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What Lies in the Wake of Various Breast Cancer Surgeries?

By
WebMD Health News
Reviewed by Annie Finnegan

Sept. 5, 2000 -- Knowing that breast reconstruction is an option softens the pain of considering mastectomy, or removal of the breast, but research in today's Journal of the National Cancer Institute says that most women still enjoy satisfying sex lives after breast cancer surgery whether they have reconstruction or not.

Breast reconstruction is a surgical procedure that forms a new "breast" after mastectomy, often with muscle or breast implants. The goal is that the woman will look the same before and after surgery.

Lead researcher Julia H. Rowland, PhD, tells WebMD that about 30% of women who had lumpectomy -- in which only a small amount of breast tissue is removed -- reported that breast cancer had a negative impact on their sex lives vs. more than 40% after mastectomy regardless of whether or not they had breast reconstruction.

Rowland's study compared physical and emotional outcomes among nearly 2,000 breast cancer survivors who had one of these three surgical procedures. Earlier research had suggested that reconstruction or surgery that left the breast intact might reduce the negative effects of breast cancer on women's sexual well-being.

The researchers had expected to find a continuum of emotional and social responses, with women who had lumpectomy least affected, those who had mastectomy plus reconstruction more affected, and those who had mastectomy without reconstruction the most affected. It is important to remember that most women who have mastectomy do so because their cancers are not the type that can be treated with less extensive surgery, such as lumpectomy.

Rowland tells WebMD, "We found no differences in emotional, social, or role function among the groups. There were no differences among the surgical groups in health-related quality of life or sexual functioning. As we expected, the women who had lumpectomy had fewer problems with body image and feelings of sexual attractiveness, but the benefit to body image was less than we expected from reconstruction." Rowland is director of the office of cancer survivorship at the National Cancer Institute in Bethesda, Md.

Patricia L. Dawson, MD, PhD, tells WebMD that knowing breast reconstruction is an option makes decisions about mastectomy easier for many women, whether they opt for reconstruction or not. Dawson, who was not involved in the study, is a surgeon specializing in diagnosing and treating breast cancer and other breast problems at the Providence Comprehensive Breast Center in Seattle.

There were no differences in actual sexual functioning -- desire, arousal, orgasm, or sexual satisfaction -- among the three surgery groups.

Women who had reconstruction reported more problems with numbness of the new breast tissue. Rowland says that this is probably because those who have had breast reconstruction are more likely to be frequently reminded of differences in sensation between the reconstructed breast and the normal breast, while those who have mastectomy without reconstruction take these differences for granted.

Rowland tells WebMD that the key factor in quality of life after breast cancer surgery now appears to be not the type of surgery but the other treatments a woman receives for her cancer. For example, chemotherapy can cause problems with sexual functioning.

Dawson tells WebMD that women contemplating reconstruction should ask themselves what they hope to receive from the procedure. "Results with skin-sparing mastectomy and reconstruction can be amazingly good, but patients should not assume that reconstruction will restore the way they looked before mastectomy," she says.

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