Breast cancer surgery: Comparing surgical groups and determining individual differences in postoperative sexuality and body change stress.

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breastconserving therapy (BCT) or MRM without breast reconstruction.The sexuality pattern for women receiving reconstructive surgery was one that was significantly different-with lower rates of activity and fewer signs of sexual responsiveness-than that for women in either of the other groups.Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT.Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes.More than 180,000 women are diagnosed with breast cancer each year, and it is estimated that 1 in 9 will develop the disease by age 85 (American Cancer Society [ACS], 2000).Surgery is usually the initial treatment for invasive breast cancer.Surgical options include breastconserving therapy (BCT; often called lumpectomy) and axillary node dissection or a modified radical mastectomy (MRM), which includes removal of all breast tissue as well as the axillary lymph nodes.Not all women receiving an MRM are eligible for breast reconstruction (i.e., tissue expander with a permanent implant, autologous tissue transfer, or a permanent implant), but those who are may elect to receive it at the time of mastectomy.Still, other women may elect to have a bilateral mastectomy (removal of the breast with the tumor as well as removal of the other, disease-free, breast).Even though this is rare, women who request such extended surgery are typically those women with a strong familial history (i.e., a first-degree relative, a mother, died of the disease at a young age), who are young when diagnosed (e.g., <45 years old), and who actively want to reduce their risk of recurrence, as the remaining breast is the most common site for disease progression (Harris, Morrow, & Bonadonna, 1993).Clinical psychologists juxtapose these medical facts about breast cancer with concern about the psychological and behavioral sequelae of the disease.Since the earliest research on the psychological aspects of cancer, breast cancer surgery has been viewed as difficult and, in some sense, traumatic.Although cancer, per se, can be a devastating illness, disease in the breast