Unless otherwise noted, information for this
section was drawn from a literature review about the psychological history of
conceptualization of breast reconstruction by Harcourt & Rumsey in 2001.
Demographic information obtained from various cancer related studies has indicated
that typically younger married white women from higher socioeconomic
backgrounds are more likely to decide upon reconstruction. Motivating factors
have been identified that include attempts to "restore feelings of
femininity and wholeness, avoid disfigurement and deformity, improve
self-confidence and to avoid an external prosthesis.
" Women often choose reconstruction as a manner of coping
or even processing their mastectomy and battle with their cancer diagnosis.
The original research of the intersection of breast reconstruction and
psychology predominately focused on the affective response of women who had
decided upon breast reconstruction.
Dissertation work
(Covich, 1999) and previous research (Harcourt & Rumsey, 2001) reported
that there
were not significant difference
s for measures of
depression, anxiety, or self-esteem between women who opted for immediate
reconstruction, delayed reconstruction, or no post-mastectomy reconstruction.
Additionally, although original research hypotheses predicted that body image satisfaction
would be higher for both reconstructive groups than for the mastectomy-only
group, women who had decided not to undergo reconstruction actually reported
higher overall body satisfaction than their reconstruction peers. Covich (1999)
proposed that women most likely opted for immediate reconstruction hoping to
"put breast cancer behind them" and attempting to diffuse their
anxieties around possible cancer recurrence. Despite the process though of
reshaping their chest to somewhat of its previous form, they reported similar
levels of anxiety to other survey
participants,
possibly because as one respondent stated "I can't believe that anyone who
has had cancer does not worry."
Although research results varied to some extent, Harcourt & Rumsey
(2001) concluded at the end of their extensive literature review that there was
not necessarily a psychological benefit at a group level for women who had
chosen reconstruction in comparison with those who remained mastectomy-only. In
fact, additional research proposes that women contemplating reconstructive
surgery may face greater psychological distress due to the decision making
process, undergoing additional medical procedures, fears of complications,
ongoing physical pain as a result of implants and/or further tissue removal,
dissatisfaction with aesthetic, or logistical outcomes of the reconstructed
breast (Harcourt & Rumsey, 2004). Although complications are more uncommon
now than in the past few decades,
Deborah
Yardley, who had already undergone a double mastectomy and "two years
later, desperate to reclaim her femininity... underwent reconstructive breast surgery",
died on the operating table after receiving
double
the recommended dose of anesthetic.
After roughly two decades with limited discernible differences in affective
states for women between various groups, more recent work has focused on
motivating factors, the levels of satisfaction with their decision,
social support, influence of medical experts, and attempting to map and
understand the decision making process. For example, the top three motivating
factors identified on a survey for choosing reconstruction included not having
to wear an external prosthesis, increasing feelings of femininity, and to feel
sexually attractive and avoid changes to their sexual relations (Contant et
al., 2000). Regarding the topic of sexuality, dissertation work has
indicated that a positive shift in sexual satisfaction is likely to occur after
reconstructive surgery, in addition to reported improvement in quality of life
(Lee, 2000). Intimacy concerns are generally prevalent amongst all patients and
books such as
Intimacy After Breast Cancer: Dealing With Your Body,
Relationships, and Sex by
Gina
Maisano help women to begin understanding and navigating what can be a
difficult road.
Given the discussion of the bulk of research covered above, Harcourt &
Rumsey (2004) criticized much of the research for approaching these topics
retrospectively. Instead, they attempted to understand the process leading up
to the actual breast reconstruction decision. Their article, which has been
cited at least nineteen times, aided the critical discourse in the field in
trying to expand the methodological "net" wider to understand the
process women engage in
addition to the outcome. Ultimately, the
research pair from the University of the West of England attempt to specify the
psychological needs of women when entering into the decision making process and
trying to identify avenues to successfully meet those needs within the
healthcare field.
Evaluating women's decision making processes on variables including the time
it takes to make a decision, the degree of information seeking the patient
engages in, patient's mood and their overall confidence in their decision has
allowed the authors to break down female patients into three main categories of
information-seeking, instant/immediate, and indecisive decision makers.
Furthermore, most women in the study who were instant/immediate decision makers
(i.e. would decide in the first meeting regarding their cancer treatment
whether or not to undergo reconstruction) did
not choose to have
reconstructive procedures. The authors attributed this trend to patients'
attentions being focused on the immediate stressors of the diagnoses and unable
to give psychological attention and energy to contemplating additional
"extra" operations. Women in the study reported feeling rushed to
make a decision or that they did not fully understand the options available to
them when communicating with providers. Contingent upon the different
approaches women may take, Harcourt & Rumsey suggested that the healthcare
field should formulate materials to disseminate information in a way that is
fitting of the patient's decision making style and provide better emotional
support: "Future research needs to examine ways of facilitating
decision-making
including
the use of decision-aids, amongst women who find the decision especially
difficult" (Harcourt & Rumsey, 2004). It is through this route that
the authors propose positive increases to patient satisfaction regardless of
their choice.
[Although not directly related, to gain an understanding of Harcourt &
Rumsey's theoretical approach to research and patient care, please consider
watching their video for the Centre for Appearance Research that they are
co-founders of in England.]
Try this link if embedded video link is
broken.
Centre for Appearance Research from
Back To The Planet on
Vimeo.
Contant C.M.E., Van Wersch A.M.E.A., Wiggers T., Wai R.T.J., Van Geel A.N.
(2000). Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy.
Patient Education and Counseling,
40 (3), pp. 201-208.
Covich, J. L. (1999). The relationship between breast
reconstruction and psychological adjustment when a mastectomy is necessary. The
University of Texas at Austin). ProQuest Dissertations and Theses, ,
159-159 p. Retrieved from
http://ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/docview/304541984?accountid=7118
Harcourt, D. and Rumsey, N. (2001). Psychological aspects of breast
reconstruction: a review of the literature. Journal of Advanced Nursing,
35: 477–487. doi: 10.1046/j.1365-2648.2001.01865.x
Harcourt, D. and Rumsey, N. (2004), Mastectomy patients'
decision-making for or against immediate breast reconstruction.
Psycho-Oncology, 13: 106–115. doi: 10.1002/pon.711
Lee, R. F. (2000). Sexual satisfaction and self-image
after post-mastectomy TRAM flap breast reconstruction. Gonzaga University).
ProQuest Dissertations and Theses, , 102-102 p. Retrieved from
http://ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/docview/230622476?accountid=7118