Coping with changes to body image

November 15, 2021

Watch time: 25 min 

Breast cancer can take a toll on how you relate and feel about your body. Sage Bolte, PhD, LCSW, CST, chief philanthropy officer and president of the Inova Health Foundation, offers insight on what factors can impact body image and provides you with practical first steps toward self-acceptance and love. 


Sage Bolte, PhD, LCSW, CST, is Chief Philanthropy Officer and President of the Inova Health Foundation in Falls Church, Virginia. She joined Inova 15 years ago as an oncology counselor and most recently served as executive director of Life with Cancer and Patient Experience for the Inova Schar Cancer Institute. She is nationally known for her work in sexual health and cancer and is a respected leader in the field of oncology social work. Read more.



Shehzin (00:00):

I did feel insecure about my chest after a double mastectomy and reconstruction, and often still do. For me, self-care has gone a long way in reducing my insecurities and improving my body image.

Keneene (00:16):

I am still struggling with my body image after breast cancer. I do not recognize the woman that I see in front of me. I try to find at least one thing daily that I like about my new appearance and go from there.

Lynn (00:33):

I was single when I was diagnosed with breast cancer. And as my body had changed, also there was thought about how would I now meet someone, and what would I say and what would I do? My body’s important. And I am also so much more than just my body.

Sage Bolte, PhD, LCSW, CST (01:24):

Hi, I’m Dr. Sage Bolte. Before we start our time today, I just wanted to start by saying the topic of body image can be triggering for some. You might notice an unexpected wave of emotions or feelings you haven’t had for a while. So, take care of yourself during our time together. Be kind to yourself. If you need to pause, pause. As we saw from the survivors you just heard from, body image is really different for everyone. Everyone has their own story, their own experience because before a cancer diagnosis, they had their own story, their own experiences with their body. And when we talk about body image, that’s really the view of one’s appearance of one’s body. And that has a significant role in the way we view our self-image, the view of our whole self. And so today we’re going to talk about what affects body image after a breast cancer diagnosis.


There are so many things that can change the way we feel about our bodies. And of course, it’s really important to remember that we all come into a breast cancer diagnosis with different experiences, as I referenced earlier. We may have had a really positive sense of our body prior to breast cancer, and we may continue to have a positive sense of ourself. We might’ve had a negative sense of self prior to breast cancer, and perhaps this cancer has rattled that further. But it’s so common because of the common experiences associated with a breast cancer diagnosis and its treatment for women to experience altered body image. The side effects like weight gain or weight loss, hair loss of all types, the changes in your skin, scarring that can occur on your breast, from a port if you’ve had a deep or a tram flap, perhaps you have scarring there. That has also influenced sensation changes.


Maybe things hurt to be touched, or maybe they’re more sensitive to be touched. And ultimately the changes in the breast can have a negative impact on one’s sense of their body image. It also can have a positive impact on one’s body image. But before we get further into talking about how we can enhance the way we feel our bodies, first and foremost, it’s so important to acknowledge the loss that a cancer diagnosis brings. It doesn’t mean we need to bathe in the loss and grief. It doesn’t mean that we have to wear this heavy blanket forever. But we have to acknowledge that grief is part of the process of healing and acceptance, and ultimately moving forward and living big in life. Grieving the losses, validating the feelings that we have, validating the thoughts that we struggle with, and offering some different thoughts, nd we’ll talk about that in a little while, is so important, because our society puts a huge emphasis, unfortunately, on body image, with topics like what is sexy or how a woman should look, what breasts should look like.


If you just walk down your local grocery aisle, you’ll see magazines showing you what they believe is sexy or beautiful. We grow up in this world as little girls with insecurities, and often as we get older, thankfully either with support and help or just maturity, we’re able to move through them. But sometimes the cancer diagnosis can surprisingly trigger those once-buried insecurities. Yet others may find a new sense of hope or strength in their body as they watch how it navigates fighting the cancer, and even when feeling weak or sick, they can see the strength they have inside that is this established resilience and optimism. And both can be true. We can struggle and be scared and be optimistic about where we’re going and how our body will heal.

So, what are some of the common changes or issues that women often face? Certainly insecurity.


“Will I still be attractive to my partner?” Or, “How will I continue to work with the changes that my body has experienced?” Some fears about being seen or touched. You might experience sensation changes that alter pleasure experiences. Certainly a breast cancer diagnosis can impact relationships, whether you’re in a partnership unpartnered, or dating, no matter how long you have been in a relationship with your partner, no matter how many years, one thing remains true: they cannot read your mind. I know, I know we wish they could. We wish that they could read our kind of passive body languages that they should pick up on that we’re feeling frustrated. Unfortunately, that’s not the way it works. So, being able to voice what you need in support, being able to voice if you’re feeling insecure is really important. And one of the tools I teach couples is stating a fact, a belief, a feeling, and an action.


