The impact of mastectomy on body image and sexuality in women with breast cancer: a systematic review
- Bárbara Martins Faria Federal University of Uberlândia. Minas Gerais - Brazil
- Isabela Martins Rodrigues Federal University of Uberlândia. Minas Gerais - Brazil
- Leticia Verri Marquez Federal University of Uberlândia. Minas Gerais - Brazil
- Uriel da Silva Pires Federal University of Uberlândia. Minas Gerais - Brazil
- Stefan Vilges de Oliveira Federal University of Uberlândia. Minas Gerais - Brazil
Abstract
Objective: The study aims to evaluate the impact of mastectomy on body image and sexuality of women with breast cancer, as well as to provide a general understanding of their quality of life. Method: This review followed the PRISMA guidelines. The expression “Mastectomy AND (sexuality OR “body image”)” was searched in Lilacs, Scielo, Pubmed and Scopus databases. Articles published in English, Portuguese and Spanish between 2010 and 2020 were selected. The text analysis was carried out by peers. Results: 69.3% (43) of the studies presented mastectomy as a technique that worsens body image, sexual functioning and quality of life of women. Less radical procedures, such as breast-conserving surgery, showed lower impact on these indicators. Breast reconstruction is an alternative to mitigate breast surgery impacts. Conclusion: Mastectomy caused the major impacts on body image, sexual functioning and quality of life. These implications need to be considered during therapeutic choice.
Downloads
Author Biographies
References
Winters S, Martin C, Murphy D, Shokar NK. Breast Cancer Epidemiology, Prevention, and Screening. Prog Mol Biol Transl Sci 2017;15:1–32. doi: https://doi.org/10.1016/bs.pmbts.2017.07.002
Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019;144:1941–53. doi: https://doi.org/10.1002/ijc.31937
Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Poortmans P, et al. Breast cancer. Nat Rev Dis Prim 2019;5:66. doi: https://doi.org/10.1038/s41572-019-0111-2
Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast. 2015;24:175–81. doi: https://doi.org/10.1016/j.breast.2015.02.002
McLaughlin SA. Surgical management of the breast: breast conservation therapy and mastectomy. Surg Clin North Am 2013;93:411–28. doi: https://doi.org/10.1016/j.suc.2012.12.006
Sinnadurai S, Kwong A, Hartman M, Tan EY, Bhoo-Pathy NT, Dahlui M, et al. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open 2018;3:48–55. doi: https://doi.org/10.1002/bjs5.50111
Türk KE, Yılmaz M. The effect on quality of life and body image of mastectomy among breast cancer survivors. Eur J Breast Heal 2018;14:205–10. doi: https://doi.org/10.5152/ejbh.2018.3875
Kołodziejczyk A, Pawłowski T. Negative body image in breast cancer patients. Adv Clin Exp Med 2019;28:1137–42. doi: https://doi.org/10.17219/acem/103626
Muzzatti B, Annunziata MA. Body image assessment in oncology: an update review. Support Care Cancer 2017; 25:1019–29. doi: https://doi.org/10.1007/s00520-016-3538-y
Koçan S, Gürsoy A. Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research. J Breast Heal. 2016;12:145–50. doi: https://doi.org/10.5152/tjbh.2016.2913
Lindau ST, Abramsohn EM, Matthews AC. A manifesto on the preservation of sexual function in women and girls with cancer. Am J Obs Gynecol 2015;213:166–74. doi: https://doi.org/10.1016/j.ajog.2015.03.039
Elmas Ö, Çakmak GK, Bakkal BH. A comparison between breast-conserving surgery and modified radical mastectomy concerning the female sexual function in breast cancer patients under 50 years of age. Turk J Oncol 2020;35:26–30. doi: https://doi.org/10.5505/tjo.2019.2135
Aerts L, Christiaens MR, Enzlin P, Neven P, Amant F. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: A prospective controlled study. Breast 2014;23:629–36. doi: https://doi.org/10.1016/j.breast.2014.06.012
Akça M, Ata A, Nayır E, Erdoğdu S, Arıcan A. Impact of surgery type on quality of life in breast cancer patients. J Breast Heal 2014;10:222–8. doi: https://doi.org/10.5152/tjbh.2014.1919
Archangelo SC V, Neto MS, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clin (Sao Paulo) 2019;74. doi: https://doi.org/10.6061/clinics/2019/e883
Arraras JI, Illarramendi JJ, De La Cruz S, Asin G, Manterola A, Ibanez B, et al. Quality of life in long-Term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery. J BUON 2016;21:1090–8.
