The psychological outcome of breast reconstruction.

My first experience with breast cancer as a nurse was in 1974. I was a 23-year-old nursing student and working as an operating room technician. A radical mastectomy was being performed on a 52-year-old woman. As I passed clamps and scissors to the two surgeons, I struggled to conceal the shock I was experiencing. "Is it really necessary to remove so much tissue for such a small lump?" "Yes," the doctor replied, "It's either this or she'll die." It was 10 years later that I would begin my work with patients undergoing breast reconstruction. During the 7-1/2 years that I worked as an operating room supervisor and assistant to a plastic surgeon, I responded to the needs of a number of women during their time of crisis. We would see each other every week or two for a year, become friends, and treatment would come to an end. Their lives would go on, and I would continue my work with a new patient, then another and another. My work with reconstruction patients continues as Patient Information Coordinator for Mentor H/S, a breast implant manufacturer. Hundreds of women who have had breast cancer call me each year. I provide information, answer questions, and help educate. Etched in my memories are emotion-filled faces and voices of shock, fear, confusion, sorrow, and resignation followed by acceptance. Individual women of various lifestyles and personalities as well as different levels of financial and social status, all have one thing in common--breast cancer, mastectomy, decisions, and reconstruction. Many were experiencing an interruption in their lives, a stress on their relationships and a drain on their finances. But the even greater challenge they faced was the life and death crisis of an illness that is both life threatening an disfiguring. Researchers such as Schain, Goldberg and Kasper have documented the psychological effects of breast-loss for women and their relationships (Schain, 1991; Goldberg, Stoltzman, & Goldberg, 1984; Kasper, 1995). Jones, Matheson, and Rowland looked at psychological adjustment, counseling needs and patients' response to their altered body image (Jones & Reznikoff, 1989; Matheson & Drever, 1990; Rowland, Holland, Chaglassian, & Kinner, 1993). The alteration of body image first occurs with mastectomy and continues with reconstruction. Goin, Cederna and Wellisch provide insight into the effects of various types of reconstruction (Goin & Goin, 1988; Cederna, Yates, Chang, Cram, & Ricciardelli, 1995; Wellisch, Schain, Noone, & Little, 1987). The following article is a compilation of my personal experience, and excerpts from literature presented as an overview of the psychological effects of mastectomy and reconstruction.