Annals of Surgical Oncology

, Volume 24, Issue 11, pp 3133–3140 | Cite as

Breast-Specific Sensuality and Sexual Function in Cancer Survivorship: Does Surgical Modality Matter?

  • Jennifer S. GassEmail author
  • Michaela Onstad
  • Sarah Pesek
  • Kristin Rojas
  • Sara Fogarty
  • Ashley Stuckey
  • Christina Raker
  • Don S. Dizon
Breast Oncology



More early-staged breast cancer patients are choosing mastectomy. No studies have addressed breast-specific sensuality (BSS), defined as the breast’s role during intimacy. We explored BSS among women undergoing lumpectomy (L), mastectomy alone (M), or with reconstruction (MR) and analyzed the association of surgical modality with sexual function.


Women undergoing breast cancer surgery between 2000 and 2013 were eligible for survey using investigator-generated questions and the Female Sexual Function Index (FSFI). Demographic and surgical data were collected by chart review. The Kruskal–Wallis test was used to analyze FSFI scores, and χ 2 or Fisher’s exact tests were used for categorical data.


Of 453 invited participants, 268 (59%) completed the survey. Of these, 69.4, 22.4, and 8.2% underwent L, MR, or M, respectively. The importance of the breast/chest wall during intimacy declined significantly regardless of surgical modality (L 83–74%, p = 0.0006; M 95–47%, p = 0.003; MR 93–77%, p = 0.002). No difference in sexual function was found between L, MR, and M (median FSFI score 28.2, 27.5, 25.9, respectively; p = 1.0). Comparing L versus MR, higher FSFI scores resulted with appearance satisfaction (29.0 vs. 22.6 p = 0.002) and preserved BSS as pleasurable breast caress (28.8 vs. 26.5, p = 0.04) and the breast as part of intimacy (28.8 vs. 24.8, p = 0.1).


Breast cancer surgery is associated with lowered BSS. However, BSS and appearance satisfaction scores are better for L and appear to correlate with improved sexual function postoperatively. These data may guide surgical counseling and contribute to survivorship outcomes.


