Non-doctoral factors influencing the surgical choice of Chinese patients with breast cancer who were eligible for breast-conserving surgery.

BACKGROUND: The rate of breast-conserving surgery (BCS) is low in China. Many patients choose mastectomy even when informed that there is no difference in the overall survival rate compared with that of BCS plus radiotherapy. This study aimed to investigate the factors that influenced the surgical choice in patients eligible for BCS. METHODS: Female patients with breast carcinoma were enrolled in a single center from March 2016 to January 2017. They made their own decision regarding the surgical approach. Univariate analysis was employed to determine the factors associated with the different breast surgical approaches. Significant factors (defined as P < 0.05) were then incorporated into multivariate logistic regression models to determine the factors that independently influenced patients' decision. RESULTS: Of the 271 patients included, 149 were eligible for BCS; 65 chose BCS and 84 chose mastectomy. On the basis of univariate analysis, patients with younger age, higher income and education, shorter admission to surgery interval, and shorter confirmed diagnosis to surgery interval were more likely to choose BCS than mastectomy (P < 0.05). Meanwhile, patients who resided in rural regions, did not have general medicare insurance, and were diagnosed with breast cancer preoperatively were more inclined to choose mastectomy than BCS (P < 0.05). The multivariate model revealed three independent influencing factors: age at diagnosis (P = 0.009), insurance status (P = 0.035), and confirmed diagnosis to surgery interval (P = 0.037). In addition, patients receiving neoadjuvant chemotherapy (NCT) were more inclined to choose mastectomy. CONCLUSION: Surgical choice of patients eligible for BCS was affected by several factors, and age at diagnosis, confirmed diagnosis to surgery interval, and insurance status were independent factors.

Women's Educational Needs and Perceptions About Survivorship Following Bilateral Mastectomy.

BACKGROUND: More women are choosing to have a bilateral mastectomy to treat unilateral breast cancer despite it not being considered the standard of care. Women are making this choice for various reasons, including anxiety of follow-up screening of the other breast, risk of cancer recurrence for the rest of their lives, and desire to maintain control over the localized cancer. Currently, evidence-based information is lacking regarding this treatment choice. In addition, the concept of survivorship has yet to be examined in this population of women. OBJECTIVES: This study aimed to explore women's educational needs and perceptions about survivorship following bilateral mastectomy as a treatment for unilateral breast cancer. METHODS: In-depth interviews were conducted with 23 women using a semistructured interview guide. Data were elicited, coded, and analyzed using thematic analysis. FINDINGS: Two themes were identified that addressed education and survivorship.

Cuidado de enfermería en paciente postoperada de mastectomía: estudio de caso / Nursing care in postoperative mastectomy patient: a case study

Introducción: El cáncer de mama es una de las neoplasias más frecuentes en mujeres a nivel mundial y causan más muertes cada año. El diagnóstico oportuno es muy importante ya que es de relevancia en la elección y eficacia del tratamiento, teniendo mayor éxito cuando se detecta temprano. La mejor estrategia para la detección temprana es a través de la prevención primaria mediante información, orientación y educación a la población femenina acerca de los factores de riesgo y la promoción de conductas favorables a la salud. El objetivo del estudio fue identificar dominios y clases afectadas en paciente postoperada de mastectomía. Materiales y Métodos: Estudio de caso en paciente femenina de 47 años de edad diagnosticada con cáncer de mama izquierda, realizándole mastectomía radical izquierda en una institución de salud del sector privado de Tampico, Tamaulipas, México. Se aplicó el proceso enfermero, realizando la valoración de enfermería con la Taxonomía II de Diagnósticos de enfermería, se describen los dominios y clases afectadas en el periodo posoperatorio, implementándose el plan de cuidados de enfermería con las interrelaciones diagnósticos, intervenciones y resultados. Resultados: La paciente evolucionó favorablemente, egresando al tercer día de la intervención quirúrgica, se proporcionó educación para sus cuidados en el domicilio. Discusión y Conclusiones: Al finalizar la investigación del caso, se observó la importancia de llevar a cabo el plan de cuidados de enfermería con las respectivas interrelaciones para brindar atención de calidad.