Bhat V, Roshini AP, Ramesh R. Does Quality of Life Among Modified Radical Mastectomy and Breast Conservation Surgery Patients Differ? A 5-Year Comparative Study. Indian J Surg Oncol 2019;10:643–8. doi: https://doi.org/10.1007/s13193-019-00962-1
Boing L, De Araujo CCR, Pereira GS, Moratelli J, Benneti M, Borgatto AF, et al. Sitting time, body image and quality of life in women after breast cancer surgery. Rev Bras Med Esporte 2017;23:366–70. doi: https://doi.org/10.1590/1517-869220172305170333
Casaubon JT, Kuehn RB, Pesek SE, Raker CA, Edmonson DA, Stuckey A, et al. Breast- Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy. J Am Coll Surg 2020;230:990–8. doi: https://doi.org/10.1016/j. jamcollsurg.2020.02.048
Cobo-Cuenca AI, Martín-Espinosa NM, Sampietro-Crespo A, Rodríguez-Borrego MA, Carmona-Torres JM. Sexual dysfunction in Spanish women with breast cancer. PLoS One 2018;13(8). doi: https://doi.org/10.1371/journal.pone.0203151
Cordero MJA, Sanchez MN, MurVillar N, Valverde EG, López AMS. Perception of body image after breast cancer surgery in women from the city of Granada. Cah Biol Mar 2014;56:2–6. doi: https://doi.org/10.7400/RENC.2014.01.1.5002
Cordero MJA, Villar NM, Sánchez MN, Pimentel-Ramírez ML, García-Rillo A, Valverde EG. Breast cancer and body image as a prognostic factor of depression: a case study in México City TT - Cáncer de mama e imagen corporal como factor pronóstico de depresión: un estudio de caso en ciudad de México. Nutr Hosp 2015;31:371–9. doi: https://doi.org/10.3305/nh.2015.31.1.7863
Cortés-Flores AO, Morgan-Villela G, del Valle CJZF, Jiménez-Tornero J, Juárez-Uzeta E, Urias-Valdez DP, et al. Quality of life among women treated for breast cancer: a survey of three procedures in Mexico. Aesthetic Plast Surg 2014;38:887–95. doi: https://doi.org/10.1007/s00266- 014-0384-5
Cortés-Flores AO, Vargas-Meza A, Morgan-Villela G, Jiménez-Tornero J, del Valle CJZF, Solano-Genesta M, et al. Sexuality among women treated for breast cancer: a survey of three surgical procedures. Aesthetic Plast Surg 2017;41:1275–9. doi: https://doi.org/10.1007/s00266-017-0960-6
Dahl CAF, Reinertsen K V, Nesvold IL, Fosså SD, Dahl AA. A study of body image in long-term breast cancer survivors. Cancer 2010;116:3549–57. doi: https://doi.org/10.1002/cncr.25251
Denewer A, Farouk O, Kotb S, Setit A, El-Khalek SA, Shetiwy M. Quality of life among Egyptian women with breast cancer after sparing mastectomy and immediate autologous breast reconstruction: A comparative study. Breast Cancer Res Treat 2012;133:537–44. doi: https://doi.org/10.1007/s10549-011-1792-8
Dubashi B, Vidhubala E, Cyriac S, Sagar TG. Quality of life among younger women with breast cancer: study from a tertiary cancer institute in south India. Indian J Cancer 2010;47:142–7. doi: https://doi.org/10.4103/0019-509x.63005
de la Hoz FE, Ospina DDL. Evaluación de la función sexual en mujeres con cáncer de mama, en el Quindío TT - Evaluation of sexual function in women with breast cancer in Quindío. Rev Av salud 2019;3:8–17. doi: https://doi.org/10.21897/25394622.1754
Fernández MER, Gregorio MÁPS, Más MB, Rodríguez AM. The impact of breast reconstruction on self-esteem and body image in patients with breast cancer. Univ Psychol 2012;11:25–41. doi: https://doi.org/10.11144/javeriana.upsy11-1.irma
