Program Can Help Ease Body Image Concerns and Improve Quality of Life

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After breast cancer treatments, which may include surgery, chemotherapy, radiation therapy, and other medicines, many women report that they don’t like their bodies and have low self-esteem, depression, and worse quality of life overall.

This is understandable. Breast cancer treatments can leave scars and discoloration, as well as cause hair loss, lymphedema, menopause, vaginal dryness, and other side effects that alter the way a woman lives her life and perceives herself.

To help address body image issues in women who have been treated for breast cancer, researchers developed a program called Restoring Body Image After Cancer (ReBIC), a group therapy program that uses guided imagery.

A study suggests that ReBIC helped improve body image as well as quality of life in women treated for breast cancer.

The research was published online on Jan. 22, 2018 by the Journal of Clinical Oncology. Read the abstract of “Restoring Body Image After Cancer (ReBIC): Results of a Randomized Controlled Trial.”

Guided imagery, sometimes known as "visualization," is a complementary medicine technique in which a person imagines pictures, sounds, smells, and other sensations associated with reaching a goal. Imagining being in a certain environment or situation can activate the senses, producing a physical or psychological effect.

Studies have shown that practicing guided imagery may be able to:

  • temporarily increase numbers of immune system cells to keep the rest of your body healthy
  • help reduce feelings of depression
  • increase feelings of well-being

This Canadian study included 194 women between the ages of 18 and 65. All the women had been diagnosed with invasive breast cancer that was not metastatic. This means that the cancer had not spread to parts of the body away from the breast, such as the bones or liver. The women also had completed all chemotherapy and radiation treatments after surgery and had no evidence of disease for 2 years. All the women also had no history of a major psychiatric disorder and were not currently participating in a therapist-led psychosocial support group.

About 75% of the women had a mastectomy and about 20% of the women had breast reconstruction.

The women were randomly assigned to one of two groups:

  • ReBIC group (131 women): The ReBIC program included eight weekly sessions that lasted 1.5 hours each. The sessions were led by two psychologists and were based on a manual that focused on three main strategies to treat body image issues:
    • guided imagery exercises to help the women express their personal identity and talk about the body image issues they had
    • group therapy principles, including creating a mutually supportive environment, learning through the shared experiences of others, and encouraging people to express their emotions and feelings
    • information on strategies to manage body image issues, vaginal dryness, anxiety, depression, etc.
  • Control group (63 women): Women in the control group didn’t receive any psychological therapy.

Women in both groups also were given a copy of Dr. Susan Love’s Breast Book, which includes a section on body image, as a reference.

On average, women in the ReBIC group were younger (average age of 48.6 compared to 52.2 in the control group) and had had less time pass since their diagnosis (37 months compared to 56 months in the control group). Also, 86.6% of women in the ReBIC group were postmenopausal compared to 74.2% of women in the control group.

The researchers used a number of questionnaires to assess the women’s body image, sexual functioning, and quality of life four times as part of the study:

  1. just before the study started
  2. 8 weeks after the study started, at the end of the ReBIC program
  3. 6 months after the study started
  4. 12 months after the study started

Overall, after the study was over, women in the ReBIC program reported less distress about the appearance of their bodies, had less body stigma, and had lower levels of breast cancer-related concerns than women in the control group. All these differences were statistically significant, which means that they were likely because of the ReBIC program and not just due to chance.

Women in the ReBIC group also reported better sexual functioning and improved quality of life at the end of the study compared to women in the control group, but these differences were not statistically significant.

“The ReBIC intervention included emotionally laden discussions about body image issues, such as embarrassment about self-image, lack of trust in body functioning, and avoidance of intimacy or exposing one’s physical self,” the researchers wrote. “Regardless of breast-conserving surgery or reconstruction, women in the study expressed feeling that their bodies had let them down, or they felt vulnerable or unattractive. Although feeling grateful for their survival, women feared being perceived as vain for expressing their body image concerns. The safety of a closed (compared with a drop-in) therapeutic group was valued and provided a trusting environment for sensitive personal discussions.”

The ReBIC program is offered in Toronto and the researchers who created the program hope to offer it more widely.

If you’re struggling with body image issues related to a breast cancer diagnosis and treatment and don’t live in an area with a ReBIC program, there are other programs that can help. Certain psychologists and counselors specialize in body image issues in people who’ve been diagnosed with cancer. There are also support groups that can be helpful. Ask your doctor or another member of your healthcare team for some recommendations.


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