The psychological and emotional impact and ways to deal with it.

“The female breast has an influence on a woman’s self-perception but also on how a woman is perceived by the society, by others.” White CA. Psycho Oncology. 2000 May-Jun;9(3):183–92. 

Breast cancer is a lot more complex than most people realize. The treatment, which can include several types of procedures, including lumpectomy, mastectomy, double mastectomy, and breast reconstruction specific to the patient, can have profound mental and emotional effects along with the obvious physical changes. At the time of diagnosis, most women experience a combination of numbness, disbelief, fear, anxiety, anger, and sadness. The tight schedule of diagnosis followed by biopsy and treatment can be overwhelming and limits any chance of truly taking a deep breath and dealing with the psychological stress of this diagnosis.

The breast itself is associated with femininity, motherhood, and sexuality and is part of the innate identity for most women. 

When the treatment process results in the loss of one or more breasts, the struggle and adjustment to a new normal can be an emotional rollercoaster. Mourning the loss of natural breasts along with a long physical recuperation period, whether or not you have reconstruction immediately or delayed, or even if you decide to go flat, is part of the recovery process. There is also the very real possibility of things not going the way they were anticipated. Breast reconstruction is a complicated process, and multiple surgeries can be necessary to achieve the best result. The body is only able to handle so many changes at a time, and over time, reconstructed breasts change and settle after surgery, so something that looks great on the operating room table may not look the same months or years later.

Managing expectations and dealing with unexpected complications is part and parcel of a breast cancer patient’s life as well as of the cancer care team taking care of the patient. 

Good communication and partnership between the patient and surgeon play a major role in how well the patient is able to deal with these procedures. The scars, change in shape and size, and decreased sensation in the breast can be depressing and affect the self-esteem of patients. It can take months and years for scars and tissue to heal, as well as for normal feelings to return. In most cases, feeling will never be restored to its original level. Most times, it is not about the mastectomy or a perfect breast after reconstruction. It is about feeling as normal as possible and as close as possible to how things were prior to the diagnosis. It is about getting used to their new body, reclaiming intimacy, and a return to a “couple” dynamic rather than a patient-caregiver relationship with their significant other.

Patients can have a profound sense of isolation and loneliness after the completion of all treatment.

Some of this may be related to family and friends who think that once surgery and treatment are over, you will be back to normal, even though this may not be true. Another compounding factor is the decreasing frequency of doctor visits. After months or years of treatment, regular close follow-up with your cancer care team, talking to and sharing your thoughts and fears with other patients during chemo treatments, and more, many women begin to feel as though they are losing their safety net of support. Some patients feel that they are now on their own to handle any issues that arise in the future and that they do not have the systems in place to see their doctor often. A fear of cancer recurrence is never far from the mind.

It is important to address concerns and fears as well as restore self-esteem and confidence. This should be considered as part of the treatment. 

Some of the ways that you can advocate for your mental and emotional wellbeing include:

• Accept your emotions. They are valid and address your fears with a healthcare provider, licensed mental health professional, trusted friend, or other survivors.
• Prioritize self-care. Focus on finding daily activities that not only make you feel good but also relieve stress and improve your well-being. This could mean reading a favorite magazine, meditating, gardening, or playing with your pet.
• Practice mindfulness or meditation. Awareness in the moment often helps reduce anxiety, stress, and fear of recurrence. Mindful meditation uses specific breathing methods and may include guided imagery, as well as other relaxation and stress reduction techniques. Research shows mindfulness meditation helps reduce stress, anxiety, and fear.
• Take control of your health. Ask your doctor for a written follow-up care plan, including what exams you need in the future and how often you should have them. Talking to your doctor about the appropriate schedule of continued check-ups will help you feel more empowered and in control. It is important that you understand that doctors and the support team are still there for you.
• Be alert and informed. Ask your doctor for a list of symptoms you should report to him or her in between check-ups, such as new lumps, bleeding, or pain.
• Maintain a healthy lifestyle. Get enough sleep and eat a healthy diet. Data shows that a Mediterranean, predominantly plant-based diet is a good way to get the essential nutrients you need to maintain good health.
• Join a support group for breast cancer survivors. Getting to know other cancer survivors will help you feel less alone as you learn how they are coping with the same worries.
• Try to find ways to communicate with loved ones. Share your thoughts and feelings with them. A support system that you are comfortable with and that will be there for you is an essential part of survivorship.
• Live in the present. Finding ways to feel grounded and focused on the present moment can help to avoid feelings of worry about future events and outcomes. Prayer and spiritual practices are helpful to some cancer patients. Other options include meditation and mindfulness exercises.
• Keep a journal. Journaling helps control your symptoms and improve your mood by helping you prioritize problems, fears, and concerns. Tracking symptoms every day helps you recognize triggers and learn ways to better control them. Journaling also provides an opportunity for positive self-talk and identifying negative thoughts and behaviors so you can start to change for the better.
• Make time for exercise. There is robust data that shows consistent exercise based on your physical capabilities, even if that means light walking for 30 minutes each day, can play a significant role in managing mental health, including anxiety and depression.

Licensed psychologists and other mental health professionals with experience in breast cancer treatment can be a fantastic support system for breast cancer survivors. Their primary goal is to help women learn how to cope with the physical, emotional, mental, and lifestyle changes associated with cancer.

Above all, make peace with yourself.

The end of breast cancer treatment begins a new phase of your life and a new normal. Regaining a sense of balance and normalcy afterward can be as challenging as the disease treatment itself. Your breasts may look and feel different, but beneath it all, they are still quintessentially you.