Background: Increasing numbers of women are choosing contralateral prophylactic mastectomy (CPM) despite the lack of knowledge about its effect on long-term psychosocial adjustment. The objective of the study was to examine patient-centered psychosocial outcomes of women with breast cancer who have CPM versus those who do not in order to enhance shared surgical decision making. Methods: We enrolled 308 women with newly diagnosed, non-hereditary breast cancer prior to surgery (CPM or no CPM) at MD Anderson Cancer Center and Kelsey-Seybold Clinic between 2012 and 2015. Women completed validated questionnaires assessing psychosocial factors including quality of life (QOL), body image concerns, cancer distress, trust in physician and decision satisfaction pre-surgery and at 1, 6 and 12-months post-surgery. Repeated measures models were fitted to assess the association between psychosocial outcomes measured at each time point and CPM status adjusting for time effect. Results: Among 252 women (mean age 56) who completed pre and post-surgery questionnaires, 60% were non-Hispanic white, 16% non-Hispanic black, 16% Hispanic, 8% mixed race and 17% had CPM. Women who had CPM had higher scores for cancer distress and body image concerns and lower scores for QOL than women who did not have CPM at pre-surgery (p = 0.04, p < 0.01, p = 0.20, respectively), and at 1 month (p = 0.42, p < 0.001, p < 0.01, respectively), 6 months (p = 0.03, p < 0.001, p = 0.05, respectively) and 12 months (p = 0.01, p < 0.001, p = 0.01, respectively) post-surgery. After adjusting for time effect, women who had CPM had higher post-surgery scores for cancer distress (p = 0.03), body image concerns (p < 0.0001), QOL (p < 0.01) and lower trust in physician (p = 0.03) than women who did not have CPM. There was no statistically significant difference by CPM status for cancer knowledge or decision satisfaction. Conclusions: This is the first study to demonstrate that psychosocial factors such as cancer distress, QOL and body image concerns are not improved by having CPM. The results highlight the importance of evaluating psychosocial factors pre- and post- surgery and the need to incorporate psychosocial assessment and counseling in the CPM decision making process.