From "no big deal" to "losing oneself": different meanings of mastectomy.

BACKGROUND

Because of early detection and advanced treatment options, more women with breast cancer survive after mastectomy and thus have to face the choice of living with or without a reconstructed breast for many years to come.

OBJECTIVE

This article investigates these women's narratives about the impact of mastectomy on their lives, as well as their reflections on breast reconstruction.

METHODS

Fifteen women were strategically chosen from a previous population-based study on mastectomy. They were contacted for further exploration in thematic narrative-inspired interviews 4.5 years after mastectomy.

RESULTS

Three types of storylines were identified. In the first storyline, the mastectomy was described as "no big deal"; losing a breast did not disturb the women's view of themselves as women, and breast reconstruction was not even worth consideration. In the second storyline, the women described the mastectomy as shattering their identity. Losing a breast implied losing oneself as a sexual being, a woman, and a person. The third storyline fell in between the other two; the sense of femininity was wounded, but not to the extent that they felt lost as women.

CONCLUSION

Our findings suggest that the experience of mastectomy due to breast cancer is very much individual and contextual. Losing a breast may be of minor or major importance.

IMPLICATIONS FOR PRACTICE

Healthcare practitioners should be attentive to how the women themselves experience the personal meaning of losing a breast and guard against vague preconceptions based on the breast-sexuality-femininity discourse and its connection to what the patient needs.