No matter what their size and shape, a woman’s breasts are connected to both her body image and her total identity as a woman. Her identity encompasses everything she presents to society. A change in her female anatomy often causes a change in a woman’s self-perception. Although it is not a universal or inevitable reaction, a woman’s identity is often shattered with the loss of a breast or female organ.
Some women with cancer begin to define themselves through the disease or the consequences of treatment. These women create a barrier between themselves and others. They may see themselves several times a day and say, “So this is me. I don’t think of myself as a woman. I am not the total person I was when I entered into this relationship.”
Women with gynecological cancers can have as much identity difficulty as those with breast cancer, even though their exterior figures may remain intact. For them, the scars of one or more surgeries are evidence that the body is no longer the same. The resulting change in hormonal activity keeps reminding women of the changes to their bodies. Women who were planning to have children are deeply affected by infertility.
With this sense of a change and “defective” identity, the woman distances herself from her partner and from the mutual enjoyment possible during sexual activity. She defines herself as different and unlovable due to the effects of therapy. A woman who feels unattractive or ugly for an extended period of time following cancer treatment will withdraw from situations where she must interrelate with other people. They, in turn, perceive her as unfriendly or as preferring to be alone, and no longer try to interact with her, leading to further social isolation.
Depression
Early in the relationship, I was satisfied probably 85% of the time. Now I’m not satisfied. I’ve been on depression medicine. I keep hoping it’s that. My doctor changed my medicine. He says, “Maybe this one will work.”
Brenda
Depression occurs in about one in four women with cancer, twice the rate of the general population. Depression and anxiety are closely related, since they can be promoted by similar conditions such as the diagnosis of a severe and possibly life-threatening illness and the presence of unpleasant symptoms, such as pain, nausea, and fatigue. In addition, there are the worries about changes in life plans, quality of life, and disease recurrence.
Depression or anxiety may also be a side effect of some treatment, such as high-dose interferon therapy. Studies have shown that heightened anxiety and depression may last months or even years following successful treatment. Jed Diamond (Male Menopause) notes one of the differences between female and male depression is that the woman constantly wonders, “Am I loveable enough?” whereas the man wonders, “Am I being loved enough?” With love so closely associated with a woman’s figure and sex in their minds, most women treated for breast and female cancers ask themselves questions similar in nature.
It is neither unusual nor shameful to become depressed when you have cancer. If you think you might be suffering from depression, seek professional help. It can markedly improve your quality of life.
Anti-depressants have helped millions of people. But like all medications, each one will work better on some people than on others, because our bodies and metabolisms are different. According to Dr. Robert Hedaya, a leading psychopharmacologist and clinical psychiatrist, “[Only] 60 to70 percent of patients respond to even the most effective medications…Thus, antidepressant medications actually can be said to relieve only 50 percent of the symptoms in 60 to 70 percent of patients.” Therefore, it benefits patients to try and find one that works well for them.
Assessing whether an anti-depressant has the desired effect must be done in the context of the patient’s behavior and habits. Dr. Hedaya notes that “Caffeine, sugar, and alcohol are the three biggest saboteurs of antidepressants. They wreak havoc on your moods, energy levels, and weight…” Therefore, the first step is to assess whether you are doing anything that could prevent the drug from helping you.
Complicating the intimacy picture for post-cancer therapy patients is that a major side effect of most antidepressants is sexual dysfunction. Women may experience reduced libido. They may sense some numbness or reduced sensitivity in the genital area when they are touched, and thus take a longer time to reach orgasm. Some will fail to reach orgasm at all. Since these patients may have emerged from therapy with sexual problems in the first place, antidepressant treatments only compound these problems. So what can the patient do?
The first step is a discussion with your doctor about alternative anti-depressants with fewer sexual side effects. A possible option to discuss is the Bupoprion class of antidepressants, which has been found to have the lowest incidence of negative sexual side effects, and sometimes even to have positive sexual effects. Chapter 12 has more detail on this class of antidepressants. Often, women have to try several different antidepressants before they find one that works against depression and does not cause sexual problems. As always, any decision on medication changes must be made with your doctor.
Complementing your medication, perhaps even as an alternative to medication with your health care provider’s counsel, are techniques such as visualization and meditation, addressed briefly in Chapter 11, that can help you improve your mind-body balance.
Living With Breast Reconstruction
Many women who have had a double mastectomy expect or are given the impression that reconstruction will give them perfectly matched, equal size breasts. In the case of a single reconstruction, they usually believe that the reconstructed breast will closely match the existing breast. Unfortunately, depending upon the quality of the reconstructive surgery and the skill of the surgeon, this is often not the case.
Many women have found that a reconstructed breast, even one well matched at the beginning, may no longer match in situations of weight change and as they get older. Mismatch can also occur with changes in the implant itself.
Other possible complications following breast reconstruction include capsular contraction (tightening of the scar tissue that forms around the implant), infection, hematoma (where blood collects around the implant), delayed wound healing, shifting of the implant, and even rejection of the implant(s) by the body. Women should also be aware that implants are not permanent, and will need to be replaced at some point in the future, requiring further surgery.
One woman had to have nine surgeries related to the reconstructive surgery, some planned and some due to unexpected complications. Nevertheless, she is glad she had the reconstruction.
Some women who have reconstruction want their body’s appearance to be as close as possible to the figure they had before surgery, and some may hope for breasts that are superior in appearance to what they had before. Sometimes this is possible and sometimes it is not. Some women have reconstructive surgery because they want to continue pleasing their partners. Unfortunately, that does not always work. “I can’t get him to put his hand on that breast,” said one woman. “If I put it there, he’ll leave it on for a minute and then take it off.” Her husband comments that her reconstructed breast does not feel as soft and natural as her other breast. Some types of reconstruction feel more natural than others.
The biggest complaint about reconstruction is that women miss feeling aroused by the touch on the breast. The reason: Reconstruction is a cosmetic solution. It does not restore the nerves; therefore the sensitivity in the breast is lost. The good news is that a couple engaging in “whole-body sex” will find plenty of other areas to touch that will arouse both partners.
The greatest benefit expressed by women who have had reconstruction is that it makes them feel that their body looks normal and attractive. Some women who had “matching work” done on the other breast even feel they got an extra bonus because their breasts are now larger or smaller than before, making them look the way they always wanted.
In this chapter, we only