Introduction: Breast cancer is one of the most common cancers in women worldwide and causes more deaths each year. Early diagnosis is very important because it is relevant in the choice and treatment efficacy, with greater success when caught early. The best strategy for early detection is through primary prevention through information, guidance and education to the female population about risk factors and promoting positive health behaviors. The aim of the study was to identify domains and affected classes in a postoperative mastectomy patient. Materials and Methods: A case study in female patients of 47 years of age diagnosed with left breast cancer, performing left radical mastectomy in a private health institution in Tampico, Tamaulipas, Mexico. The nursing process was applied, making the nursing assessment with Taxonomy II Nursing Diagnoses, domains and affected classes in the postoperative period are described, implementing the nursing care plan with interrelationships, diagnoses, interventions and outcomes. Results: The patient improved, egressing the third day after surgery, education was provided for care at home. Discussion and Conclusions: After investigating the case, the importance of carrying out the plan of nursing care with the respective relationships to provide quality care was observed.

A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay.

PURPOSE: To examine effects of music therapy and progressive muscle relaxation training on depression, anxiety and length of hospital stay in Chinese female breast cancer patients after radical mastectomy. METHODS: A total of 170 patients were randomly allocated to the intervention group (n = 85) receiving music therapy and progressive muscle relaxation training plus routine nursing care and the control group (n = 85) receiving routine nursing care. Music therapy and progressive muscle relaxation training were performed twice a day within 48 h after radical mastectomy, once in the early morning (6a.m.-8a.m.) and once in the evening (9p.m.-11p.m.), for 30 min per session until discharged from the hospital. RESULTS: A general linear model with univariate analysis showed that the intervention group patients had significant improvement in depression and anxiety in the effects of group (F = 20.31, P < 0.001; F = 5.41, P = 0.017), time (F = 56.64, P < 0.001; F = 155.17, P < 0.001) and group*time interaction (F = 6.91, P = 0.009; F = 5.56, P = 0.019). The intervention group patients had shorter length of hospital stay (12.56 ± 1.03) than that of the control group (17.01 ± 2.46) with statistical significance (F = 13.36, P < 0.001). CONCLUSION: Music therapy and progressive muscle relaxation training can reduce depression, anxiety and length of hospital stay in female breast cancer patients after radical mastectomy.

BresDex: helping women make breast cancer surgery choices.

Women diagnosed with early breast cancer face a difficult decision between mastectomy and breast conservation surgery with radiotherapy. BresDex is an interactive decision-making support tool, designed to go together with the assistance and information these women currently receive, to help them in making the right choices. This paper will discuss the concepts behind this decision-making tool, the development of the project and the role of clinical photography within it.

Why do women accept to undergo a nipple sparing mastectomy or to reconstruct the nipple areola complex when nipple sparing mastectomy is not possible?

In a retrospective study, we investigated the reasons why women accepted to undergo a nipple sparing mastectomy (NSM) and why women who could not keep their nipple areola complex (NAC) decided to reconstruct it. We intended to investigate whether keeping the NAC plays a psychological role, to state possible advantages of NSM. Between 2004 and 2006, 310 women with NAC sparing and 143 patients with successive NAC reconstruction were mailed a single open-ended question at follow-up 12 months after final breast reconstruction surgery or final NAC reconstruction with tattoo. The purpose was to explore personal motivations that drove women to accept NSM or to perform a NAC tattoo reconstruction. Responses were classified into 11 categories by five reviewers. We performed an analysis of the relative frequency of emerging issues. Socio-demographic and clinical data were collected. Among the patients who responded to the open-ended question, 190 patients preserved their NAC, and 100 patients received postponed NAC reconstruction. Women in the NSM group were significantly younger (P = 0.02), more highly educated (P < 0.0001), and more frequently lived in Northern Italy (P = 0.03). The reasons for accepting NSM were more frequently related to body image satisfaction and integrity of the body (P = 0.002), reduction of psychological distress (P = 0.003), and surgeon's influence (P < 0.0001). Esthetic reasons were highly associated to the control group. These results help us to better understand the psychological impact of NAC sparing versus NAC reconstruction. NSM was accepted because it was perceived as a technique that preserved the integrity of the body, reduced the feeling of mutilation, improved the breast cosmetic results, and reduced psychological distress regarding the loss of the breast.

Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: a randomized clinical trial.

AIM: This paper is a report of a clinical trial of the effects of music therapy on anxiety of female breast cancer patients following radical mastectomy. BACKGROUND: There is insufficient evidence on the effects of music therapy on state anxiety of breast cancer patients following radical mastectomy. METHODS: A Hall's Core, Care, and Cure Model-based clinical trial was conducted in 120 female breast cancer patients from March to November 2009. A randomized controlled design was utilized. The patients were randomly allocated to the experimental group (n = 60) received music therapy in addition to routine nursing care, and the control group (n = 60) only received routine nursing care. A standardized questionnaire and the State Anxiety Inventory were applied. The primary endpoint was the state anxiety score measured at pretest (on the day before radical mastectomy) and at three post-tests (on the day before patients were discharged from hospital, the second and third time of admission to hospital for chemotherapy respectively). RESULTS: The pretest score revealed that the majority of the patients had a moderate level (77·5%) and 15% had severe level of state anxiety. The repeated-measure ancova model analysis indicated that the mean state anxiety score was significantly lower in the experimental group than those in the control group at each of the three post-test measurements. The mean difference between the experimental and control group together with 95% confidence intervals were -4·57 (-6·33, -2·82), -8·91 (-10·75, -7·08) and -9·69 (-11·52, -7·85) at the 1st post-test, 2nd post-test and 3rd post-test respectively. CONCLUSION: Music therapy is found to have positive effects on decreasing state anxiety score.

A prática da reconstrução mamária no universo psicoafetivo da mulher mastectomizada / The practice of breast reconstruction in the psychic and emotional universe of woman submited to mastectomies

Objetivo: conhecer e analisar o significado da reconstrução mamária em mulheres portadoras de câncer submetidas à mastectomia radical ou sua perspectiva, por meio de informações por elas aportadas, sentimentos, adesão e sentidos relacionados a sua prática, com vistas a subsidiar a abordagem desse tratamento no campo da saúde pública brasileira. Métodos: para isso, foi realizado um estudo exploratório de natureza qualitativa, utilizando-se entrevistas com um grupo de 20 mulheres a respeito da reconstrução mamária. Resultados e discussão: verificou-se a influência positiva do procedimento sobre a qualidade de vida e bem-estar, quando incluído na terapêutica médica. Como fator negativo, registrou-se a falta de informação por parte das mulheres a respeito da possibilidade cirúrgica da reconstrução mamária como parte importante do tratamento.

Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy.