Gargantini AC, Casari LM. body image and body image quality of life in women with mastectomy. Comparison of women with immediate reconstruction, delayed reconstruction or without reconstruction. Psicooncologia 2019;16:43–60. doi: https://doi.org/10.5209/PSIC.63647
Gass JS, Onstad M, Pesek S, Rojas K, Fogarty S, Stuckey A, et al. Breast-specific sensuality and sexual function in cancer survivorship: does surgical modality matter? Ann Surg Oncol 2017;24:3133–40. doi: https://doi.org/10.1245/s10434-017-5905-4
Gomes NS, Soares MBO, Silva SR da. Autoestima e qualidade de vida de mulheres submetidas à cirurgia oncológica de mama TT - Self-esteem and quality of life in women undergoing breast cancer surgery Autoestima y calidad de vida de mujeres sometidas a cirugía por cáncer de mama. REME 2015;19:120–6. doi: https://doi.org/10.5935/1415-2762.20150030
Hadi N, Soltanipour S, Talei A. Impact of modified radical mastectomy on health-related quality of life in women with early stage breast cancer. Arch Iran Med 2012;15:504–7.
Han J, Grothuesmann D, Neises M, Hille U, Hillemanns P. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obs 2009;282:75–82. doi: https://doi.org/10.1007/s00404- 009-1302-y
Härtl K, Schennach R, Müller M, Engel J, Reinecker H, Sommer H, et al. Quality of life, anxiety, and oncological factors: A follow-up study of breast cancer patients. Psychosomatics 2010;51:112–23. doi: https://doi.org/10.1176/appi.psy.51.2.112
Howes BH, Watson DI, Xu C, Fosh B, Canepa M, Dean NR. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study. J Plast Reconstr Aesthet Surg 2016;69:1184–91. doi: https://doi.org/10.1016/j.bjps.2016.06.004
Irarrázaval ME, Kleinman P, Silva RS, González LF, Torres C, Fritis M, et al. Quality of life in chilean breast cancer survivors. Rev Med Chil 2016;144:1567–76. doi: https://doi.org/10.4067/S0034-98872016001200008
Jabłoński MJ, Streb J, Mirucka B, Słowik AJ, Jach R. The relationship between surgical treatment (mastectomy vs. breast conserving treatment) and body acceptance, manifesting femininity and experiencing an intimate relation with a partner in breast cancer patients. Psychiatr Pol 2018;52:859–72. doi: https://doi.org/10.12740/PP/91916
Jabłoński MJ, Mirucka B, Streb J, Słowik AJ, Jach R. Exploring the relationship between the body self and the sense of coherence in women after surgical treatment for breast cancer. Psychooncology 2019;28:54–60. doi: https://doi.org/10.1002/pon.4909
Jay M, Creelman B, Baliski C. Patient reported outcomes associated with surgical intervention for breast cancer. Am J Surg 2019;219:816–22. doi: https://doi.org/10.1016/j.amjsurg.2019.04.006
Kennedy F, Harcourt D, Rumsey N, White P. The psychosocial impact of ductal carcinoma in situ (DCIS): A longitudinal prospective study. Breast 2010;19:382–7. doi: https://doi.org/10.1016/j.breast.2010.03.024
Lagendijk M, van Egdom LSE, van Veen FEE, Vos EL, Mureau MAM, van Leeuwen N, et al. Patient-reported outcome measures may add value in breast cancer surgery. Ann Surg Oncol 2018;25:3563–71. doi: https://doi.org/10.1245/s10434-018-6729-6
Li S, Li L, Zheng H, Wang Y, Zhu X, Yang Y, et al. Relationship between multifaceted body image and negative affect among women undergoing mastectomy for breast cancer: a longitudinal study. Arch Womens Ment Heal 2018;21:681–8. doi: https://doi.org/10.1007/s00737-018-0860-z
