Hart D
Plast Surg Nurs. 1996 Fall;16(3):167-71.
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.
1974年，我作为一名护士首次接触到乳腺癌患者。当时我是一名23岁的护理专业学生，同时兼任手术室技术员。一位52岁的女性正在接受根治性乳房切除术。当我把夹子和剪刀递给两位外科医生时，努力掩饰自己内心的震惊。“就这么一个小肿块，真的有必要切除这么多组织吗？”“是的，”医生回答，“要么这样做，要么她就会死。”10年后，我开始从事为接受乳房重建手术的患者提供护理的工作。在担任手术室主管兼整形外科医生助手的7年半时间里，我在许多女性面临危机时为她们提供帮助。我们会在一年的时间里每隔一两周就见面，成为朋友，然后治疗结束。她们的生活将继续，而我会继续与新的患者打交道，一个接一个。作为乳房植入物制造商美敦力公司的患者信息协调员，我仍在继续为接受重建手术的患者提供服务。每年都有数百名患过乳腺癌的女性给我打电话。我提供信息、回答问题并帮助她们了解相关知识。铭刻在我记忆中的是那些充满情感的面孔，以及她们震惊、恐惧、困惑、悲伤、顺从继而接受的声音。不同生活方式、性格各异，经济和社会地位也不同的女性，都有一个共同点——乳腺癌、乳房切除术、相关决策以及乳房重建。许多人生活受到了影响，人际关系紧张，经济上也捉襟见肘。但她们面临的更大挑战是这种既危及生命又有损容貌的疾病所带来的生死危机。像沙因、戈德堡和卡斯珀等研究人员已经记录了乳房缺失对女性及其人际关系的心理影响（沙因，1991年；戈德堡、斯托尔茨曼和戈德堡，1984年；卡斯珀，1995年）。琼斯、马西森和罗兰研究了心理调适、咨询需求以及患者对身体形象改变的反应（琼斯和雷兹尼科夫，1989年；马西森和德雷弗，1990年；罗兰、霍兰德、查格拉斯ian和金纳，1993年）。身体形象的改变首先发生在乳房切除术后，并随着重建手术持续存在。戈因、塞德娜和韦利施深入探讨了各种类型重建手术的影响（戈因和戈因，1988年；塞德娜、耶茨、张、克拉姆和里恰尔代利，1995年；韦利施、沙因、努恩和利特尔，1987年）。以下文章汇集了我的个人经历，以及从文献中摘录的内容，旨在概述乳房切除术和乳房重建的心理影响。