BACKGROUND: Breast cancer remains the most important cancer among women worldwide. The disease itself and treatment may have a profound impact on the patients' psychological well being and quality of life. Depression is common in breast cancer patients and affects the therapeutic effects as well as prolongs the duration of hospital stay. However, few studies reported the effectiveness of music therapy on depression and duration of hospital stay of female patients with breast cancer after radical mastectomy. METHODS: One hundred and twenty subjects were recruited to this clinical trial and randomly allocated to two groups. The experimental group (n = 60) received music therapy on the basis of routine nursing care, whereas the control group (n = 60) only received the routine nursing care. The whole intervention time was from the first day after radical mastectomy to the third time of admission to hospital for chemotherapy. Data of demographic characteristics and depression were collected by using the General Questionnaire and Chinese version of Zung Self-rating Depression Scale (ZSDS) respectively. One pre-test (the day before radical mastectomy) and three post-tests (the day before discharge from hospital, the second and third admission to hospital for chemotherapy) were utilized. Duration of hospital stay was calculated from the first day after radical mastectomy to the day of discharged from hospital. RESULTS: The mean depression score of all subjects was 37.19 ± 6.30. Thirty-six cases (30%) suffered from depression symptoms, with 26 (72.2%) mild depression cases, 9 (25.0%) moderate depression cases, and 1 (2.8%) severe depression case. After music therapy, depression scores of the experimental group were lower than that of the control group in the three post-tests, with significant differences (F = 39.13, P < 0.001; F = 82.09, P < 0.001). Duration of hospital stay after radical mastectomy of the experimental group ((13.62 ± 2.04) days) was shorter than that of the control group ((15.53 ± 2.75) days) with significant difference (t = -4.34, P < 0.001). CONCLUSIONS: Music therapy has positive effects on improving depression of female patients with breast cancer, and duration of hospital stay after radical mastectomy can be reduced. It is worthy of applying music therapy as an alternative way of nursing intervention in clinical nursing process of caring female patients with breast cancer.

Percepções de mulheres sobre a repercussão da mastectomia radical em sua vida pessoal e conjugal / Women’s perceptions on the impact of radical mastectomy in the irpersonal and marital life / Percepción de las mujeres sobre el impacto de la mastectomía radical en su vida personal y conyugal

O presente estudo é uma pesquisa descritiva de natureza qualitativa que teve por objetivo identificar como asmulheres submetidas a mastectomia radical percebem a influência desta cirurgia em sua vida pessoal e conjugal. As participantes foram nove mulheres que tinham passado por mastectomia havia mais de um ano e residiamcom companheiro. Os dados foram coletados no período de julho a setembro de 2006, por meio de entrevista semiestruturada. A análise dos dados foi subsidiada pela análise de conteúdo, que permitiu a construção dascategorias: A reconstrução da vida após a mastectomia radical; Mudanças na vida conjugal: A importância doapoio do companheiro; As cicatrizes emocionais deixadas pela mastectomia na vida sexual; e A busca de novasmaneiras de viver sem a mama. Os resultados apontam os sentimentos dessas mulheres em face da experiênciade viver no mundo sem a mama e as prováveis influências da cirurgia na vida conjugal. O estudo traz umareflexão sobre o cuidado com a mulher e seu companheiro no enfrentamento da mastectomia.

Descriptive, qualitative research identifies how women who underwent a radical mastectomy perceive the surgeryimpact on their personal and marital life. Nine women who had undergone mastectomy for more than a year andlived with a partner participated in the research. Data were collected from July to September 2006, through asemi-structured interview. Data analysis was supported by content analysis, reinforcing the division intocategories: life rebuilding after deep mastectomy; changes in marital life: the importance of the partner support;emotional scars left by mastectomy on sexual life; and, the search for new ways of living without a breast. Theresults show these women’s feelings when they experience living in a world without breast and the possibleimpact caused by the surgery on their marriage. The study brings forth reflections about the care to be given towomen and theirs partner in coping with mastectomy.

El presente estudio es una investigación descriptiva cualitativa que tuvo como objetivo identificar cómo lasmujeres que se sometieron a una mastectomía radical perciben la influencia de esta cirugía en su vida personal yconyugal. Las participantes fueron nueve mujeres que habían pasado por mastectomía desde hace más de unaño y vivían con el compañero. Los datos fueron recolectados en el período de julio a septiembre de 2006, através de una entrevista semiestructurada. El análisis de datos fue apoyada por el análisis de contenido, quepermitió la construcción de las categorías: La reconstrucción de la vida después de la mastectomía radical;Cambios en la vida conyugal: La importancia del apoyo del compañero; Las cicatrices emocionales dejadas porla mastectomía en la vida sexual; y La búsqueda de nuevas formas de vida sin el seno. Los resultados muestranlos sentimientos de estas mujeres delante de la experiencia de vivir en el mundo sin el seno y las probables influencias de la cirugía en la vida conyugal. El estudio trae una reflexión sobre el cuidado con la mujer y su compañero en el enfrentamiento de la mastectomía.

