Table 4.

Summary of patient-reported outcomes from included studies (n = 7)

PROM	Author	Effect of contralateral symmetrizing mastectomy on patient-reported outcomes	Conclusion
	Measurement tool
Satisfaction with decision (SWD)	Baker 202032	% satisfied with results Odds ratios for factors associated with satisfaction < 3/5 on Likert scale (lower OR = higher satisfaction):  Low surgeon support for decision/flat denial (OR 3.85, p < 0.001)  BMI > 30 (OR 2.74, p < 0.001)  UM (OR 1.99, p < 0.002).  First choice of surgery is CSM (OR 0.63, p = 0.049)  Surgeon with exclusive breast practice (OR 0.56, p < 0.002)  Adequate information given for surgical options (OR 0.48, p < 0.0001)	Women are satisfied with CSM Good overall satisfaction for all breast surgery Surgeon factors and complications with reconstruction influence satisfaction Trend toward higher satisfaction with reconstruction in Huang’s study but no difference in Deliere’s Patients should be encouraged to speak to others about their experiences to help with decision-making
	Likert scale questionnaire (3-item)
	Deliere 202118	% of participants with high decision regret (top quartile on decision regret scale): BM: 10% BM + R, no surgical complications: 9% BM + R with surgical complication: 28% (p < 0.0001 for difference between BM procedures on chi-square test) UM: 27.5% UM + R, no surgical complications: 23% UM + R with surgical complication: 38.6% (p = 0.0006 for difference between UM procedures on chi-square test)
	Decision Regret Scalea (5-item)
	Huang 202020	Mean SWD for BM ± reconstruction (whole cohort) was 4.85/5 Factors associated with higher SWD:  Use of other cancer patients’ experiences to help decision-making (95.2% SWD vs. 61.8% without using others’ experiences, OR 9.4, p = 0.049).  Autologous reconstruction versus no reconstruction (OR 5.83)  Implant reconstruction versus no reconstruction (OR 4.01) (p = 0.306 for difference between BM, BM + autologous reconstruction and BM + implant reconstruction)
	Satisfaction with Decision scalea (6-item)
Body image	Huang 201822	No difference between groups, reconstruction not associated with better body image.	Mixed results, vary by questionnaire used Questionnaires may not be best placed to explore complex topic of body image after CSM
	BIBCQa
	Rosenberg 202028	BM without reconstruction had highest% of participants with “a fair amount” of issues (responses of at least “a fair amount” on CARES scale) for each subscale item. Groups compared: BM, BM + R, UM, UM + R, breast-conserving surgery. (p < 0.002 for differences between groups on chi-square test)
	CARESa
	Hwang 201623	CSM versus UM (without reconstruction): no difference BREAST-Q scores (out of 100, higher score means better outcome): BM: 54, UM: 54.7, BM + R:62, UM + R: 59.9 On multivariate analysis, BM (± reconstruction) and reconstruction were independently associated with better scores.
	“Satisfaction With Breasts” scale of BREAST-Qa
	Lim 202124	Multivariate analysis: immediate reconstruction conferred score increase of 7.15 (p = 0.002) UM±R (vs BM±R) conferred score increase of 8.04 (p = 0.008)
	“Satisfaction With Breasts” scale of BREAST-Qa
QoL	Huang 201822	No difference between groups, reconstruction not associated with better QoL.	QoL not different between surgical groups
	FACT-Ba
	Hwang 201623	CSM versus UM (without reconstruction): no difference. BREAST-Q scores (out of 100, higher score means better outcome): BM: 69.1, UM: 69.3, BM + R: 71.7, UM + R: 73.9 On multivariate analysis, BM (± reconstruction) and reconstruction were independently associated with better scores.
	“Psychosocial Well-Being” scale of BREAST-Qa
	Lim 202124	Multivariate analysis: immediate reconstruction conferred score increase of 6.60 (p = 0.007) UM±R (vs. BM±R) conferred score increase of 3.24 (p = 0.21)
	“Psychosocial Well-Being” scale of BREAST-Qa
Sexuality	Hwang 201623	CSM versus UM (without reconstruction): no difference. BREAST-Q scores (out of 100, higher score means better outcome): BM: 39.9, UM: 42.7, BM + R: 48.6, UM + R: 50 On multivariate analysis, reconstruction was independently associated with better scores.	Mixed results Some evidence for negative impact compared with other surgical groups
	“Sexual Well-Being” scale of BREAST-Qa
	Lim 202124	Multivariate analysis: immediate reconstruction conferred score increase of 18.98 (p = 0.0001) UM±R (vs. BM±R) conferred score increase of 0.57 (p = 0.80)
	“Sexual Well-Being” scale of BREAST-Qa
	Rosenberg 202028	BM without reconstruction had highest % of participants with “a fair amount” of issues (responses of at least “a fair amount” on CARES-SF scale) for each subscale item. Groups compared: BM, BM + R, UM, UM + R, breast-conserving surgery. (p < 0.001 – 0.36 for differences between groups on chi-square test)
	CARES-SFa
Physical	Hwang 201623	CSM versus UM (without reconstruction): no significant difference in BREAST-Q scores. BREAST-Q scores (out of 100, higher score means better outcome): BM: 75, UM: 76.2, BM + R: 74.5, UM + R: 76.8	No evidence for difference between surgical groups
	“Physical Well-Being” scale of BREAST-Qa
	Lim 202124	Multivariate analysis: immediate reconstruction conferred score increase of 4.07 (p = 0.027) UM±R (vs. BM±R) conferred score decrease of 1.33 (p = 0.44)
	“Physical Well-Being” scale of BREAST-Qa
Flat denial (quantitative part of study)	Baker 202032	20.7% felt surgeon did not support their decision to go flat. 22.2% experienced a high level of flat denial (scoring <3/5 points on Likert scale) Two significant factors were associated with flat denial (<3/5 on Likert scale) (lower OR = lower flat denial):  Female surgeon (OR 0.59, p = 0.001)  Surgeon with exclusive breast practice (OR 0.48, p < 0.0001)	Many women experienced clinicians who do not support choice of CSM. Female clinicians and those with exclusive breast practice less likely to exhibit flat denial
	3-item (Likert scale) questionnaire

PROM patient-reported outcome measure, SWD satisfaction with decision, CSM contralateral symmetrising mastectomy, OR odds ratio, BMI body mass index, UM unilateral mastectomy, BM bilateral mastectomy, BM + R bilateral mastectomy with reconstruction, UM + R unilateral mastectomy with reconstruction, BIBCQ Body Image After Breast Cancer Questionnaire, CARES Cancer Rehabilitation Evaluation System, QoL quality of life, FACT-B Functional Assessment of Cancer Therapy–Breast, CARES-SF Cancer Rehabilitation Evaluation System–Short Form

Validated tool

^aStatistics are given after multivariate analysis where available