  1. 1.
    Fisher B. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–1241.CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–1232.CrossRefPubMedGoogle Scholar
  3. 3.
    Kummerow KL. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.CrossRefPubMedGoogle Scholar
  4. 4.
    Rutter CE. Growing use of mastectomy for ductal carcinoma-in situ of the breast among young women in the United States. Ann Surg Oncol. 2015;22(7):2378–2386.CrossRefPubMedGoogle Scholar
  5. 5.
    Rosenberg SM. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–381.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Fisher CS. Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. Ann Surg Oncol. 2012;19(10):3246–3250.CrossRefPubMedGoogle Scholar
  7. 7.
    Fancher TT. A woman’s influence to choose mastectomy as treatment for breast cancer. J Surg Res. 2009;153(1):128–131.CrossRefPubMedGoogle Scholar
  8. 8.
    Matsen CB et al. Skin flap necrosis after mastectomy with reconstruction: a prospective study. Ann Surg Oncol. 2016;23(1):257–64.CrossRefPubMedGoogle Scholar
  9. 9.
    El-Tamer MB et al. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Schover, L.R et al. (1995) Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer. 1995; 75(1):54–64.Google Scholar
  11. 11.
    Avis NE, Crawford S, Manuel J. Psychosocial problems among younger women with breast cancer. Psychooncology. 2004;13(5):295–308.CrossRefPubMedGoogle Scholar
  12. 12.
    Knobf MT. The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nurs. 2001;24(3):201–210; quiz 210–1CrossRefPubMedGoogle Scholar
  13. 13.
    Wilmoth MC. The aftermath of breast cancer: an altered sexual self. Cancer Nurs. 2001;24(4):278–86.CrossRefPubMedGoogle Scholar
  14. 14.
    Fobair, P et al. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Speer JJ et al. Study of sexual functioning determinants in breast cancer survivors. Breast J. 2005;11(6):440–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Meyerowitz BE et al. Sexuality following breast cancer. J Sex Marital Ther. 1999;25(3):237–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Ganz PA et al. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501–14.CrossRefPubMedGoogle Scholar
  18. 18.
    Ganz PA et al. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol. 1999;17(8):2371–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Thors CL, Broeckel JA, Jacobsen PB. Sexual functioning in breast cancer survivors. Cancer Control. 2001;8(5):442–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Rowland JH et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Ganz PA et al. Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst. 2004;96(5):376–87.CrossRefPubMedGoogle Scholar
  22. 22.
    Engel J et al. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3):223–31.CrossRefPubMedGoogle Scholar
  23. 23.
    Pozo C et al. Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol. 1992;10(8):1292–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Yurek D, Farrar W, Andersen BL. Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol. 2000;68(4):697–709.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Perez M et al. Changes in sexual problems over time in women with and without early-stage breast cancer. Menopause. 2010;17(5):924–37.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Aerts L et al. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast. 2014;23(5):629–36.CrossRefPubMedGoogle Scholar
  27. 27.
    Rivadeneira, D.E et al. Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J. 2000;6(5):331–335.PubMedGoogle Scholar
  28. 28.
    Petit JY et al. When mastectomy becomes inevitable: the nipple-sparing approach. Breast. 2005;14(6):527–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Gerber B et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238(1):120–7.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Wang F et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21(10):3223–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Didier F et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118(3):623–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Levin R. The breast/nipple/areola complex and human sexuality. Sex Relation Ther. 2006;21(2):237–49.CrossRefGoogle Scholar
  33. 33.
    Levin R, Meston C. Nipple/breast stimulation and sexual arousal in young men and women. J Sex Med. 2006;3(3):450–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Turnbull OH et al. Reports of intimate touch: erogenous zones and somatosensory cortical organization. Cortex. 2014;53:146–54.CrossRefPubMedGoogle Scholar
  35. 35.
    Robinson VC. Support for the hypothesis that sexual breast stimulation is an ancestral practice and a key to understanding women’s health. Med Hypotheses. 2015;85(6):976–85.CrossRefPubMedGoogle Scholar
  36. 36.
    Rosen, R et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRefPubMedGoogle Scholar
  37. 37.
    Baser RE, Li Y, Carter J. Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer. 2012;118(18):4606–18.CrossRefPubMedGoogle Scholar
  38. 38.
    Mohammedi J. The Female Sexual Function Index [Fsfi]: Validation of the Iranian version. Payesh. 2008;7(3):269–78.Google Scholar
  39. 39.
    Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Bartula I, Sherman KA. The Female Sexual Functioning Index (FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support Care Cancer. 2015;23(9):2633–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Meyer-Bahlburg, H.F., Dolezal C., The female sexual function index: a methodological critique and suggestions for improvement. J Sex Marital Ther. 2007;33(3):217–24.CrossRefPubMedGoogle Scholar
  42. 42.
    Hayes RD. Assessing female sexual dysfunction in epidemiological studies: why is it necessary to measure both low sexual function and sexually-related distress? Sex Health. 2008;5(3):215–8.CrossRefPubMedGoogle Scholar
  43. 43.
    (SEER), N.C.I. Cancer Stat Facts: Female Breast Cancer 2013;
  44. 44.
    Hewitt M, Stovall E. From cancer patient to cancer survivor: lost in translation, 2006.Google Scholar
  45. 45.
    Harris J. Diseases of the breast. Lippincott Williams & Wilkins, 2014.Google Scholar
  46. 46.
    Langellier KM, Sullivan CF. Breast talk in breast cancer narratives. Qual Health Res. 1998;8(1):76–94.CrossRefPubMedGoogle Scholar
  47. 47.
    Young I. Breasted experience: the look and the feeling philosphy and medicine. 1992;43:215–230.Google Scholar
  48. 48.
    Gilbert E, Usher JM, Perz J. Sexuality after breast cancer: a review. Mauritius. 2010;66:397–407.Google Scholar
  49. 49.
    Spence J. Cultural sniping: the art of transgression. London: Sage, 1995.Google Scholar
  50. 50.
    Moyer A. Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol. 1997;16(3):284–98.CrossRefPubMedGoogle Scholar
  51. 51.
    Mock V. Body image in women treated for breast cancer. Nurs Res. 1993;42(3):153–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Kwait R, Pesek S, Onstad M, Edmonson D, Ghandi C, Raker C, Stuckey A, Gass J. Preserving sexual function in breast cancer survivorship: does surgical modality matter? Ann Surg Oncol. 2016;23:93–94CrossRefGoogle Scholar
  53. 53.
    Butler EC, Kwait R, Pesek S, Stuckey A, Gass JS. Appearance satisfaction in breast cancer survivorship: does time heal and does surgical modality matter? Poster Session presented at American Society of Breast Surgery Annual Meeting, Las Vegas, NV (2017)Google Scholar
  54. 54.
    Peled AW et al. Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72(Suppl 1):S48–52.PubMedGoogle Scholar
  55. 55.
    Schlenz I et al. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000;105(3):905–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Bresser PJ et al. Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg. 2006;117(6):1675–1682; discussion 1683–4.CrossRefPubMedGoogle Scholar
  57. 57.
    Temple WJ et al. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol. 2006;24(21):3367–73.CrossRefPubMedGoogle Scholar
  58. 58.
    Murthy V, Chamberlain R. Defining a place for nipple sparing mastectomy in modern breast care: an evidence based review. Breast J. 2013;9(6):571–81.CrossRefGoogle Scholar
  59. 59.
    Dossett L et al. Prospective evaluation of skin and nipple-areola sensation and patient satisfaction after nipple-sparing mastectomy. J Surg Oncol. 2016;114(1):11–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Khan A, Zhang J, Sollazzo V, Mohammed K, Gui G. Sensory changes of the reconstructed breast envelope after skin-sparing mastectomy. EJSO. 2016;42:973–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Peled AW et al. Patient reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72:276–80.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Jennifer S. Gass
    • 1
    • 2
    Email author
  • Michaela Onstad
    • 3
  • Sarah Pesek
    • 4
  • Kristin Rojas
    • 5
  • Sara Fogarty
    • 6
  • Ashley Stuckey
    • 1
    • 7
  • Christina Raker
    • 8
  • Don S. Dizon
    • 9
    • 10
  1. 1.Breast Health CenterWomen and Infants’ HospitalProvidenceUSA
  2. 2.Department of SurgeryBrown University Warren Alpert Medical SchoolProvidenceUSA
  3. 3.Gynecologic OncologyMD Anderson Cancer CenterHoustonUSA
  4. 4.St. Peter’s HospitalSt. Peter’s Health Partners Medical AssociatesAlbanyUSA
  5. 5.Obstetrics and GynecologyWomen and Infants’ HospitalProvidenceUSA
  6. 6.Department of SurgeryGreater Baltimore Medical CenterTowsonUSA
  7. 7.Gynecologic OncologyWomen and Infants HospitalProvidenceUSA
  8. 8.Division of ResearchWomen and Infants’ Hospital of Rhode IslandProvidenceUSA
  9. 9.Gynecologic OncologyMassachusetts General HospitalBostonUSA
  10. 10.Harvard Medical School, MedicineBostonUSA

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