Luutonen S, Sintonen H, Stormi T, Salminen E. Health-related quality of life during adjuvant radiotherapy in breast cancer. Qual Life Res 2013/11/10. 2013;23:1363–9. doi: https://doi.org/10.1007/s11136-013-0554-y
Maharjan M, Thapa N, Adhikari RD, Petrini MA, Amatya KS. Quality of life of Nepalese women post mastectomy. Asian Pac J Cancer Prev 2018;19:1005–12. doi: https://doi.org/10.22034/APJCP.2018.19.4.1005
Manganiello A, Hoga LAK, Reberte LM, Miranda CM, Rocha CAM. Sexuality and quality of life of breast cancer patients post mastectomy. Eur J Oncol Nurs 2011;15:167– 72. doi: https://doi.org/10.1016/j.ejon.2010.07.008
Martins JO de A, Santos AAP dos, Holanda JB de L, Trindade RFC da, Lima LKP. Sexualidade de mulheres submetidas à mastectomia: identificação das fases afetadas no ciclo da resposta sexual TT - Sexuality of women submitted to mastectomy: identification of phases affected in the sexual response cycle Sexualidad de mujeres submetida. Rev Pesqui (Univ Fed Estado Rio J, Online) 2020;12:67–72. doi: https://doi.org/10.9789/2175-5361.rpcfo.v12.7013
Metcalfe KA, Semple J, Quan ML, Vadaparampil ST, Holloway C, Brown M, et al. Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Ann Surg Oncol 2012;19:233–41. doi: https://doi.org/10.1245/s10434-011-1828-7
Moreira H, Canavarro MC. A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease. Eur J Oncol Nurs 2010;14:263–70. doi: https://doi.org/10.1016/j.ejon.2010.04.001
Moreira JR, Neto MS, Pereira JB, Biasi T, Garcia EB, Ferreira LM. Sexualidade de mulheres mastectomizadas e submetidas à reconstrução mamária TT - Sexuality of women that suffered mastectomy and those who had been submitted to the mammary reconstruction. Rev Bras Mastologia 2010;20:177–82.
Munshi A, Dutta D, Kakkar S, Budrukkar A, Jalali R, Sarin R, et al. Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study. Radiother Oncol 2010;97:288–93. doi: https://doi.org/10.1016/j.radonc.2010.04.008
Mushtaq M, Naz F. Body image satisfaction, distress and resilience in women with breast cancer surgery: A within group study. J Postgrad Med Inst 2017;31:39–43.
Neto MS, Menezes MVA, Moreira JR, Garcia EB, Abla LEF, Ferreira LM. Sexuality after breast reconstruction post mastectomy. Aesthetic Plast Surg 2013;37:643–7. doi: https://doi.org/10.1007/s00266-013-0082-8
Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ. Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 2016;76:640–4. doi: https://doi.org/10.1097/sap.0000000000000242
Nowicki A, Licznerska B, Rhone P. Evaluation of the quality of life of women treated due to breast cancer using amputation or breast conserving surgery in the early postoperative period. Pol J Surg 2015;87:174–80. doi: https://doi.org/10.1515/pjs-2015-0040
Núñez C, Navarro A, Cortés S, López J, Aguirre-Loaiza H, Trujillo C. Body image (BI) and coping strategies (CS): Analysis of medical and surgical characteristics in women diagnosed with breast cancer. Ter Psicol 2018;36:59–69. doi: https://doi.org/10.4067/S0718-48082018000200059
Öztürk D, Akyolcu N. Assessing sexual function and dysfunction in Turkish women undergoing surgical breast cancer treatment. Jpn J Nurs Sci 2016/04/05. 2016;13:220–8. doi: https://doi.org/10.1111/jjns.12106
Pegorare ABG de S, Silveira K da R, No APS, Barbosa SRM. Assessment of female sexual function and quality of life among breast cancer survivors who underwent hormone therapy tt - Avaliação da função sexual e da qualidade de vida de mulheres sobreviventes do câncer de mama submetidas a hormonioterapia. Mastology (Impr) 2017;27:237–44. doi: https://doi.org/10.5327/Z259453942017000016166
