Coping With the Loss of a Breast

By: David Wellisch, PhD
By: Mary Jane Massie, MD
Perhaps one of the most frightening things a woman could hear her doctor say is, "You have breast cancer." The potential health impact of any cancer is traumatic enough, but when it?s breast cancer there are myriad psychological, emotional and sexual issues that complicate the picture. The impact of the loss of one or both breasts cannot be underestimated.
Below, Mary Jane Massey, a psychiatrist at Memorial Sloan-Kettering Cancer Center and Dr. David Wellish, a psychologist at the UCLA School of Medicine, discuss methods that can help women, and their loved ones, come to terms with this difficult process.

Q: What sort of psychological issues develop for patients who are facing a mastectomy before they have the surgery?
DAVID WELLISCH, MD: There can be the issues of more extensive body image alteration and anxiety about what that?s going to be like. Especially for some groups of women, such as women who are unmarried or without partners, that may add to their concerns about finding a suitable significant other.

Q: Do patients sometimes underestimate the impact of losing one or both breasts?
MARY JANY MASSEY, MD: We have so many opportunities for women to talk with other women before surgeries. Most surgeons have superlative nursing education teaching teams. Many centers have mental health professionals--psychiatrists, psychologists, social workers, psychiatric nurse clinicians--who are part of the team, so I don?t think women have the surprises that they felt they had in the 1970s. Many women have seen several breast surgeons or have seen plastic surgeons. They?ve had ample time to talk with other women who have gone through the procedure. They see pictures of what a mastectomy scar looks like, or what a reconstructed breast looks like.


DAVID WELLISCH, MD: But there is a very common and expected reaction to the loss of a breast, and that is grief and mourning. Women need to understand that this is not an abnormal reaction or any kind of a mental illness. It is a normal reaction to loss, and they can expect that they will have some period of grief and mourning until they feel resolved.

Q: Initially, I would presume, the goal is, "Let?s get rid of the cancer, and if it means a mastectomy, let?s do it." but other issues might develop over a period of time after the surgery, when things have calmed down again.
DAVID WELLISCH, MD: That?s right. I think that there can be a great deal of relief over getting this out of one?s body. But then, yes, other feelings do start to come up naturally and understandably.

Q: How can reconstruction help, and is there a downside?
MARY JANY MASSEY, MD: Many women who have reconstruction say it kind of diminished the impact of the loss. The downside is that some procedures are quite lengthy. Most of my patients who are considering reconstruction want to talk with me about length of time under anesthesia, and sometimes, for women who have implants placed, there are weeks of weekly visits to the plastic surgeon?s office to complete the expansion process, and there are several surgeries. Women, together with their surgeons, need to think through, "What would I like to do, and what am I really able to do, given what else is going on in my cancer treatment and in my life to make this an appropriate choice for myself?"
Q: One of the things that you think a breast cancer patient should absolutely not hear from anyone is, "It?s just a breast. No big deal."
DAVID WELLISCH, MD: Right. Those are, at times, fatal words from a husband or spouse. "I didn?t marry you for your breast. Get over it." There are three or four other things that I think are important for men to consider. I think they need to consider not trying to give the women a pep talk, as if this was some sort of a sporting event. I counsel them not to play Santa Claus and try to make up for a sense of loss by giving her gifts. I think the other thing men need to remember is that although a woman may be initially somewhat less interested in sex, maybe, they still very much want and need affection and that men shouldn?t back off from them.

Q: How important is it for a mastectomy patient to get therapy for these issues? Do you think enough of them are being referred to a psychologist or a psychiatrist?
DAVID WELLISCH, MD: The most fundamental issue is the threat to her life, of having what is potentially--obviously not always--a life-threatening illness. Whether a woman has had conservative surgery or a mastectomy, there still remains for all women a threat to their lives. That is a fundamental psychological issue to be dealt with.


Q: Absolutely. And not just for the patient, but for the friends, family members, and children who surround the patient. Are you seeing a move to make sure that those groups get counseling as well?
DAVID WELLISCH, MD: We?re seeing some move. Still, the primary focus remains on the patient herself, but there is certainly more consciousness about the needs of children and significant others.

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