Beautiful After Breast Cancer Foundation

Prevention

Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.

Diagnosis

I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.

The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.

Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.

Treatment

The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.

The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.

"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.

The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.

Revalidation

Those treated for cancer often need a long period to recover.

Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.

There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.

Quality of life

Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.

Psychology

A diagnosis of breast cancer can have a significant impact on the physical, psychological and emotional well-being of patients and their families. Remember your emotional well-being is just as important as your physical health. Everyone needs some support during difficult times, especially when dealing with a serious illness.

Psycho-oncology

The emotional effects of breast cancer

A diagnosis of breast cancer can have a significant impact on the physical, psychological and emotional well-being of patients and their families. Remember your emotional well-being is just as important as your physical health. Everyone needs some support during difficult times, especially when dealing with a serious illness.Having to face cancer is probably one of the most stressful situations you are ever likely to face. There is no right or wrong way to cope. Only what is right for you. Give yourself plenty of time to adapt. Be patient and don’t expect too much too soon – have realistic expectations.

Challenges include adjusting to the illness; the stresses of medical treatment; emotional needs; depression, anxiety, relationship and caregiving strains; coping with pain, insomnia and other symptoms; and much more. Patients and their care-givers frequently require short-term and longer-term support to help them address these emotional difficulties and mental health problems.

It is important to note that specially trained individuals at your local psycho-oncology service are available to help you and your family from diagnosis, through breast cancer treatment and life beyond cancer.

The psycho-oncology service specialises in emotional difficulties and mental health problems and exists to provide supportive care to patients and their families from diagnosis to life beyond cancer. The service is provided by a multi-disciplinery team to include a psychiatrist, a counsellor, a psychotherapist and specialist nurses. Together, these specially trained staff help patients and their families address a spectrum of problems to include anxiety, depression, relationship difficulties and other concerns related to cancer and its treatment in the short or longer term. The psycho-oncology team work closely with other staff offering specialist support and rehabilitation.

Anyone who thinks they may benefit from these services should talk to their local GP, oncologist, surgeon or oncology nurse specialist and ask to be referred. If some support services are not available in your area, find other ways to cope. Talk to your medical social worker or community health officer too. Welcome support from friends and neighbours. It is not a sign of failure to ask for help or to feel unable to cope on your own. Once other people understand how you are feeling, they can give you more support.

External Links

https://www.cancer.ie/sites/default/files/content-attachments/understanding_emotional_effects_of_cancer.pdf

www.rcpsych.ac.uk

http://www.christie.nhs.uk/the-foundation-trust/patient-information/support-and-rehabilitation/psycho-oncology.aspx

References

Psychological issues and the breast

When discussing the female breast, one must take into consideration it’s value as more than just an anatomical body part. Its importance is based on both the context and cultural influences. A breast is part of a living human being and cultural perceptions and attitudes can affect its significance. In Western society the breast has a highly sexual role, but breasts can also be seen in terms of their function (reproduction and lactation), cosmesis, emotion and psychology.

For centuries, the female breast has been a popular subject in literature, poetry and painting. Breasts are considered a symbol of femininity and beauty. Their functional significance is cross-cultural with regard to motherhood and the bond that accompanies breastfeeding between a mother and her child.

In contrast, in Eastern, South American and African cultures, the connotations associated with the female breast are less sexual. In these societies many other body parts or characteristics influence sexual attraction. In Western culture the breast also plays an important role in the sexual experience. Couples may use the breast as a source of sexual excitement and attach an erogenous significance.

The breast is therefore an indispensable part of the female body and makes a women feel whole. Hence, its loss can be extremely distressing. This degree of distress varies from individual to individual. It does not matter whether your breasts are large or small, they are a part of you and who you are as a person.

The perception of ones attractiveness can be affected by the opinion of others. Self image is also determined by the media, which has a significant impact in the modern era. Looking good is often equated with feeling good, both physically and psychologically but this is not always the case.

Feeling good about oneself cannot be determined by your size, weight or appearance. It’s all about ones physical, mental and social well-being. How we view ourselves and each other. Society often focuses only on fragments, parts of an individual: her hips, her thighs, and – especially in Western culture – her breasts. But what if we don’t like this part of our body? What if we actually lose this part? And what about the effect on the person as a whole?