Prates ACL, Freitas-Junior R, Prates MFO, Veloso MF, Barros NM. Influence of body image in women undergoing treatment for breast cancer. Rev Bras Ginecol Obs 2017;39:175–83. doi: https://doi.org/10.1055/s-0037-1601453
Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Heal 2014;29:632–50. doi: https://doi.org/10.1080/08870446.2013.879136
Rahman MM, Hossain AFMA, Ahsan A, Monalisa NN, Rahman K, Azad SA. Moving beyond cancer: Immediate impact on the health-related quality of life of breast cancer patients after mastectomy. Bangladesh Med Res Counc Bull 2016;41:52–8. doi: https://doi.org/10.3329/bmrcb.v41i2.29974
Retrouvey H, Kerrebijn I, Metcalfe KA, O’Neill AC, McCready DR, Hofer SOP, et al. Psychosocial functioning in women with early breast cancer treated with breast surgery with or without immediate breast reconstruction. Ann Surg Oncol 2019;26:2444–51. doi: https://doi.org/10.1245/s10434-019-07251-9
Seara LS, Vieira RX, Pechorro PS. Sexual function and body image in mastectomized women. Rev Int Androl 2012;10:106–12. doi: https://doi.org/10.1016/S1698-031X(12)70063-8
Sherman KA, Woon S, French J, Elder E. Body image and psychological distress in nipple-sparing mastectomy: the roles of self-compassion and appearance investment. Psychooncology 2016;26:337–45. doi: https://doi.org/10.1002/pon.4138
Spatuzzi R, Vespa A, Lorenzi P, Miccinesi G, Ricciuti M, Cifarelli W, et al. Evaluation of social support, quality of life, and body image in women with breast cancer. Breast Care 2016;11:28–32. doi: https://doi.org/10.1159/000443493
Streb J, Jabłoński MJ, Słowik A, Babczyk D, Jach R. Indications for sexology consultation in women after surgical treatment due to breast cancer. Ann Agric Env Med 2018;26:379– 84. doi: https://doi.org/10.26444/aaem/89733
Sun Y, Kim SW, Heo CY, Kim D, Hwang Y, Yom CK, et al. Comparison of quality of life based on surgical technique in patients with breast cancer. Jpn J Clin Oncol 2013;44:22– 7. doi: https://doi.org/10.1093/jjco/hyt176
Słowik AJ, Jabłoński MJ, Michałowska-Kaczmarczyk AM, Jach R. Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. Psychiatr Pol 2017;51:871–88. doi: https://doi.org/10.12740/PP/OnlineFirst/63787
Telli S, Gürkan A. Examination of sexual quality of life and dyadic adjustment among women with mastectomy. Eur J Breast Heal 2020/01/09. 2020;16:48–54. doi: https://doi.org/10.5152/ejbh.2019.4969
Tsai HY, Kuo RN, Chung KP. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: A multicenter study in Taiwan. Jpn J Clin Oncol 2017;47:909–18. doi: https://doi.org/10.1093/jjco/hyx099
Wani S, Khan T, Teli M, Khan N, Mir L, Lone M, et al. Breast specific functional and symptom analysis in female breast cancer survivors. J Cancer Res Ther 2018;14:521–6. doi: https://doi.org/10.4103/0973-1482.165867
Wu TY, Chang TW, Chang SM, Lin YY, Wang JD, Kuo YL. Dynamic changes of body image and quality of life in breast cancer patients. Cancer Manag Res 2020;11:10563–71. doi: https://doi.org/10.2147/CMAR.S223314
Oliveira LB, Dantas ACLM, Paiva JC, Leite LP, Ferreira PHL, Abreu TMA. A feminilidade e sexualidade da mulher com câncer de mama. Rev Científica da Esc da Saúde / Univ Potiguar. 2013;3(1):43–53.
