DOES RECONSTRUCTIVE BREAST SURGERY AND BREAST-CONSERVING THERAPY IMPROVE THE QUALITY-OF-LIFE

Diseases and malfunctions of the sexual organs are always linked to a woman's sense of identity and, in most cases, will impair it. This ent ails the question of whether and how the disease or the removal of a s exual organ affects the gender identity and female body image, and the patient's sexuality as well. When developing operative procedures dri ven by functional/cosmetic considera tions, it was assumed that a less er extent of visible operative mutilation would also involve a lesser psyche-social burden. Numerous studies have produced differentiated co nclusions with the one major difference between the operation procedur es located in the area of body image and femininity. Women operated on with breast retention have a significantly better body image with mor e positive bodily/sexual self-esteem that do women following a mastect omy. When it comes to coping with the illness most studies find no dif ferences dependent on the type of operation involved. The argument mos t frequently adducted for mastectomy is the allegedly lower fear of re cidivation experienced by mastectomy amputees. Significantly more appr ehension is reported among women operated on with breast retention. Th ese women were afraid of having received the 'wrong' operation. Anothe r reported sourer of apprehension is the uncertainty as to whether the surgeon has in fact removed the entire tumor. Mastectomy amputees, co nversely, are more certain that the cancer has been cured. However, ma stectomy amputees also tended to report more fear of the future and mo re frequent thoughts about their illness Studies which examined the pr e-operative situation and counseling as interaction variables found th at a free option to decide on the type of operation, or a fostering of autonomous decision making, reduces subsequent psychiatric morbidity. Breast amputation should not be talked down to a purely cosmetic prob lem. Gynecological operations of this kind are also major intervention s in the life-story of the women involved. Breast retention can allevi ate difficulties in certain areas and lead to a better quality of life subsuming physical, psychological and social well-being.