Psychological issues

When discussing the female breast, one must take into consideration it’s value as more than just an anatomical body part. Its importance is based on both the context and cultural influences. A breast is part of a living human being and cultural perceptions and attitudes can affect its significance. In Western society the breast has a highly sexual role, but breasts can also be seen in terms of their function (reproduction and lactation), cosmesis, emotion and psychology.

For centuries, the female breast has been a popular subject in literature, poetry and painting. Breasts are considered a symbol of femininity and beauty. Their functional significance is cross-cultural with regard to motherhood and the bond that accompanies breastfeeding between a mother and her child.

In contrast, in Eastern, South American and African cultures, the connotations associated with the female breast are less sexual. In these societies many other body parts or characteristics influence sexual attraction. In Western culture the breast also plays an important role in the sexual experience. Couples may use the breast as a source of sexual excitement and attach an erogenous significance.

The breast is therefore an indispensable part of the female body and makes a women feel whole. Hence, its loss can be extremely distressing. This degree of distress varies from individual to individual. It does not matter whether your breasts are large or small, they are a part of you and who you are as a person.

The perception of ones attractiveness can be affected by the opinion of others. Self image is also determined by the media, which has a significant impact in the modern era. Looking good is often equated with feeling good, both physically and psychologically but this is not always the case.

Feeling good about oneself cannot be determined by your size, weight or appearance. It’s all about ones physical, mental and social well-being. How we view ourselves and each other. Society often focuses only on fragments, parts of an individual: her hips, her thighs, and – especially in Western culture – her breasts. But what if we don’t like this part of our body? What if we actually lose this part? And what about the effect on the person as a whole?

What does a normal breast look like? Watch the following video by Laura Dodsworth: 

The breast and aesthetic surgery

It is important for you as a woman to accept responsibility for the way you look at your own body and how you decide to deal with the effects of illness or surgery. If you are dissatisfied with your breasts, you must find a way to cope with this feeling. Our body is the platform from which we perceive the world and in which we are observed. Our body image is more than just physical appearance. It tells us about the way we look at ourselves and whether we find ourselves worthwhile.

The significance of the role your breasts play will vary differently from woman to woman. Aesthetic or cosmetic surgery changes not only the body itself, but the way the body is perceived. It was previously assumed that women who opted for breast augmentation, had emotional problems but in fact they appear to be as psychologically stable as other women. The characteristic that these patients share is that they are more unhappy with their body image. This negative self-image can have serious consequences for their self-esteem, confidence and the feelings of being a complete women and sexual partner. The same psychological problems are also noted in women who wish to have a breast reduction. Constant awareness of the breasts in clothing, reinforced by the impression that people are always staring, coupled with functional problems, can be extremely self-destructive. Breast surgery, in both cases, results in a significant improvement in self-esteem and body image.

For these reasons, it is vital to include a psychological component in the assessment prior to surgery. Not every patient needs to go and see a psychologist or psychiatrist prior to surgery however! In additon to the medical consultation, during which the information and choice of procedure is determined, it is crucial to learn more about the women behind the patient. Both woman and surgeon need to understand each other: a woman must be clear why a particular implant has been chosen and how it will be positioned, but the surgeon should appreciate what the women is hoping to achieve and what her expectations are. Unrealistic expectations can later lead to even more psychological problems.
The plastic surgery process can be viewed as a contract where both the treatment team and the patient have a shared responsibility. Post operative support from a psychological point of view, in addition to the medical care, is an absolute requirement.

Your plastic surgeon’s input is usually all that is required as part of the counselling process but in some difficult cases, the assistance of a psychologist is useful. Body Dysmorphic Disorder (BDD) is a mental illness where one is excessively preoccupied with one’s appearance. Such individuals feel extremely unattractive and that feeling tends to dominate their lives. They often resort to cosmetic surgery, but on the grounds of their fragile mental health, fail to qualify. This disorder also includes depression and psychological or psychiatric counseling is indispensable.