What does a normal breast look like? Watch the following video by Laura Dodsworth: 

https://www.youtube.com/watch?v=qVP6fTgrHKI



The breast and aesthetic surgery

It is important for you as a woman to accept responsibility for the way you look at your own body and how you decide to deal with the effects of illness or surgery. If you are dissatisfied with your breasts, you must find a way to cope with this feeling. Our body is the platform from which we perceive the world and in which we are observed. Our body image is more than just physical appearance. It tells us about the way we look at ourselves and whether we find ourselves worthwhile.

The significance of the role your breasts play will vary differently from woman to woman. Aesthetic or cosmetic surgery changes not only the body itself, but the way the body is perceived. It was previously assumed that women who opted for breast augmentation, had emotional problems but in fact they appear to be as psychologically stable as other women. The characteristic that these patients share is that they are more unhappy with their body image. This negative self-image can have serious consequences for their self-esteem, confidence and the feelings of being a complete women and sexual partner. The same psychological problems are also noted in women who wish to have a breast reduction. Constant awareness of the breasts in clothing, reinforced by the impression that people are always staring, coupled with functional problems, can be extremely self-destructive. Breast surgery, in both cases, results in a significant improvement in self-esteem and body image.

For these reasons, it is vital to include a psychological component in the assessment prior to surgery. Not every patient needs to go and see a psychologist or psychiatrist prior to surgery however! In additon to the medical consultation, during which the information and choice of procedure is determined, it is crucial to learn more about the women behind the patient. Both woman and surgeon need to understand each other: a woman must be clear why a particular implant has been chosen and how it will be positioned, but the surgeon should appreciate what the women is hoping to achieve and what her expectations are. Unrealistic expectations can later lead to even more psychological problems.
The plastic surgery process can be viewed as a contract where both the treatment team and the patient have a shared responsibility. Post operative support from a psychological point of view, in addition to the medical care, is an absolute requirement.

Your plastic surgeon’s input is usually all that is required as part of the counselling process but in some difficult cases, the assistance of a psychologist is useful. Body Dysmorphic Disorder (BDD) is a mental illness where one is excessively preoccupied with one’s appearance. Such individuals feel extremely unattractive and that feeling tends to dominate their lives. They often resort to cosmetic surgery, but on the grounds of their fragile mental health, fail to qualify. This disorder also includes depression and psychological or psychiatric counseling is indispensable.



The breast and reconstructive surgery

The diagnosis of cancer affects the depths of a woman’s physical and mental integrity. The significance of her breasts assumes a whole new dimension. Not only is the organ itself affected, but it becomes an enemy of the body as a whole. Women are therefore compelled to seek treatment of that breast, not just to restore their self-image but also for the overall health benefits. In that respect, some women have a frightening image of the breast functioning as a time bomb, especially if there are associated genetic factors.

After surgery, the connection with your body needs to be rediscovered. The ‘mutilation’ of the breast, a part of your whole person, is quite an intense experience. The way you deal with this emotion and the disease, plays an extremely important part in your recovery. It is not only physical but also a psychological adjustment process. Feelings of fear, shame, insecurity, anger and frustration can all be experienced. Your balance as a woman, literally and figuratively, needs to readjust.

Early on in the cancer process, intimacy and sexuality in particular, are usually affected. Over time, once the treatment has finished, a woman and her partner usually find a new equilibrium. Sexual satisfaction after the disease can be predicted on the basis of the overall psychological health and satisfaction of a relationship. The extent to which the breast was damaged, appears to have little impact. A couple that, despite the difficult period of illness and treatment, supports each other emotionally and continues to share intimacy through, for example, cuddling, generally returns to a fully satisfactory sex life, because both partners are already largely familiar with the physical changes that have occured.

Physical contact is important, and the pelvic area can be reinvigorated through massage oil and relaxation exercises. It is important to realize that the operated or missing breast is also in need of touching and caressing and it is a good way to become familiar with the changed body.

Unfortunately, for couples where distance has arisen during the illness, a feeling of uneasiness often prevails.

If you and your partner have totally stopped having sex because of the cancer, more work is needed to regain your sexual relationship. Open communication is vital. As a woman, you do not know what is going on in the mind of your partner and vice versa. The healthy partner may falsely assume that ill people do not need sex and can also feel guilty about their own sexual desires. It is also relatively common for men to avoid their sexual partners for fear of hurting them. If these fears remain unspoken, a woman sometimes thinks she is no longer attractive to her partner, leading to further psychological problems. The fear of infidelity by a healthy partner is an additional burden.

