Body Image among Breast Cancer Patients after Surgery

1. Body Image among Breast Cancer Patients after Surgery Yeong-Yuh Juang M.D. Consultation-Liaison Psychiatric Service Department of Psychiatry, Chang Gung Memorial Hospital at Linkou 12.Nov.2011 16th RRI Conference

2. What Is Body Image？

3. Venus with a Mirror, by Titian, ca. 1555

4. How you see yourself when you look in the mirroror when you picture yourself in your mind. • What you believe about your own appearance (including your memories, assumptions, and generalizations). • How you feel about your body, including your height, shape, and weight. • How you sense and control your body as you move.

5. Impacts of breast cancer • Diagnosis and treatment of breast cancer can affect psychological, sexual and physical functioning to a great extent • QoL includes, the patients’ subjective view of their • physical, social, emotional and cognitive functioning • psychological parameters of fear, body image, satisfaction with health care towards the cosmetic result of the surgical treatment

6. women treated with mastectomy • felt less attractive • more self-conscious, • did not like their overall appearance, • dissatisfied with their scar • avoided contact with people Journal of Clinical Psychology in Medical Settings. 16(4):311-21, 2009.

8. Body image after surgery • Patients underwent mastectomy showed a significantly less favorable body image compared with those treated with BCT • Stage I was associated with the most favorable body image, stage IIIB with the least favorable. • Younger patients reported a better cosmetic result, compared with older patients. • Patients with a disease-free interval <1 year reported a significant better body image than patients with a longer disease-free interval Annals of Oncology 14: 1064–1071, 2003

9. mastectomy patients had significantly lower body image, role, and sexual functioning scores and their lives were more disrupted than BCT patients. • Even patients > or =70 years of age reported higher body image and lifestyle scores when treated with BCT. • Body image, sexual functioning, and lifestyle disruption scores did not improve over time. Breast Journal. 10(3):223-31, 2004

10. Body image was an important factor in treatment decisions for 31% of women. • Women selecting conservative therapy often have a more positive body image than do those undergoing mastectomy • Women who received breast conservation had better body image 2 years after treatment • body image, in turn, predicted 2-year mental health J Clin Oncol 2004;22:4002-4009. Cancer 2010;116;3549–57.

11. body image was related to perceived losses and influences. • Losses included missing body parts (mastectomy), loss of menses, loss of sexual sensation, and ultimately, loss of womanhood (perceived femininity) • “influences” related to the quality of relationships before the diagnosis of cancer and the amount of control and information the patient had

12. Sexuality and Body Image • evidence suggests that changes in body image after breast cancer and its treatment may have direct effects on sexuality, sexual response, sexual roles, and relationships. • Most studies have found that survivors who had a good sexual relationship before therapy continued to have a satisfying relationship after surgery for breast cancer. AJN 2006 (106), No. 3 Supplement 32-38.

13. Body image and sexual problems • Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis. • Half of the pt experienced at least one problem much of the time. • Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction • poorer mental health, lower self-esteem, and partner's difficulty understanding one's feelings. Psycho-Oncology. 15(7):579-94, 2006

14. Body image on couple • Women's depressive symptoms and men's marital satisfaction predicted women's self-acceptance, • but not women's perceptions of their partners' acceptance of their appearance. • Female's relationship satisfaction and perspective on common dyadic coping predicted women's perceptions of their partner's acceptance of their appearance Psycho-Oncology. 19(10):1061-8, 2010 Oct.

15. Body image on couple • Understanding and support from the partner were also critical for the survivor to be able to obtain and maintain healthy sexual roles and relationships. • A baseline assessment is critical in developing a plan to address the sexual and emotional needs of a person with cancer and her partner. • Working with a couple, facilitate an effective dialogue between them and explore strategies to minimize the impact on their current relationship AJN 2006 (106), No. 3 Supplement 32-38.

16. The Experience of Receiving Breast Reconstruction in Women of Taiwan • dream of a wonderful future • unexpected reality • struggling to accept • balancing vanity with life priorities • coming to terms: no regret Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010

17. The Experience of Receiving Breast Reconstruction in Women of Taiwan • 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. Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010

18. What to do？ • need more preoperative information about what changes in body image to expect after surgery • a mastectomy proved to be associated with higher body shame and less satisfaction with appearance • breast conserving surgery is associated with a better body image, because of their less mutilating effects European Journal of Oncology Nursing 14 (2010) 263-270

19. What to do？ • efforts to improve physical attractiveness to provide women with a sense of control over their appearance changes, can lead to lower levels of depression later on. • psycho-educational group intervention：Addressing intimacy and partner communication • The sexual life reframing program focused on the physical, psychological, and relational aspects of sexual health elements, H. Sackey et al. EJSO 2010;36:756-762. Cancer Nursing 2011;34(2): 142-149.

20. What to do？ • increase hope and therefore the support for the psychosocial adjustment of patients should play a vital role in increasing their quality of life. • Beauty treatment • physical exercise significantly improve psychosocial wellbeing, individual body image, and physical fitness. • treated for depression • Surgical intervention Asian Pacific Journal of Cancer Prevention, Vol 12, 2011 Onkologie 2011;34:248–253

21. Thank you for your attention !