Younger women appear to experience more concerns about body image,98 greater emotional distress99,100 and poorer adjustment100 following breast surgery than older women.
There is little evidence to suggest a substantial difference in post-operative psychological morbidity according to type of surgery.101 However, some research suggests that younger women experience greater distress following mastectomy than breast conserving surgery.102 Women who undergo breast conserving surgery are also more likely to report better body image than those who have a mastectomy.103 Breast conserving surgery provides an opportunity to preserve the breast shape, facilitates a better fit of clothing, and usually avoids the need for a prosthesis or reconstructive surgery. Evidence that younger women are generally more likely to select breast conserving surgery over mastectomy87,101,104 suggests that concern for body image is an important consideration.
Several studies have reported that, for many young women, fear of cancer and recurrence are prevalent following surgery.50-52 Women may also experience sexual difficulties,105,106 such as a reluctance to resume sexual relations, loss of libido, or feelings of sexual unattractiveness.107
Breast reconstruction
Women report a number of benefits following reconstruction, including more positive body image,108 more positive partner attitudes,109,110 feeling more comfortable without a prosthesis,110 feeling ‘whole’ again, and thinking less about cancer.111,112
There has been little systematic research about age and reconstruction. One exception is a recent study that examined age-related patient satisfaction and psychosocial morbidity following surgery. Among women aged younger than 40 years, those who had breast conserving surgery or reconstruction were less likely to feel sexually unattractive or anxious, and reported more positive body image, than those who had a mastectomy alone.113 In one small randomised trial
involving 64 women aged younger than 60 years,women who received breast reconstruction had lower rates of psychological distress in the short term and improved body image at three and 12 months post-surgery compared with controls.114
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