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 conser vation or reconstruction for early stage disease. Methods. Questionnai res were completed at a mean of 4 years after surgery by 72 women who had partial mastectomy and 146 women who had immediate breast reconstr uction after mastectomy. Results. In general, fewer than 20% of women reported poor adjustment on the domains measured. The two groups did n ot differ in overall psychosocial adjustment to illness, body image, o r satisfaction with relationships or sexual life. There was a specific advantage of partial mastectomy over breast reconstruction in terms o f maintaining pleasure and frequency of breast caressing during sexual activity. Women who had undergone chemotherapy had more sexual dysfun ction, poorer body image, and more psychological distress. Hormonal th erapy and radiation therapy, however, did not measurably affect qualit y of life. Factors predictive of greater psychosocial distress include d a troubled marriage, a poor body image, sexual dissatisfaction, less education, and treatment with chemotherapy. Conclusions. The choice o f local treatment had little psychosexual impact, whereas chemotherapy was associated with long term impairments.