Effects of breast cancer surgery and surgical side effects on body image over time

Abstract

We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction) and surgical side-effects severity on early stage (0–IIA) breast cancer patients' body image over time. We interviewed patients at 4–6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal relationships among body image problems, surgery type, and surgical side-effects severity using the Generalized Estimating Equation approach, controlling for demographic, clinical, and psychosocial factors. We compared regression coefficients of surgery type from two models, one with and one without surgical side-effects severity. Of 549 patients enrolled (mean age 58; 75% White; 65% BCS, 12% mastectomy, 23% mastectomy with reconstruction), 514 (94%) completed all four interviews. In the model without surgical side-effects severity, patients who underwent mastectomy with reconstruction reported poorer body image than patients who underwent BCS at T1–T3 (each P < 0.02), but not at T4. At T2, patients who underwent mastectomy with reconstruction also reported poorer body image than patients who underwent mastectomy alone (P = 0.0106). Adjusting for surgical side-effects severity, body image scores did not differ significantly between patients with BCS and mastectomy with reconstruction at any interview; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The impact of surgery type on body image within the first year of definitive surgical treatment was explained by surgical side-effects severity. After 2 years, body image problems did not differ significantly by surgery type.

Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes

“…Compared to women in the high-stable group, women in the recovery group were less likely to have undergone breast-conserving therapy, explaining previous longitudinal studies showing surgery type predicted only short-term body image [3,4,6,7,9]. No previous studies have related self-image and sexuality trajectories over the year following primary BC surgery to predicting longer term psychosocial outcomes.…”

“…Body image and sexuality are two domains particularly sensitive to the effects of BC treatment [1][2][3][4][5][6][7][8][9][10]. However, the relationship of treatment type with body image and sexuality is inconsistent.…”

“…Despite studies showing that women who received breast conserving therapy experience fewer body image and sexuality difficulties compared to women receiving mastectomy or those with mastectomy and breast reconstruction [1-3, 5, 8, 10], other studies found no significant differences attributable to surgery type [4,7,9]. Attempting to resolve this discrepancy, recent longitudinal studies have examined changes in body image and sexuality over time by surgery type [3,4,6,7,9]. Findings suggested that surgery type predicted body image and psychosexual adjustment in the short-term but not the longer term.…”

Functionality in Women with Breast Cancer: The Use of International Classification of Functioning, Disability and Health (ICF) in Clinical Practice

“…In further studies in groups of women who were subjected to different kinds of treatment, after adjusting raising confusion factors, we could verify that body image worsened in women who had undergone breast reconstruction compared with those who had undergone conservative treatment36 ) .…”

Self-concept and emotional well-being in patients with breast cancer

“…Consequently, emotional well-being is affected and this disruption in the normal psychological function is related to the alterations in the body image (Anillo, 2000;Avis, Crawford & Manuel, 2004;Begovic-Juhant, Chmielewski , Iwuagwu & Chapman , 2012;Brandberg et al, 2008;Chang et al, 2014;Collins et al, 2011;Falk, Reinertsen, Nesvold, Fossa & Dahl, 2010;Fobair et al, 2006;Helms, O'Hea & Corso, 2008;. McClelland, Holland & Griggs, 2015;Przezdciecki et al, 2013).…”