Santos DB, Vieira EM. Imagem corporal de mulheres com câncer de mama: Uma revisão sistemática da literatura. Cien Saude Colet 2011;16:2511–22. doi: https://doi.org/10.1590/S1413-81232011000500021
de Almeida TR, Guerra MR, Filgueiras MST. Repercussões do câncer de mama na imagem corporal da mulher: Uma revisão sistemática. Physis 2012;22:1003–29. doi: https://doi.org/10.1590/S0103-73312012000300009
Aureliano W de A. “... e Deus criou a mulher”: Reconstruindo o corpo feminino na experiência do câncer de mama. Estud Fem 2009;17:49–70. doi: https://doi.org/10.1590/S0104-026X2009000100004
Didier F, Radice D, Gandini S, Bedolis R, Rotmensz N, Maldifassi A, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Trea. 2008;118:623–33. doi: https://doi.org/10.1007/s10549-008-0238-4
Palmeira CS, Santos LS, Silva SMB da, Mussi FC. Estigma percebido por mulheres com excesso de peso. Rev Bras Enferm 2020;73(4):e20190321. doi: https://doi.org/10.1590/0034-7167-2019-0321
Cesnik VM, Santos MA dos. Mastectomia e Sexualidade: Uma Revisão Integrativa. Psicol Reflex Crit 2012;339–49. doi: https://doi.org/10.1590/S0102-79722012000200016
Vaziri S, Lotfi-Kashani F. Sexuality after breast cancer: need for guideline. Iran J Cancer Prev 2012;5:10–5.
Hart AM, Pinell-White X, Losken A. The psychosexual impact of postmastectomy breast reconstruction. Ann Plast Surg 2015;77:517–22. doi: https://doi.org/10.1097/SAP.0000000000000665
Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: a review. Maturitas. 2010;66:397-407. doi: https://doi.org/10.1016/j.maturitas.2010.03.027
Santos DB, Santos MA dos, Vieira EM. Sexualidade e câncer de mama: Uma revisão sistemática da literatura. Saúde Soc 2014;23:1342–55. doi: https://doi.org/10.1590/S0104-12902014000400018
Male DA, Fergus KD, Cullen K. Sexual identity after breast cancer: Sexuality, body image, and relationship repercussions. Curr Opin Support Palliat Care 2016;10:66–74. doi: https://doi.org/10.1097/SPC.0000000000000184
Boswell EN, Dizon DS. Breast cancer and sexual function. Transl Androl Urol 2015;4(2):160–8. doi: https://doi.org/10.3978/j.issn.2223-4683.2014.12.04
Chang YC, Chang SR, Chiu SC. Sexual Problems of Patients with Breast Cancer after Treatment: A Systematic Review. Cancer Nurs 2018;42:418–25. doi: https://doi.org/10.1097/NCC.0000000000000592
Simeão SF de AP, Landro ICR, De Conti MHS, Gatti MAN, Delgallo WD, De Vitta A. Qualidade de vida em grupos de mulheres acometidas de câncer de mama. Cien Saude Cole. 2013;18:779–88. doi: https://doi.org/10.1590/S1413-81232013000300024
Arndt V, Stegmaier C, Ziegler H, Brenner H. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: A population-based study. J Cancer Res Clin Oncol 2008;134:1311–8. doi: https://doi.org/10.1007/s00432-008-0418-y
Cordova LZ, Hunter-Smith DJ, Rozen WM. Patient reported outcome measures (PROMs) following mastectomy with breast reconstruction or without reconstruction: A systematic review. Gland Surg 2019;8:441–51. doi: https://doi.org/10.21037/gs.2019.07.02
Oliveira RR de, Mororais SS, Sarian LO. Efeitos da reconstrução mamária imediata sobre a qualidade de vida de mulheres mastectomizadas. Rev Bras Ginecol Obs 2010;32:602–8 doi: https://doi.org/10.1590/S0100-72032010001200007
Article download
License
In order to support the global exchange of knowledge, the journal Psicooncología is allowing unrestricted access to its content as from its publication in this electronic edition, and as such it is an open-access journal. The originals published in this journal are the property of the Complutense University of Madrid and any reproduction thereof in full or in part must cite the source. All content is distributed under a Creative Commons Attribution 4.0 use and distribution licence (CC BY 4.0). This circumstance must be expressly stated in these terms where necessary. You can view the summary and the complete legal text of the licence.