Breast cancer is an incredibly fraught experience for patients. Even beyond the diagnosis and treatment, the experience can create emotional issues that linger long after remission. Patients can have issues related to body image that can dramatically affect their self-esteem and sexuality as they work to regain a sense of normality in their daily lives.
Can the specific type of surgery patients with breast cancer undergo have an effect on these issues of self image? A new study in JAMA Surgery suggests that it is quite possible.
Sexuality and Body Image
Researchers have studied how breast cancer treatment can affect the body image of women who have undergone mastectomy. A 2016 study in Journal of Breast Health found that many of the patients who participated used negative statements to describe their appearance after their mastectomy.¹ What researchers found was that often, these women believed the breast to be an integral part of both femininity and beauty. Their body images were altered considerably; some women said it affected the clothing they bought, while others said they felt relations with their husbands had been affected. Many said it even caused them to avoid social interactions.
The JAMA Surgery study, published in September 2020, focused on women who were diagnosed with stage 0 to 3 unilateral breast cancer at age 40 or younger between 2006 and 2016.² A total of 826 women participated in the study; 31% underwent breast-conserving surgery (BCS), 24% underwent unilateral mastectomy (UM), and 45% underwent bilateral mastectomy (BM). Reconstruction surgery was performed in 84% of patients who underwent either unilateral or bilateral mastectomy.
The researchers followed up with patients after their procedure about physical functioning, body image, sexuality, and symptoms of depression and anxiety. Patients completed both quality of life and psychosocial assessments, and although patients who underwent bilateral or unilateral mastectomies did report fewer issues of body image from year 1 to year 5, they still reported significantly more body image issues than those who underwent breast-conserving surgery. The same was true in terms of sexuality and issues of anxiety, though they did not find significant differences between groups for depression levels.
Consistently for all 3 groups, the investigators reported improved quality of life over time. But the correlation between a greater number of body image issues and more extensive breast cancer surgery stayed consistent as well; patients who underwent bilateral mastectomy reported worse body image issues in year 5 than the breast-conserving surgery patients did in year 1. Although all 3 groups reported having myriad emotional issues, the study comes to the conclusion that patients undergoing more extensive surgery are at greater risk for worse anxiety, sexual health, and body image.
What Should You Tell Your Patients?
Patients with breast cancer patients receiving all forms of treatment should be warned of the emotional toll that treatment could take. However, if your patient is undergoing unilateral or bilateral mastectomy, you should let them know that they could be at increased risk for body image issues, anxiety, and other issues pertaining to psychosocial health.
Part of the experience of being a resource for your patients is to make sure they know that even with improved quality of life over time, they may still endure body image problems and that it is not uncommon. They have experienced significant trauma, and the emotional impact can linger for longer than they may anticipate. Keeping them prepared for this, recommending therapies to help, and being a supportive ally at this time is essential.