"A struggle between vanity and life": the experience of receiving breast reconstruction in women of Taiwan.

BACKGROUND: Understanding the role of sociocultural factors on women's experiences of breast reconstruction is needed to provide better care and avoid erroneous assumptions of these women's needs. OBJECTIVE: The purpose of this study was to understand the lived experiences of Taiwanese women with breast cancer who receive breast reconstruction following mastectomy in Taiwan. METHODS: A qualitative research design, guided by the philosophy of hermeneutic phenomenology, was selected to guide the study. In-depth interviews were conducted 1 to 2 times with each participant and explored the women's experiences related to making decisions about, undergoing, and recovering from breast reconstruction. RESULTS: Seven women who received either autologous breast reconstruction or saline implants were recruited in southern Taiwan. Five themes were identified, including "dream of a wonderful future," "unexpected reality," "struggling to accept," "balancing vanity with life priorities," and "coming to terms: no regret." CONCLUSION: Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations. This ambivalence, combined with a culture that values selflessness and the placement of family first, resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. IMPLICATIONS FOR PRACTICE: Clinical implications include the importance of regular and authentic patient-health care provider communication throughout the process of breast reconstruction, including recovery, and better acknowledgement of Taiwanese women's body image concerns associated with breast reconstruction.

Breast reconstruction using tissue expander and TRAM flap with vascular enhancement procedures.

The transverse rectus abdominis myocutaneous (TRAM) flap can create a good breast shape, however, the patchwork-like scar obviously shows that the breast has been reconstructed. To reconstruct a breast without the patchwork-like appearance, we used a two-stage procedure using a tissue expander before transplanting a de-epithelialised TRAM flap. In addition, to avoid fat necrosis and resorption in a large TRAM flap, we performed two vascular enhancement procedures, surgical delay and supercharging microvascular anastomosis. The surgical delay, which consisted of an extended skin island delay and a vascular delay, was performed when the tissue expander was placed under the breast skin in the first stage. As the extended skin island delay, zones 3 and 4 of the TRAM flap were elevated and silicone sheets were laid under the flaps. As the vascular delay, the deep inferior epigastric vessels (DIEV) on the pedicle side were ligated. In the second stage, the de-epithelialised TRAM flap was transferred into the expanded breast skin pocket. The flap was double pedicled with supercharging microvascular anastomosis between DIEV on the contra-pedicle side of the flap and the thoracodorsal vessels of the recipient site. This surgery was performed on 20 post modified radical mastectomy patients to reconstruct large breasts without patchwork-like scars, and every TRAM flap survived perfectly without fat necrosis or resorption. All patients were satisfied with the reconstructed breasts and the abdominal contour without abdominal wall hernia or any other complications.

Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study.

PURPOSE: Breast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery. METHODS: QOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23. RESULTS: Breast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years. CONCLUSIONS: Whereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.

O perfil da sexualidade em mulheres com câncer de mama / The sexual profile of the breast cancer woman