The breast and reconstructive surgery

The diagnosis of cancer affects the depths of a woman’s physical and mental integrity. The significance of her breasts assumes a whole new dimension. Not only is the organ itself affected, but it becomes an enemy of the body as a whole. Women are therefore compelled to seek treatment of that breast, not just to restore their self-image but also for the overall health benefits. In that respect, some women have a frightening image of the breast functioning as a time bomb, especially if there are associated genetic factors.

After surgery, the connection with your body needs to be rediscovered. The ‘mutilation’ of the breast, a part of your whole person, is quite an intense experience. The way you deal with this emotion and the disease, plays an extremely important part in your recovery. It is not only physical but also a psychological adjustment process. Feelings of fear, shame, insecurity, anger and frustration can all be experienced. Your balance as a woman, literally and figuratively, needs to readjust.

Early on in the cancer process, intimacy and sexuality in particular, are usually affected. Over time, once the treatment has finished, a woman and her partner usually find a new equilibrium. Sexual satisfaction after the disease can be predicted on the basis of the overall psychological health and satisfaction of a relationship. The extent to which the breast was damaged, appears to have little impact. A couple that, despite the difficult period of illness and treatment, supports each other emotionally and continues to share intimacy through, for example, cuddling, generally returns to a fully satisfactory sex life, because both partners are already largely familiar with the physical changes that have occured.

Physical contact is important, and the pelvic area can be reinvigorated through massage oil and relaxation exercises. It is important to realize that the operated or missing breast is also in need of touching and caressing and it is a good way to become familiar with the changed body.

Unfortunately, for couples where distance has arisen during the illness, a feeling of uneasiness often prevails.

If you and your partner have totally stopped having sex because of the cancer, more work is needed to regain your sexual relationship. Open communication is vital. As a woman, you do not know what is going on in the mind of your partner and vice versa. The healthy partner may falsely assume that ill people do not need sex and can also feel guilty about their own sexual desires. It is also relatively common for men to avoid their sexual partners for fear of hurting them. If these fears remain unspoken, a woman sometimes thinks she is no longer attractive to her partner, leading to further psychological problems. The fear of infidelity by a healthy partner is an additional burden.

These facts clearly indicate that it is extremely important that the fears of both partners are identified and openly discussed as part of a personal and intimate relationship. It is obvious that a lack of emotional support may lead to mutual misunderstandings. Two people who love each other may even be driven apart. If such a situation continues, it can escalate and result in avoidance and an increasing psychological distance, making couples feel like strangers living side by side.

For many women, breast reconstruction can offer a solution. It is important that you are fully informed by your surgeon and crucial that he/ she shares in the significance of your breast for both partners. Your surgeon must also be aware of the expectations that you both have. If you show emotion during the consultation, it does not demonstrate psychological weakness. On the contrary, it shows security about your vulnerability in the relationship with your surgeon.

After an immediate reconstruction, when the mastectomy and breast reconstruction are performed at the same time, women often do not really feel that they have lost a breast. This is psychologically very important. The feeling of missing a breast can be devastating to some women’s body image. Reconstruction can be a positive event, even a significant time after the cancer treatment. Once again the psychological benefit is often almost as impressive as the physical one. The gap underneath your shirt, your bra, bikini is a constant reminder of your loss, a permanent association with illness, during a period of your life that you would like to forget.

Nevertheless, it is worth mentioning that not much psychological research exists on breast reconstruction and the decision to proceed is a very personal one. Practice shows that most women reach this decision themselves and only rarely does a women choose a reconstruction as a result of pressure from her partner. On the contrary, research shows that partners would prefer that there loved one avoided any additional operations, if possible.

Usually a woman chooses to proceed based on her own inner feelings and the perception of her body. This does not mean that open discussions with a partner about the impending surgery are not significant. On the contrary, a partner also needs sufficient time to get adjust to the change. The desire to be desired goes beyond external appearance, it is something very intimate and personal.