Mastectomy and Reconstruction
For many women, a mastectomy can significantly challenge the way they perceive their body and their femininity. Whether a woman was informed that a mastectomy was medically necessary or she elected the mastectomy among other options (either prophylactically or instead of a lumpectomy), the loss of the breast(s) can represent a loss of a women’s previous body integrity and can result in body-image concerns.
For many women, the loss of their natural breast(s) represents the loss of their former self, and as such, may need to be grieved. Many women facing the surgery, however, feel as though they cannot or should not allow themselves to entertain these feelings of loss because of internal and/or societal pressure to display strength and remain focused solely on survival.2 Even if immediate reconstruction is available, the physical and emotional adjustment to the reconstructed breast(s) and altered physical appearance can take time. For some women, the reconstruction process can be prolonged and involve numerous surgeries; during this time, women may find their self-image in flux as they continually adapt to and integrate the physical changes into their new sense of self.
Lymphedema can impact a woman far beyond her active treatment, and for many, this persistent, noticeable swelling of the extremities serves as a continued reminder of their cancer.3 The swelling can make it difficult to use the impacted limb for everyday tasks, and wearing a compression garment can make women feel self-conscious. Women sometimes find that their previous clothing no longer fits or that they have to modify physical activity to accommodate the lymphedema—all of which can be frustrating.
Studies have shown that women routinely report not feeling adequately informed by their medical team about the potential of lymphedema,3 and having to confront a chronic condition after their treatment has ended can feel like another blow dealt by the cancer.
What Clinicians Can Do
Recognize that body-image concerns may be difficult for women to bring up; they may feel shame or that image and appearance concerns are not worthy of attention. By normalizing that women can struggle with these concerns during breast cancer treatment, the clinician gives the woman “permission” to have these feelings and discuss them.
Help patients locate wigs and/or scarves before all of their hair falls out. For many women, knowing that they have a wig on hand before they need to use it is comforting and can reduce anxiety about the process.