It’s important to respect the different ways that young women feel after mastectomy

In the UK, nearly 10,000 young women are diagnosed with breast cancer every year and the treatment for many is mastectomy – the surgical removal of one or more of their breasts. It's easy to assume that the effect on their body image will be negative, and UK guidelines currently state that all mastectomy patients should be told about options for reconstructive surgery. However, a key message to emerge from a new survey of young women who have undergone mastectomy is that there is huge variability in how they are affected, and that any support therefore needs to be individualised.

Sarah Grogan and Jayne Mechan (the latter has a diagnosis of breast cancer) conducted an online survey of 49 women recruited via an online support network, all of whom had undergone unilateral or bilateral mastectomy before the age of 45. Analysing their answers, the researchers identified four main themes.

The first concerned the way the women spoke of how they'd initially downplayed worries of aesthetics because their priority was survival. They also distanced themselves from the affected parts of their breasts and objectified them: "The thing for me was just to remove the offending article", "I just had a gut feeling that I wanted the whole thing taken …".

Post-mastectomy, body confidence became an issue, but some coped better than others. "I have lost all self-confidence in my naked body," said one woman. "Body image has never worried me. I am who I am and I don't go out to impress people," said another.

The third theme was "changed identity". Some women described compensating for their changed appearance: "wearing skirts, more make-up", said one. "I want my body to look and feel strong so am doing quite a lot of weight lifting to try and remove the feeling that my body was weak and failed me," said another. Others described the difficulties of adjustment: "I feel like I don't recognise myself anymore. I used to wear low cut tops and now I cover up."

The final theme on the effects of cancer treatment, including scars, weight gain and early menopause also revealed a variety of experiences among the women. Some took a positive view: "My scars are my war wounds of life. … I'm proud of them". Others described how they were more bothered by the overall changes to their appearance: "Do not feel great about body image at all. Have gained weight due to early menopause, think that bothers me more than my breasts".

The researchers said their results suggested women undergoing mastectomy may benefit from interventions that include body acceptance techniques and advice on media literacy, to help them critique cultural pressure to be slender. Above all they said they were struck by the "variability of experience of women experiencing a relatively similar event." They said this insight has implications for health professionals – "it is important [they] do not expect homogenous patterns of negative responses in women who have had mastectomies so that they are able to provide tailored support if and when needed."

Further reading

Grogan, S., & Mechan, J. (2016). Body image after mastectomy: A thematic analysis of younger womens written accounts Journal of Health Psychology DOI: 10.1177/1359105316630137