosocial health and satisfaction, with rates of 35% and 25%, respectively.
Need for standardized screening
Based on this data, investigators highlighted a need for a standardized approach. Seventy-two percent of patient-reported outcome measures (PROMs) were only used once, with psychological outcomes assessed using 1 to 8 PROMs across studies. This highlighted a wide variation, underscoring the need for a validated screening tool before mastectomy.
A mastectomy is performed in over 25% of breast cancer patients, many of whom are hospitalized for shorter periods after surgery. However, the procedure requires long-term follow-up care, highlighting the risks of adverse psychosocial health outcomes.
“Now that there are so many more survivors of breast cancer, we can’t miss the opportunity to study quality of life outcomes for our patients since they are living so much longer after their diagnosis and treatment,” said Elizabeth Berger, MD, MS, FACS, senior author and assistant professor of surgery at Yale School of Medicine.
Lifestyle and prevention strategies
Breast cancer prevention strategies may also be considered to improve patient health.2 In a video interview with Contemporary OB/GYN, Neal Barnard, MD, FACC, president of the Physicians Committee for Responsible Medicine, discussed potential strategies to protect patients.
The discussion centered on a policy from the American Medical Association (AMA) with 4 primary strategies of reducing breast cancer risk. These included adopting a plant-based diet, engaging in regular physical activity, minimizing or avoiding alcohol, and maintaining a healthy body weight.
According to Barnard, the first and fourth strategies can be accomplished simultaneously, as plant-based diets often support weight control. Additionally, these changes in lifestyle can improve outcomes after diagnosis, increasing patients’ sense of control over their health.
“I’m hoping that when people put this to work, that families will have more power, less fear— that families will stay together longer,” said Barnard.
References
- Mastectomy linked to worsened sexual health, body image after surgery. American College of Surgeons. October 3, 2025. Accessed October 10, 2025. https://www.eurekalert.org/news-releases/1100518.
- Barnard N. Neal Barnard, MD, FACC, highlights AMA's new breast cancer prevention guidelines. Contemporary OB/GYN. June 23, 2025. Accessed October 10, 2025. https://www.contemporaryobgyn.net/view/neal-barnard-md-facc-highlights-ama-s-new-breast-cancer-prevention-guidelines.