Introdução: O câncer de mama é a neoplasia maligna responsável por cerca de 20% dos óbitosentre as mulheres. Os tratamentos utilizados promovem, de modo geral, alterações na autoimagem,na imagem corporal, no autoconceito e na sexualidade feminina. Assim, objetivou-seavaliar a presença ou não de disfunções sexuais em mulheres com câncer de mama submetidas àmastectomia radical. Métodos: Foram avaliadas, pelo período de um ano, 52 mulheres entre 50e 60 anos de idade, divididas em dois grupos: controle, composto por 37 mulheres com tumoresbenignos de mama e 15 submetidas à mastectomia radical, utilizando o Watts Sexual FunctionQuestionnaire (WSFQ), que avalia os quatro componentes da experiência sexual, incluindo aspercepções sobre desejo sexual, interesse, orgasmo e satisfação, específico para avaliar a sexualidadeem sujeitos com patologias clínicas, previamente aplicado na população brasileira1,2. A essequestionário foram acrescidas questões qualitativas visando a avaliação e a observação das reaçõesdas pacientes diante do diagnóstico cirúrgico e das possíveis alterações advindas da mastectomiaradical na auto-estima, no humor, na capacidade de planejar o futuro e na manutenção do relacionamentoafetivo-sexual. Testes estatísticos para medidas repetidas, análise de correlação entrevariáveis e análise exploratória de dados multidimensionais estão entre as técnicas utilizadas paraavaliar o conjunto de dados. Resultados: As principais variações detectadas ao longo do tempo foram:o desejo sexual, no grupo-controle, e a excitação, no grupo submetido à mastectomia radical.Avaliando-se o impacto do tempo, considerando-se comparativamente os dois grupos, observou-sepiora no desejo das pacientes pertencentes ao grupo-controle comparado ao grupo de mastectomiaradical. Conclusão: A presença de disfunções sexuais em ambos os grupos estavam relacionadas àsmudanças na auto-estima, na auto-imagem, na imagem corporal e no self feminino.

Background: Breast cancer is a malignant neoplasia responsible approximately for 20% of deaths amongwomen. In general, treatments used promote alterations in self-image, in body image, in self-awareness,and in female sexuality. So we aim to evaluate the presence or not of sexual dysfunctions in women withbreast cancer submitted to radical mastectomy. Methods: for a period of one year, 52 women between50 and 60 years old were evaluated, divided in two groups: control group, composed by 37 women withbenign breast tumors, and a second group of 15 submitted to radical mastectomy, both using the WattsSexual Function Questionnaire (WSFQ), that evaluates four components of sexual experience, includingthe perceptions about sexual desire, interest, orgasm, and satisfaction, specific for evaluating sexuality insubjects with clinical pathologies, previously applied in the Brazilian population1,2. To this questionnairewere added qualitative questions with the purpose of evaluating and observing patients’ reactions facing the surgical diagnosis and the possible resulting alterations of radical mastectomy in self-esteem, in mood,in the capacity of planning their future, and in the maintenance of the affective-sexual relationships. Statisticaltests for repeated measures, analysis of correlation among variables and analysis of multidimensionalexploratory data are between the techniques used to evaluate the data. Results: The main variationsdetected along this period of time, were sexual desire, in the control group, and excitement in the groupsubmitted to the radical mastectomy. Evaluating the impact of the time, considering comparatively bothgroups, there was a worsening in the desire in control group patients when compared to the radical mastectomygroup. Conclusion: the presence of sexual dysfunction in both groups was related to changes inself-esteem, self-image, body-image, and in the feeling of femininity.

Satisfaction of women after mastectomy for nursing care.

PURPOSE: The assessment of satisfaction of women after mastectomy for nursing care. MATERIAL AND METHODS: The research was carried out on a group of 217 patients after radical mastectomy and took place at Surgical Clinic of Swietokrzyskie Oncology Centre in Kielce. Authors' assessment scale was used in research. RESULTS: Tested patients assessed nurses' professional tasks in terms of therapy as very high. The lowest marks were given to nurses' tasks in terms of physical rehabilitation. On intermediate level in patients' assessment were nursing, prophylactic, psychosocial support and educational tasks. Patients after mastectomy in younger age group (less then 50 years) assessed nurses' therapy tasks (p < 0.05) significantly higher in comparison to group of women in the age of 50 and more. Married and professional active women assessed significantly higher therapeutic and nursing tasks. Moreover, therapeutic tasks were higher assessed by women with two-sided mastectomy. CONCLUSIONS: 1) Patients assessed nurses' professional tasks realised in terms of therapy as very high, while nursing service as far as physical rehabilitation is concerned was assessed as very low. 2) The higher level of satisfaction from therapy tasks was seen in younger patients (under 50), married, professionally active, not longer than 1 year after the operation and with two-sided mastectomy.

Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy.

PURPOSE: Besides the quality of the aesthetic results, the quality of life after surgery is one of the most important criteria when reviewing different operation methods, especially in oncologic diseases. This study was performed to evaluate the difference in the health-related quality of life following breast conserving surgery and autologous breast reconstruction after mastectomy. PATIENTS AND METHODS: Hundred and forty-four breast cancer patients were included in this study. Sixty seven patients underwent breast conserving surgery followed by radiotherapy. In 77 patients a mastectomy was performed with immediate or late reconstruction. To evaluate the health-related quality of life we used the SF-36 self-administered questionnaire. RESULTS: A significant difference was found in quality of life in the subscale "physical functioning" showing better results in the breast reconstruction group (P = 0.01). No significant difference was found in the other subscales, but there was a tendency to a better "emotional role" among the breast reconstruction patients. CONCLUSION: Our study demonstrated that autologous tissue breast reconstruction in breast cancer patients did not affect adversely the health-related quality of life compared to breast conserving therapy when the quality of life is assessed by the standardized questionnaire SF-36. In particular, the physical function is not reported to be significantly influenced negatively by the more extensive surgical therapy.

Body image after bilateral prophylactic mastectomy: an integrative literature review.

Bilateral prophylactic mastectomy (BPM) can reduce a woman's risk for breast cancer by 80%. Thus, women who are at high risk for familial breast cancer are increasingly opting for BPM as a preventative option. Research indicates that there are psychological benefits to BPM, including a reduction in anxiety about developing breast cancer. The purpose of this integrative review is to summarize the research that has examined the effect of prophylactic mastectomy on women's subsequent body image. Thirteen studies were reviewed. The majority of women were satisfied with their decision. However, the majority of studies indicate that up to one-half of the women suffer a negative effect on body image and changes in sexuality. Knowledge of these findings can improve the practitioner's ability to counsel women regarding this radical decision. Further research, particularly prospective studies, are needed to examine women's body image prior to BPM so that the impact of prophylactic mastectomy can be examined more thoroughly.

A sexualidade das pacientes submetidas à mastectomia radical / The sexuality of patients submitted to radical mastectomy

O diagnóstico e o tratamento do câncer de mama promovem alterações na vida da mulher, entre elas, as relacionadas à vivência de sua sexualidade. Avaliar a presença de problemas ligados à sexualidade em pacientes submetidas a mastectomia radical. Este trabalho é um estudo piloto de outro com um número maior de pacientes. Foram avaliadas as alterações da sexualidade em pacientes submetidas a mastectomia radical com (n = 10) e sem reconstrução (n = 9), com três meses de pós-cirúrgico, utilizando o Watts Sexual Function Questionnaire, um questionário norte-americano que avalia os quatro componentes da experiência sexual - incluindo as percepções sobre desejo sexual, interesse, orgasmo e satisfação -, específico para mensurar a sexualidade em sujeitos com patologias clínicas. A este questionário foram acrescidas questões objetivando a avaliação e a observação das reações das pacientes frente ao diagnóstico cirúrgico e às possíveis alterações advindas da mastectomia radical na auto-estima, no humor, na capacidade de planejar o futuro e na manutenção do relacionamento afetivo-sexual. Os resultados preliminares mostraram que as pacientes submetidas a mastectomia radical sem reconstrução apresentam indícios positivos de disfunções sexuais (anorgasmia) quando comparadas ao grupo que fez reconstrução. Indícios da presença de depressão foram observados em 31,57% da amostra. Destas pacientes, duas (uma em cada grupo) verbalizaram intenção suicida durante a aplicação do questionário. Há indícios de comprometimento da sexualidade em pacientes submetidas a mastectomia radical sem reconstrução, quando comparadas àquelas submetidas a mastectomia radical com reconstrução, no que concerne à presença de disfunção orgásmica.