So, let me give you an example. I’ve heard the story over and over again from women who post-surgery, post-mastectomy or lumpectomy — maybe they have a drain — they’re standing at the kitchen sink, washing out their cup, and their partner comes up behind them and hugs them, expressing love, wanting to show affection and inadvertently there’s discomfort or pain. And maybe you push his or her hand aside or you jump. Your partner makes note, “OK, don’t do that again. I don’t want to hurt her.” And so a month or two goes on and your partner hasn’t come and done that hug that he or she normally does. And your dialogue begins: “They must not find me attractive. Why aren’t they touching me anymore?” And often that can be a train taking off very fast with a lot of negative thoughts that leads to significant implications for where your mind goes.


And often a conclusion that just isn’t factual.

So, before that train departs any faster, have a conversation with your partner. State a fact: “Ever since my surgery, you haven’t touched me as much.” State a belief: “I think it’s because you don’t find me attractive.” State of feeling: “It makes me sad that cancer’s impacted this part of our relationship.” And then most importantly, give them an action. What can they do about it? “I want you to initiate touch more often when you come home from work or when I come home from work, I want you to embrace me. I want you to kiss me. I want you to tell me that I’m beautiful and that you love me.” Give them something to do so they can participate and your healing, but also participate in helping you feel more confident. If you aren’t in a partnership and you’re dating,


Think about when you would disclose, how do you disclose? I know those are often questions that people, when they’re dating, have. “Do I disclose on the first date? On the sixth date?” First of all, everybody has their own way of engaging in dating. Some people lay everything out on the table on that first date. It’s really important to be authentically you. However, I have one piece of advice related to that. Typically, on your first date, you’re not disclosing everything — all the challenges and successes you’ve had in life. You’re just getting to know each other. And by date four usually you’re catching feelings, you might have experienced some strong attraction, and you want that date five. Before those feelings get stronger, before physical intimacy takes place, having that conversation is really important. And to do that confidently, you might want to consider practicing that with one of your friends.


How do you disclose? When we talk about disclosure, one of the most important things is just being confident in your story — being able to answer questions about what this cancer diagnosis means and what it doesn’t mean, what feels good and what doesn’t, what do you want, right? And conversations and topics around fertility and all the other things might come up. Be prepared to answer questions with confidence. Now, I say that that waiting until the fourth date might be of benefit. However, with, with social media being what it is today, so many women are sharing their story on social. So, if you have shared your story on social, be prepared that he or she probably already knows about your cancer diagnosis. And that’s actually something to consider.

When you think about sharing your story on social, what are you sharing? How much are you sharing?


Is this something that you want to be out there forever? Because once it’s out there, it’s out there. And if on a date, it gets brought up, be again, prepared to answer with confidence, because that will help put them at ease as well.

All the while, as we move forward in our journey, giving ways to support yourself with compassion, to have empathy towards the things that you’re struggling for to show yourself self-care and love and asking, how can I improve my relationship with my body? This may seem very oversimplified. However, our thoughts are one thing that we can actually have pretty good control over. Not right away. Certainly it takes practice, but if we can catch that negative thought that judging self-talk, that self-critical voice and raise our awareness of how that impacts how we feel: “Gosh, every time I have a thought like that, I get a knot in my stomach.(12:35) I get a knot in my chest, or I feel just anxious or sad.” When we can catch that thought, be aware that that thought can be reframed to something more positive that can ultimately impact our feelings. So, for example, if you wake up every morning and think, “Ugh, I look like that again,” how might that make you feel? Probably sad, discouraged, not optimistic, but what if instead, when you caught that thought you offered yourself a different thought — not something that’s inflated or overly optimistic, but honest, like: “I’m going to do everything I can today to help my body heal.” And offering yourself that thought, as soon as that negative thought happens, allows you to shift, reframe, and focus on what you can control.


The other opportunity we have is evaluating and changing, not just our toxic thoughts, but perhaps toxic relationships. Are there people around you who are draining you? I like to picture it like a sponge and a bucket full of water. You know, there are times when that dry sponge gets put in that bucket, and all the water goes into that sponge; all the energy is taken from that bucket. Are there people in your life who are sucking you dry? Now is an opportunity to reassess who you’re spending energy on, and then who fills you up? Who offers you affirmation? Who offers you hope, encouragement? Those are the people that you can choose to put in that bucket, because cancer provides us with a great excuse to exit toxic relationships. It doesn’t mean we can stop working at our place of employment if we don’t like one of our team members, but we can evaluate how much we want to interact with them.


We can evaluate how much we want to interact with our in-laws or others in our life. And we have control over how we let them affect us. Another tool. When that thought enters your head, ask yourself, “Would I say this to another person? If I wouldn’t say this to another person, why am I saying this to myself?” I know that sounds oversimplified, but there is truth in catching those thoughts and really challenging them. Because if we wouldn’t say it to someone else, why are we offering such negative thoughts to ourself? Shift, move, reframe. Instead of “I’m ugly,” “My smile is still my smile.” If you can’t find a physical descriptor initially that you can align with, maybe try to find a positive characteristic about yourself, that you feel good about, or ask a friend to give you something positive in reflection on your body image that you can hold onto, that you can use and say to yourself on a regular basis.