These facts clearly indicate that it is extremely important that the fears of both partners are identified and openly discussed as part of a personal and intimate relationship. It is obvious that a lack of emotional support may lead to mutual misunderstandings. Two people who love each other may even be driven apart. If such a situation continues, it can escalate and result in avoidance and an increasing psychological distance, making couples feel like strangers living side by side.

For many women, breast reconstruction can offer a solution. It is important that you are fully informed by your surgeon and crucial that he/ she shares in the significance of your breast for both partners. Your surgeon must also be aware of the expectations that you both have. If you show emotion during the consultation, it does not demonstrate psychological weakness. On the contrary, it shows security about your vulnerability in the relationship with your surgeon.

After an immediate reconstruction, when the mastectomy and breast reconstruction are performed at the same time, women often do not really feel that they have lost a breast. This is psychologically very important. The feeling of missing a breast can be devastating to some women’s body image. Reconstruction can be a positive event, even a significant time after the cancer treatment. Once again the psychological benefit is often almost as impressive as the physical one. The gap underneath your shirt, your bra, bikini is a constant reminder of your loss, a permanent association with illness, during a period of your life that you would like to forget.

Nevertheless, it is worth mentioning that not much psychological research exists on breast reconstruction and the decision to proceed is a very personal one. Practice shows that most women reach this decision themselves and only rarely does a women choose a reconstruction as a result of pressure from her partner. On the contrary, research shows that partners would prefer that there loved one avoided any additional operations, if possible.

Usually a woman chooses to proceed based on her own inner feelings and the perception of her body. This does not mean that open discussions with a partner about the impending surgery are not significant. On the contrary, a partner also needs sufficient time to get adjust to the change. The desire to be desired goes beyond external appearance, it is something very intimate and personal.

Intimacy and sexuality

Changes to sexual well-being can be one of the most problematic aspects of life after breast cancer, with the impact lasting for many years after treatment, associated with serious physical and emotional adverse effects. Having a serious illness almost always takes some kind of toll on your sex life. But breast cancer can bring all thoughts of intimacy and sexuality to a screeching halt.

Treatments can bring on temporary and sometimes permanent premature menopause, making intercourse painful. Chemotherapy and radiation often lead to crushing fatigue. The medications you take, as well as the emotional effects of the disease, can lead to depression. And of course, from the changes wrought by surgery to the hair loss and puffiness of chemotherapy, breast cancer can have a devastating effect on your body image. The sexual side effects of breast cancer can linger long after treatment stops. A 2007 follow-up report on young breast cancer survivors, conducted by researchers at the University of California-Berkeley, found that some women reported persistent sexual difficulties five years after their treatment. According to the National Cancer Institute, about one out of every two women who’ve undergone breast cancer treatment, experience long-term sexual dysfunction.

But even as you get comfortable with the “new you” in the mirror, other parts of your body may be causing you problems. You may go through temporary menopause because of chemotherapy. Or if you have estrogen-receptor positive breast cancer, you may be taking hormonal therapy that can leave you in a menopausal state for years. The resulting vaginal dryness and other symptoms may make it painful to even think about having sex.

Here are some simple strategies to improve your sexual health and help you cope with your body image changes:

  • Vaginal moisturizers. These aren’t lubricants, which are intended for use during sex. Instead, they’re like the moisturizers you use on your face and hands, to benefit the tissues themselves. They are introduced as a suppository into the vagina adding moisture back into the vaginal space and giving it that natural elasticity. If you are experiencing a stretching, painful sensation like the skin is going to split, you don’t have enough moisture.

  • Lubricants. Lubricants should be combined with regular, ongoing use of vaginal moisturizers for best results.

  • Exercises. The classic Kegel exercises, tightening and releasing the sphincter muscle as you do when you urinate, are also great for making intercourse easier. If you do Kegels right before intimacy, you fatigue the vaginal muscles causing them to relax.

  • Lingerie: If you’re still not comfortable with your new body, that’s what lingerie is for! There’s nothing wrong with getting a little help. At the same time, it can help to conceal areas you’re still shy about.

 


Websites

http://www.webmd.com/breast-cancer/features/breast-cancer-sex-and-intimacy?page=3

http://www.mskcc.org/cancer-care/adult/breast/sexual-health

 


References

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