The diagnosis and treatment for breast cancer promotes changes in women's life, and beside this, those related with her sexual life. Evaluate the presence of sexual problems related to the sexuality of women submitted to radical mastectomy. Methods: this work has a pilot character of a study with a larger number of patients. They were evaluated changes of the sexuality in patients submitted to the radical mastectomy patients with reconstruction (n = 10) and to the radical mastectomy patients without reconstruction (n = 10), at three months after the surgery, using Watts Sexual Function Questionnaire, an American questionnaire which assesses four components of sexual experience which includes perceptions of sexual desire, arousal, orgasm and satisfaction, specific to evaluate sexuality in people with clinic pathologies. To this questionnaire were added aiming ate the evaluation and observation of the reactions of the patients in front of the surgical diagnosis and the possible alterations resulted of the radical mastectomy in self-esteem, in the humor, in the capacity to plan the future and in maintenance of the affectionate-sexual relationship. The results of this investigation are preliminary, regarding a pilot sample and they showed that the patients submitted to radical mastectomy without reconstruction positive presents indication of sexual dysfunction, mainly in what it concerns to orgasmic function (orgasmic dysfunction), when compared with the group with reconstruction. Indications of the depression presence were observed in 31,57% of the sample. Of these patients, two (one in each group) related suicidal intention during the questionnaire application. There is indication sexuality compromising in patients submitted to the radical mastectomy without reconstruction when compared to those underwent to radical mastectomy with reconstruction, in what concerns to the presence of orgasmic dysfunction.

Comfort, control, or conformity: women who choose breast reconstruction following mastectomy.

Following breast amputation women commonly are presented with two choices: to wear a prosthesis or undergo reconstruction. Breast restoration is assumed to allow a full emotional and physical recovery from a breast cancer crisis. Surgical reconstruction is offered to women as the final step in regaining a sense of complete womanhood, enabling a sense of optimism that both body and self will "get back to normal." This article examines 5 women's accounts of breast reconstruction and asks how breast reconstruction figures in the remaking of self following mastectomy. Issues pertaining to the reasoning behind seeking out the procedure, experiences of finding the right surgeon, and how women feel toward their reconstructed postsurgical body are examined. In conclusion it is argued that a number of contradictory expectations are held by women seeking reconstructions. While women suggest that reconstruction will restore lost femininity, sexuality, and normalcy in most cases it is not the procedure that enables this but the elimination of the hassles of prostheses. In contrast to the complete sense of self they expected to regain through reconstruction they articulate a restoration that is simply pragmatic. It is only once women have undertaken this last bastion of hope that they are forced to renegotiate their sense of themselves as women with or without breasts.

Sexualidade da mulher após a mastectomia / Woman sexuality after mastectomy / Sexualidad de la mujer después de la mastectomia

O Estudo teve como obejto as expressões de sexualidade da mulher portadora de câncer de mama submetida à mastectomia radical. Utilizou abordagem fenomenológica fundamentada em Martin Heidegger e alcançou o objetivo proposto de desvelar o sentido das expressões de sexualidade da mulher mastectomizada. Mediantes depoimentos gravados em encontros com 15 mulheres, foi possível construir as unidades de significação. Numa compreensão vaga para se acostumar e conviver com o corpo mutilado; do acanhamento, da evitação e estranheza devido a falta de uma mama; do tratamento afetivo e atencioso que recebeu do companheiro; da retomada das atividades normais do dia a dia e da alegria em viver e recuperar a integridade física...