Study: No 'Emotional' Difference With Reconstruction

If you opt for reconstruction of your breast after a mastectomy, it won't make you feel any better about your body than if you just had a mastectomy by itself, according to a new study. Women who had only the lumps removed instead of the entire breast are most satisfied with their sexual attractiveness after breast cancer surgery.

But when it gets down to the details of their love lives, women who've had reconstruction do just as well as the other two groups.

"They [women with breast reconstruction] reported a more global feeling of a lack of sexual attractiveness, but when you get down to specifics [like arousal, desire, orgasms and feeling attractive for their partners], there were no differences in their responses," says Julia Rowland of the National Cancer Institute. She was the lead author of a study assessing the psychosocial effects of the three most common surgeries for breast cancer one year after treatment.

The findings are part of a study of almost 2,000 breast cancer survivors that found that on most measures of quality of life, women had the same responses no matter what surgery they chose to treat their disease.

"It doesn't matter what you choose with respect to breast surgery," says Rowland, director of the National Cancer Institute's Office of Cancer Survivorship. "Women seem to have equivalent outcomes for a least one year in terms of health-related quality of life and sexual function, although the women who have lumpectomies clearly benefit in terms of body image."

After one year, Rowland says, varying outcomes seem related to the age of the woman and other treatments she uses for breast cancer.

The results of the study, one of the largest of its kind, are published in today's Journal of the National Cancer Institute.

In the study, 1,957 breast cancer patients -- ages 31 to 88 -- who live in Los Angeles and Washington, D.C., answered a questionnaire about how they felt one year after surgery. More than half -- 57 percent -- of the women had lumpectomies, 26 percent had mastectomies and 17 percent had mastectomies with breast reconstruction.

Women in the mastectomy-with-reconstruction group were younger than those in the lumpectomy or mastectomy groups (average ages were 50.3, 55.9 and 58.9, respectively), and were also more likely to be white, have a partner, a college education and a higher income.

Questions asked about the disruptions women experienced in their daily life, as well as their emotional responses to their disease and their sense of well-being.

"At one year, you can see no differences between women and the different surgeries in their health-related quality of life," Rowland says. "[These findings suggest that] women can really tailor their treatment to suit their lifestyle needs."

Among the findings the authors found surprising was that women who had reconstruction after their mastectomies were as dissatisfied with their sex lives as those women who'd had mastectomies alone, 45.5 percent and 41.3 percent, respectively. Women who had lumpectomies were more satisfied, with only 29.8 percent reporting a negative impact on their sex lives.

It could be their younger age, as well as the treatments available to them that affected their reports of sexual dissatisfaction Rowland says.

"We don't know what options those women had [in choice of surgery]," she says. "If they were women who had hoped to have a lumpectomy, and as a consequence got less than they would have desired, they might be more critical at the outset and [would be] set up for disappointment."

Also a factor, says New York City oncologist Barry Kaplan, is women's expectations of breast reconstruction.

"The women who select to have breast reconstruction are reaching to achieve the same result -- [they want to look] as they looked before, which can't happen," he says. "They are therefore less satisfied."

Physically, the mastectomy patients, including those who had reconstruction, had more discomfort than the women who had lumpectomies. Fifty-two percent of women who had reconstruction complained of numbness, and 13 percent of women who had mastectomies alone complained of the sensation of pins and needles. Almost twice as many mastectomy patients (46.6 percent) reported arm swelling as lumpectomy (24 percent) patients or mastectomy with reconstruction (25.8 percent) patients.

What To Do: A thorough rundown of breast cancer treatments can be found at The American Cancer Society. To find out what your risk is for breast cancer, take a risk test at The Women's Cancer Network.

SOURCES: Interviews with Julia Rowland, Ph.D., director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, Md.; Barry Kaplan, M.D., director, division of Hematology and Oncology, New York Hospital Medical Center, Queens, N.Y., clinical associate professor, New York Hospital - Cornell Medical Center, New York City; Sept. 6 Journal of the National Cancer Institute.

By Janice Billingsley HealthSCOUT Reporter

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