Does Reconstructive Breast Surgery and Breast-Conserving Therapy Improve the Quality of Life?

Abstract

Diseases and malfunctions of the sexual organs are always linked to a woman’s sense of identity and, in most cases, will impair it. This entails the question of whether and how the disease or the removal of a sexual organ affects the gender identity and female body image, and the patient’s sexuality as well. When developing operative procedures driven by functional/cosmetic considerations, it was assumed that a lesser extent of visible operative mutilation would also involve a lesser psycho-social burden. Numerous studies have produced differentiated conclusions with the one major difference between the operation procedures located in the area of body image and femininity. Women operated on with breast retention have a significantly better body image with more positive bodily/sexual self-esteem that do women following a mastectomy. When it comes to coping with the illness most studies find no differences dependent on the type of operation involved. The argument most frequently adducted for mastectomy is the allegedly lower fear of recidivation experienced by mastectomy amputees. Significantly more apprehension is reported among women operated on with breast retention. These women were afraid of having received the ‘wrong’ operation. Another reported source of apprehension is the uncertainty as to whether the surgeon has in fact removed the entire tumor. Mastectomy amputees, conversely, are more certain that the cancer has been cured. However, mastectomy amputees also tended to report more fear of the future and more frequent thoughts about their illness. Studies which examined the pre-operative situation and counseling as interaction variables found that a free option to decide on the type of operation, or a fostering of autonomous decision making, reduces subsequent psychiatric morbidity. Breast amputation should not be talked down to a purely cosmetic problem. Gynecological operations of this kind are also major interventions in the life-story of the women involved. Breast retention can alleviate difficulties in certain areas and lead to a better quality of life subsuming physical, psychological and social well-being.

Psychosoziale Aspekte der Brustrekonstruktion

“…Ziel sollte es also sein, beruhend auf dem Wissen über die psychosoziale Problematik von Frauen mit Brustkrebs, den Patientinnen durch suffiziente Information zu einer Entscheidungsautonomie zu verhelfen. Diese kann dazu beitragen, eine spätere psychiatrische Morbidität zu senken [21]. Ebenso werden die Patientinnen selektiert, die sich bewusst gegen eine Brustrekonstruktion entscheiden [22].…”