Breast cancer is the most common cancer affecting females but thankfully due to advances in early detection and treatment, the survival is improving. The treatment of breast cancer is a combination of surgery, radiation, chemotherapy, targeted therapy and hormone therapy. Surgery is a very important component of breast cancer treatment. But remember breasts belong to attributes of feminity, attractiveness, sexuality, identity, womanhood, motherhood and nurturance. Removal of partial or whole breasts is a very difficult decision. It is scary, it’s raw, it’s emotional. It can be life altering but it’s absolutely essential for saving life.
Mastectomy is a common surgical procedure which involves complete removal of single or both breasts depending on stage and extent of breast cancer but its effect on appearance as well as its psychological and social consequences are not given due importance. Many women think that if they get their complete breasts removed, the cancer will not come back. But unfortunately, it’s not so. Although there are many artificial prosthesis available and it’s also possible to do breast reconstructive surgeries, it can never replace the natural breast.
Breast conservation surgery is a procedure where the affected part of breast cancer is removed with a safety margin. Whenever partial removal is done, radiation therapy to the remaining breast is a must to prevent relapse. Many studies have shown that results of a combination of breast conserving surgery and radiation therapy are equal to mastectomy without compromising survival. In fact many patients after mastectomy may also need radiation therapy. Now thanks to advances in chemotherapy, it’s possible to shrink the tumor by giving chemotherapy before surgery and it can make breast conservation possible even in advanced cases. So radiation therapy is a big gift to women and if used along with breast conservation it helps to preserve the dignity of women.
Amputation of mammary gland can cause “half woman complex”. This trauma can permanently change her. There is “no back to old me’. It causes myriad feelings of mutilation, loss of a very important organ, reduced self-esteem, depreciation in the value of the body, fear to regain sense of bodily attractiveness, difficulty in accepting the change in physical condition, negative self -perception of one’s changed body, rejection by partner, fear of returning to sexual activities and reduced sense of competence. In fact many women feel that loss of complete breast is a daily reminder of cancer for years.
The loss of the breast for women is a major mental injury and this has significant psychological effects on them. The multiple adverse effects include mood disorders (depression, anxiety, and anger), hopelessness, changes in body esteem, loss of identity, problems in shoulder mobility, fear of relapse of the illness and ultimately it effects eventual success in different aspects of life. We know that women are the most important pillars of the family and society. So, if we improve the psychological status of women, we don’t only improve their survival, but also the mental health of the family and it can lead to a happy home.
So, removal of breasts apart from physical disability,also leads to decreased physical function, role function, emotional function, social function and sexual function. So before starting treatment, there should be holistic need assessment of the woman to help her prepare and cope with altered body image. There should be goal setting, skills training and counselling to target dysfunctional thoughts, emotions and behaviour. After treatment there should be focus on strength training, yoga, aerobics, relaxation activities and psychosexual therapy.
So it’s important that treating doctors as well the family should understand the patient and her goals before starting treatment. As health professionals, we should acknowledge body image as a potential concern. The option of partial and complete breast removal, it’s benefit, potential harms and expected outcome should be clearly explained to her. She should be given the option of breast conservation and radiation whenever it’s possible without compromising oncological outcomes. With the availability of advanced and sophisticated forms of radiation, it’s now possible not just to save the breast but also to save her lungs, heart, food pipe, opposite breast as well from side effects. Let the woman decide what she wants. She should be involved in decision making. Her pain matters. Her choice matters. Her healing matters. What she wants that matters. It’s her breast, so it should be her decision.
My message to any female diagnosed with breast cancer would be- Your trauma is real and valid and you deserve a space to talk about it. You are a survivor of the unfairness of life. Scream if you have to, then straighten your crown and keep moving. Remember behind every scar, there is an untold story of survival. Remember in-spite of the scar you are awesome, you are loved, you are supported. Simply breathe. Preserve your peace. Wear your new life. Start loving yourself- the beginning of lifetime recovery. Give yourself a pep talk like “Hello- I am beautiful”. Respect your sacred being and watch your self- confidence soar. Dive deeper into your own depths and discover yourself in pockets of the most sombre waves. Be who you are meant to be – an ocean, proud and whole.
Dr. Indu Bansal Aggarwal
Director Radiation Oncology
Narayana Superspecilty Hospital
Gurgaon
9719612605
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Dr Indu Bansal Oncologist 