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How Breast Cancer May Affect Body Image

Scars, Hair Loss, and Weight Gain Are Among the Challenges

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Updated December 05, 2008

(LifeWire) - Breasts have been a symbol of femininity and sexuality since civilization began, so it is not unusual for a breast cancer patient to feel that the disease has attacked her body image along with her breast tissue.

"Yes, I feel like people are staring, and it is hard to find clothes, and yes, I get frustrated a lot," one woman wrote on the National Breast Cancer Foundation Survivor online forum. "But ... I had to learn to love my body again."

Whether a cancer patient preserved her breasts, removed them or reconstructed them, learning to accept and even love a postdiagnosis body is a process. Be sure to include family, friends and especially partners in this aspect of cancer treatment, and never be afraid to talk about body image issues with a physician.

Breast Cancer and Body Image

Breast cancer does not just lead to mastectomy scars. Radiation can lead to redness and soreness on the affected area, and chemotherapy often causes hair loss and weight gain. Experiencing these types of body changes can be especially challenging for younger women, as research has shown that these women tend to be bothered more by these changes than women over 67.

It can be difficult to express the sense that one's body has betrayed her or that the loss of one or both breasts can feel like an end to being female. A woman dealing with the effects of breast cancer may begin to avoid intimacy, dress alone or in the dark or even limit bathing. These behaviors are common but should lessen and improve with time. If you or a loved one needs help coping with body image issues, talk to a physician, support group or trusted counselor.

Surgical Options and Body Image

Women can become self-conscious about their breasts simply because breast cancer impacts an intimate part of the body. In many cases, though, it is not the cancer that causes the emotional scars related to breast cancer - it is the treatment.

At the time of diagnosis, most women are faced with three possible surgical options:

  • Lumpectomy, the removal of the cancerous tissue and a small amount of normal tissue around the lump
  • Partial mastectomy, the removal of the cancer tissue and a larger amount of the remainder of the breast than that taken in the lumpectomy procedure. A partial mastectomy usually involves a quadrant or two of the breast.
  • Mastectomy, the removal of one or both breasts

There is no definitive study on how these surgical treatments affect self-esteem and body image. When considering surgical choices, each woman needs to think about her type of cancer, her physician's recommendations, family history, the risk of recurrence and, of course, any anticipated body image issues.

Be sure to ask questions and conduct research on each option. Do not be afraid to ask other breast cancer survivors, whether online or through a support group, how the surgeries affected their self-esteem.

Lumpectomy, Mastectomy and Reconstruction

Though a lumpectomy or partial mastectomy does preserve the breast, some women who choose these procedures will see what plastic surgeons call "distortions" in the appearance of the breast. These distortions can include scarring or significant changes in breast size. According to one study, though, severe distortions are uncommon. One study reported that, of 256 women who opted for a lumpectomy, 48.3% reported only a slight discrepancy in size and no skin changes. Approximately 41.5% reported a noticeable different in size or slight skin changes, while only 10.2% indicated a significant change in either their skin or breast size.

Some women will choose to use a prosthesis, which fits inside a bra, to fill out clothes and avoid questions. Other women, specifically younger women, may opt for reconstructive surgery. This surgery can be performed at the same time as the mastectomy, which makes for a long surgery but eliminates the need for another trip to the operating room and the emotional effects of seeing mastectomy scars. Reconstruction can also be performed after mastectomy wounds have healed, using either implants or tissue from the patient's own body.

There are countless medical studies of the psychological benefits of reconstructive surgery. Some studies report that women who chose reconstruction surgery experience a healthier body image than women who do not; however, other studies indicate that women who select reconstructive surgery have higher anxiety about breast loss than women who do not choose to undergo this surgery.

It is important to have realistic expectations regarding the breast reconstruction. Some women are disappointed when their reconstructed breasts do not look like their original breasts. It is also important to remember that breast reconstruction can involve multiple surgeries over a period of several months. These surgeries can include a procedure to create an artificial nipple, if desired. Cancer experts do not recommend saving the nipple from the cancerous breast, because cancer cells can remain in the nipple tissue.

Caution: Immediate reconstruction is actually not an option for the majority of women. Since a reconstructed breast may not heal well if further radiation or adjunct chemotherapy is required, reconstruction can end up being a problematic mistake. Overall, this can make the jobs of other physicians following up on the procedure very difficult. As such, other members of a patient's care team must sign off before the procedure can take place.

Tips for Maintaining a Positive Body Image

Just as with any psychological issue, women with breast cancer can benefit from engaging in an honest conversation about their cancer-related body image issues. In addition to just "getting it out there," women can do several things to take charge of improving their self-esteem.

Partners can go a long way to be loving and supportive in regards to woman's changing body image. Expressing acceptance and encouragement as a woman makes changes in wardrobe, hairstyle, or even diet and exercise can help her make the transition from a pre-cancer to a post-cancer body. One study found that sex therapy and couples counseling improved self-esteem among women with cancer.

Dr. Helen Coons, a psychologist who specializes in women's health and mental health, recommends breast cancer survivors strengthen their self-image through everything from exercising regularly, getting treated for depression, improving communication, relearning how to be intimate, as well as giving themselves a treat, such as a manicure or a new bra. In addition, she says several of her patients have seen drastic self-image improvements by asking their plastic surgeon to improve the appearance of their incision site. Dr. Coons encourages women to become active, as exercise can reduce depression and improve overall self-esteem.

Sources:

"Breast Reconstruction After Mastectomy." Cancer.org. 6 Sep. 2007. American Cancer Society. 9 Jun. 2008.

Deutsch, Melvin and John Flickinger. "Patient Characteristics and Treatment Factors Affecting Cosmesis Following Lumpectomy and Breast Irradiation." American Journal of Clinical Oncology. 24:4(2003): 350-353. 9 Jun. 2008.

"Discussions: Body Image." NationalBreastCancer.org. 9 Apr. 2008. National Breast Cancer Foundation. 9 Jun. 2008.

Fobair P., S.L. Stewart, S. Chang, C. D'Onofrio, P.J. Banks and J.R. Bloom. "Body Image and Sexual Problems in Young Women with Breast Cancer." Psycho-Oncology. 15:7(2006): 579-594. 9 Jun. 2008.

Kalaitzi C., V.P. Papadopoulos, K. Michas, K. Vlasis, P. Skandalakis and D. Filippou. "Combined Brief Psychosexual Intervention After Mastectomy: Effects on Sexuality, Body Image, and Psychological Well-Being." Journal of Surgical Oncology. 96:3(2007): 235-240. 9 Jun. 2008. (subscription)

Maguire, Peter and Collin Parkes. "Coping With Loss: Surgery and Loss of Body Parts." British Medical Journal. 316:7137(1998): 1086-1088. 9 Jun. 2008.

Montebarocci O, Lo Dato F, Baldaro B, Morselli P, and Rossi NC. "Anxiety and Body Satisfaction Before and Six Months After Mastectomy and Breast Reconstruction Surgery." Psychological Reports. 101 (2007) 100-106. 9 Jun 2008. (subscription)

Nahabedian, Maurice. "Breast Reconstruction After Mastectomy: A Woman's Choice." Avon Foundation Breast Center at Johns Hopkins. 2008. Johns Hopkins Medical Institutes. 9 Jun. 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist living in Kansas City, Mo. Her work has appeared in The Dallas Morning News, Better Homes and Gardens Special Interest Publications and Kansas City Magazine.
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