Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality.
BACKGROUND
This retrospective study compared psychosocial adjustment, body image, and sexual function in women who had either breast conservation or reconstruction for early stage disease.


METHODS
Questionnaires were completed at a mean of 4 years after surgery by 72 women who had partial mastectomy and 146 women who had immediate breast reconstruction after mastectomy.


RESULTS
In general, fewer than 20% of women reported poor adjustment on the domains measured. The two groups did not differ in overall psychosocial adjustment to illness, body image, or satisfaction with relationships or sexual life. There was a specific advantage of partial mastectomy over breast reconstruction in terms of maintaining pleasure and frequency of breast caressing during sexual activity. Women who had undergone chemotherapy had more sexual dysfunction, poorer body image, and more psychological distress. Hormonal therapy and radiation therapy, however, did not measurably affect quality of life. Factors predictive of greater psychosocial distress included a troubled marriage, a poor body image, sexual dissatisfaction, less education, and treatment with chemotherapy.


CONCLUSIONS
The choice of local treatment had little psychosexual impact, whereas chemotherapy was associated with long term impairments.
Schover
L R
LR
Center for Sexual Function, Cleveland Clinic Foundation, OH 44195-5041.
Yetman
R J
RJ
Tuason
L J
LJ
Meisler
E
E
Esselstyn
C B
CB
Hermann
R E
RE
Grundfest-Broniatowski
S
S
Dowden
R V
RV
D000970:Antineoplastic Agents / Q000009:adverse effects; D001828:Body Image; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008393:Marriage; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012725:Sexual Behavior; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D013997:Time Factors
D000970:Antineoplastic Agents