Another reminder: we put a whole lot of energy into body image. And especially when we’re in relationships, thinking that, "If I’m not the way I used to look, or if something is a little less normal than it used to be, if my breast doesn’t look like it used to that, my partner won’t want me or someone won’t want me.” But let’s remember the majority of relationships, at least the long and healthy ones, are not solely established on physical attributes, right? They’re established on connection, on transparency, on sharing life together, on sharing challenges and sharing joys — so much more than physical attributes.


So, how can you live into a healthy and happy life? Certainly, again, when we think about what we have control over, take control of what you can in everyday matters — your sleep, caffeine and alcohol intake, your exercise and movement, all of those can play a positive role in how you feel about your body. Is there something you can wear that helps you feel more confident? Is there something you can do to your hair that helps you feel more confident? Are the relationships in your life, the ones that offer you encouragement, hope -— again, fill you up?

And one of the other areas you can ask yourself to really tune in on, to check in on: how much time are you spending on social media?


Oftentimes find ourselves sucked into other people’s social media lives. And that can be a dangerous path because it can fuel the fire of negativity. Maybe we see someone from our high school, who’s had all these accolades and looks amazing, and we are constantly berating ourselves with “Why couldn’t I be that? Why am I not that?” Or we see another survivor who looks like they’re just doing so much better than I am. That’s not helpful information. That’s not encouraging information. In fact, it’s often a trap and a quick spiral down to “I’ll never have. I can’t. I won’t.” And what we want to be filling our heads with is “I can. I am. I am capable. I am beautiful.”


Certainly, I often hear women say, “I don’t want to talk to a plastic surgeon. That feels so vain.” There’s nothing vain about going and talking to an expert, whether it’s a plastic surgeon or an aesthetician, but an area on your body that you feel less confident on. Maybe there is something simple that can be done to help enhance the way that you feel about that area of your body, or to help minimize a scar, or to help with hair that’s changed.

Seek out support. And that can be seeking out a support group. That could be seeking out support from your faith community. That could be seeking out support from a therapist. But getting other eyes and ears involved in your life to help ground you and offer you different statements than the ones that you are offering yourself when negative and/or growing those positive ones are so important.


Plus, just hearing in a support group that other people are struggling with the same thing you’re struggling with can certainly help you feel less alone, less isolated, less alienated.

Another powerful tool is starting a gratitude journal. There are amazing things that can happen before we rest our head on our pillow. We end our day with just five minutes. Start with one minute of gratitude, the ability to say “thank you” or “what I’m thankful for,” what you’re grateful for today. And if you can start your day that way, too, even better. And part of that is because, remember, we believe the things we tell ourselves, right? That negative thought that I tell myself unintentionally maybe, or sometimes intentionally, we believe them. So, why not start helping ourselves think about more positive things by telling ourselves something more positive? That doesn’t mean blind optimism or saying you’re the most beautiful woman in the world.


Although, again, if that is how you feel, that is fantastic. But just even offering yourself something positive, like: “I have all the tools and support I need to embrace today, to feel good in my body today.” And that also means inviting people in, surrounding yourself with people who don’t question why you’re struggling with those feelings, don’t undermine how your’re feeling, but ask how they can show up for you. Support you. Certainly challenge those thoughts that are unrealistic. Like, “I’m ugly.” Have those people that you trust ready to challenge and offer you something that’s affirming.

The question around, “How can I feel like me again?” comes up a lot. And this refers to that grief. You know, cancer changes us. It changes the way we see life. It often impacts relationships. And, as we’ve talked about in our time together, it changes the way we feel about our body.


And sometimes it changes whether we trust our body. Other times it gives us a different respect for our body and what it can do, what it can get through. So, we may never feel like ourselves again. Yyou may not feel like your pre-cancer self again, but that doesn’t mean that you can’t feel stronger, sexier, more beautiful. Smell and take in life in a bigger way. It just means it can’t look the same because we can’t go backwards. But we can do the things that we know help fill us up. What are the things that you loved before cancer that you can still do? Sometimes we focus on so many of the things that we can’t do. We forget all the things we can. “I loved exercising.” Great. What kind of movement can you do? You may not be able to run that marathon yet, but can you do a walk with a friend? Can you take hike? Can you get in your body and connect to your body?


How can you feel connected to your sense of self by listening, by filling yourself with things that are positive, by taking time to acknowledge when you’re hurting and giving yourself something that you need in that space? And maybe that’s taking just a couple of minutes a day to do something special just for you — that helps you feel better about your body, better about your body image. Maybe it’s that lipstick you’ve wanted to wear for a while. Maybe it’s that blouse that you saw that you really wanted to buy. Maybe it’s a perfume. Maybe it’s just sitting outside and letting the sun hit your face. Give yourself time and space to connect to the things that make you feel alive. Give yourself time and space to do something that feels good to your body. That feels good in your body. Again, we can’t go back to who we were. We can’t go back to the body that we had before, before, but you can embrace and live into the body you have now by identifying those thoughts, surrounding yourself with people who can lift you up. Take some steps to think about ways that you can help yourself feel more sexy, or strong, or whatever word that you connect to — that helps you feel good in your body. Keep looking forward. Thank you.