This leaflet is for patients who have been referred to the psychology team within the department of plastic surgery. You have been referred because you are considering having risk-reducing breast surgery to remove one or both breasts, known as a mastectomy.

You may also be considering having breast reconstruction after your risk-reducing breast surgery.

This leaflet answers common questions about what will happen when you meet with the psychologist. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor.

What is risk-reducing mastectomy?

Risk-reducing breast surgery involves removing healthy breast tissue from one (unilateral) or both (bilateral) breasts and is known as risk-reducing mastectomy. Risk-reducing mastectomy is recommended to women who are at a high risk of developing breast cancer.

This may be because they have inherited a particular gene (for example, BRCA1 or BRCA2) or because there is a significant history of breast cancer in their family. You may or may not have experience of having breast cancer yourself.

Why have I been referred to a psychologist?

You have been referred to a psychologist as part of our care for women who are considering a risk-reducing mastectomy. Our team of psychologists is specialised in supporting patients with physical health conditions and those who have surgery which results in changes to their appearance.

Women often find it helpful to talk through the various options that may be available to them. This includes discussing their thoughts, feelings, motivations, and expectations about the procedure as well as the choice to not have risk-reducing surgery.

Research suggests that women who have the chance to talk through their expectations are less likely to regret the decision they make and are more likely to adjust (physically and psychologically) after the surgery, if they choose to have this procedure.

It is also an opportunity to talk through all the reasons for having, or not having, surgery with somebody who is impartial. This can be helpful if you occasionally find it difficult to talk to your partner, family, or friends, who may have their own worries or opinions.

You will also get a chance to talk about your expectations for how things might be after the surgery should you opt for this. This can help you feel prepared for any changes that the surgery brings and help you to adjust.

It is important to note that the psychologist does not make the decision for you about whether you should have surgery, they are there to listen and help you talk through the options.

What if I am considering breast reconstruction after my risk reducing mastectomy?

You may also be considering breast reconstruction if you choose to have risk reducing surgery. You may have received a lot of information about breast reconstruction surgery.

For example, your surgeon may have spoken to you about the timing of reconstructive surgery or the type(s) of reconstruction you could have. There will also be the opportunity to discuss your thoughts and feelings on this at your appointment.

Things to know when deciding to have risk-reducing mastectomy:

  1. mastectomy permanently removes breast tissue, and it cannot be reversed.
  2. mastectomy will not eliminate all risk of breast cancer, though it reduces your risk significantly.
  3. There is a chance of risk or side effects from your surgery, your surgical team will explain these to you.
  4. will be a recovery period following surgery.
  5. women experience negative feelings following surgery related to the loss of their breasts and their changed appearance.

What will happen at my psychology appointment?

You will meet with the psychologist for an hour usually. During your appointment, the psychologist will take notes. These are part of your medical record. If there is any information you do not wish to have on your medical record, then you will need to let the psychologist know.

Unfortunately, there may be times where the psychologist may still need to record this information and the psychologist will clearly explain the reasons for this.

The psychologist will ask you about your understanding of the risk of developing breast cancer, your personal experience and the impact of cancer within your family (if applicable). They are also interested to hear about any doubts about or reasons for your preferred choice, whether this is ongoing monitoring or having surgery.

The psychologist will also find out what you understand about the surgery and its risks. They will help you think about your recovery and adjusting to changes in your body following surgery, including the common emotional reactions that women can experience and how you might feel about your body.

You are welcome to bring your partner, a family member or a friend to the consultation. Bringing your partner can be particularly helpful when you are concerned about the impact of surgery on your relationship.

The appointment is an opportunity for you to share your feelings and concerns. The psychologist can help you feel confident that you have considered all the information and that you have come to the best decision for you.

What happens after my appointment?

Where you have further questions or concerns, the psychologist can arrange for you to speak to the professional in the team who is best placed to help you. This might be the breast care nurse, the clinical nurse specialist, the breast surgeon or the plastic surgeon. You can also have a further appointment with the psychologist if needed, as well as one after the surgery if you feel this would be helpful.

We are able to support you should you have any difficulties in adapting to the change in your body. This can include how you feel about your body and what you feel able to or not able to do.

You may feel that this is not the right time for surgery and would prefer to wait. In this case, we are more than happy to see you again in the future about this decision. You can keep this leaflet safe for your own reference and you can access our psychology support at any time.

After your appointment, the psychologist will write to the professional that referred you to summarise the discussion, highlight any particular concerns that you may have, and provide some recommendations in terms of your follow-up care if appropriate. You will get a copy of this letter, as will your GP and any other professionals who are involved in your care.

If there are any reasons why you would prefer for certain information not to be copied to certain professionals, please speak to the psychologist about this at the appointment.