Breast-conserving surgery, also known as lumpectomy, followed by radiation therapy is a good alternative to mastectomy and usually has better cosmetic results in women diagnosed with small breast cancers. Still, depending on how much breast tissue is removed during lumpectomy, the size and shape of the breast that was operated on can change significantly.
The study reviewed here asked more than 700 women who had a lumpectomy about their quality of life, feelings about their bodies, their health status, and other psychosocial aspects of their lives. After the lumpectomy, women whose breasts looked significantly different from each other (asymmetrical) were four times more likely to feel ashamed of their bodies or stigmatized compared to women whose breasts looked similar to each other (symmetrical). Women whose breasts looked different from each other also were 60% less likely to believe they were healthier after breast cancer surgery compared to women whose breasts looked similar. The greater the difference in appearance between a woman's breasts after lumpectomy, the more likely she was to be depressed.
If you're having a lumpectomy to treat breast cancer, talk to you doctor BEFORE the surgery about how both your breasts will look after lumpectomy, as well as the reconstruction options available if you're not satisfied with the way your breasts look. Because lumpectomy is usually followed by radiation therapy, your surgeon probably won't recommend reconstruction at the same time as lumpectomy. Still, knowing how your breast will look after lumpectomy and knowing all the reconstruction options available to you can help you feel better about yourself and your health after surgery.
After you've recovered from lumpectomy and any other treatments you may have, if you're not happy with the way your breast looks, tell your doctor about your concerns and ask about reconstruction. It's possible to have reconstructive surgery years after lumpectomy, so it's never too late to talk about your options. Talk to an experienced breast reconstruction surgeon who can help you decide what's best for your unique situation.
If you're having mastectomy instead of lumpectomy and want to know more about breast reconstruction, talk to your surgeon about reconstruction BEFORE your mastectomy is scheduled. Tell your breast surgeon you're considering reconstruction and you'd like to have a breast reconstruction surgeon involved in evaluating your options. There are many reconstruction choices and the best time to explore all available options is before you have surgery to treat breast cancer.
Visit the Breastcancer.org Breast Reconstruction section to learn more about the different types and timing of breast reconstruction.
ANN ARBOR, Mich., July 9 (MedPage Today) -- Pronounced asymmetry after breast-conserving surgery for cancer can lead to significant psychosocial problems that may need preoperative counseling, investigators here concluded.
Breast asymmetry correlated significantly with feelings of stigmatization and perceived lack of improvement in health after treatment, Jennifer J. Waljee, M.D., of the University of Michigan, and colleagues reported in the July 10 issue of the Journal of Clinical Oncology.
The occurrence of depressive symptoms increased with the extent of breast asymmetry, which also predicted worse quality of life.
"Identifying patients at risk for postoperative asymmetry at the time of consultation may allow for improved referral for supportive counseling, prosthetics, and reconstruction," the authors concluded.
The effect of surgery on psychosocial outcomes in breast cancer patients is controversial, and the potential underlying mechanisms poorly understood. Prior studies have focused primarily on differences between mastectomy and breast conservation.
Although breast-conserving surgery is considered the least disfiguring surgical option, outcomes vary widely, the authors noted. Moreover, patients who undergo breast-conserving surgery are not counseled in advance about reconstruction and may have more limited options, compared with women who have mastectomies.
In an effort to clarify associations between breast asymmetry and psychosocial outcomes in breast cancer survivors, Dr. Waljee and colleagues examined survey responses from 714 patients treated with breast-conserving surgery from January 2002 through May 2006. The survey covered five aspects of psychosocial functioning: overall quality of life, depression, fear of recurrence, stigmatization, and perceived change in health status.
Postoperative breast asymmetry was assessed by means of the Breast Cancer Treatment and Outcomes Survey.
The results showed that women with significant breast asymmetry were more than four times as likely to feel stigmatized as were women with minimal postsurgical breast asymmetry (OR 4.58, 95% CI 2.77 to 7.55). Additionally, women with significant breast asymmetry were almost 60% less likely to report improved or unchanged health status (OR 0.43, 95% CI 0.27 to 0.66).
The frequency of depressive symptoms increased from 16.2% in women with minimal breast asymmetry, to 18% in those with moderate asymmetry, to 33.7% in women with pronounced breast asymmetry (P=0.002). Women with minimal breast asymmetry had a mean quality of life score of 86.3 compared with 82.4 for women with pronounced asymmetry (P<0.001).
The authors noted that the study was retrospective and cross-sectional. They could not determine causality or rule out the possibility that the associations between aesthetic outcome and psychosocial functioning may be mediated by other factors such as sexual function, body image, and use of psychological counseling.
They also pointed out that the study sample was drawn from a single institution and was homogenous with respect to sociodemographic factors so that it may not be generalizable to other groups of women.
The study was supported by the Robert Wood Johnson Clinical Scholars Program.
The authors reported no disclosures.
Primary source: Journal of Clinical Oncology Source reference: Waljee JF, et al "The effect of aesthetic outcome following breast conserving surgery on psychosocial functioning and quality of life" J Clin Oncol 2008; 26: epub.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
Learn more about our commitment to your privacy
© 2009 Breastcancer.org - All rights reserved.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
_tcm8-332386.jpg "wellness_dvd_promo")