Epidemiology

Breast Cancer Research and Treatment

, Volume 126, Issue 1, pp 167-176

Effects of breast cancer surgery and surgical side effects on body image over time

  • Karen Kadela CollinsAffiliated withDivision of Health Behavior Research, Department of Medicine, Washington University School of MedicineAlvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine Email author 
  • , Ying LiuAffiliated withDepartment of Surgery, Washington University School of Medicine
  • , Mario SchootmanAffiliated withDivision of Health Behavior Research, Department of Medicine, Washington University School of MedicineAlvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • , Rebecca AftAffiliated withAlvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of MedicineDepartment of Surgery, Washington University School of MedicineJohn Cochran Veterans Administration Hospital
  • , Yan YanAffiliated withAlvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of MedicineDepartment of Surgery, Washington University School of Medicine
  • , Grace DeanAffiliated withDepartment of Psychiatry and Behavioral Sciences, UC Davis Health System
  • , Mark EilersAffiliated withDepartment of Surgery, Southern Illinois University School of Medicine
  • , Donna B. JeffeAffiliated withDivision of Health Behavior Research, Department of Medicine, Washington University School of MedicineAlvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Abstract

We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction) and surgical side-effects severity on early stage (0–IIA) breast cancer patients’ body image over time. We interviewed patients at 4–6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal relationships among body image problems, surgery type, and surgical side-effects severity using the Generalized Estimating Equation approach, controlling for demographic, clinical, and psychosocial factors. We compared regression coefficients of surgery type from two models, one with and one without surgical side-effects severity. Of 549 patients enrolled (mean age 58; 75% White; 65% BCS, 12% mastectomy, 23% mastectomy with reconstruction), 514 (94%) completed all four interviews. In the model without surgical side-effects severity, patients who underwent mastectomy with reconstruction reported poorer body image than patients who underwent BCS at T1–T3 (each P < 0.02), but not at T4. At T2, patients who underwent mastectomy with reconstruction also reported poorer body image than patients who underwent mastectomy alone (P = 0.0106). Adjusting for surgical side-effects severity, body image scores did not differ significantly between patients with BCS and mastectomy with reconstruction at any interview; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The impact of surgery type on body image within the first year of definitive surgical treatment was explained by surgical side-effects severity. After 2 years, body image problems did not differ significantly by surgery type.

Keywords

Body image Breast cancer Psychosocial factors Quality of life Surgical side effects Surgery type