September 2017 Ask the Expert: Body Image
Body image is the way you perceive yourself and how you look. It refers to how attractive you feel and how attractive you think others find you. Body image is not just physical, because how you see yourself is also how you feel about yourself and how confident you are. It includes your emotions, beliefs and perceptions of your body.
Breast cancer and its treatment may change how you feel about your body. You may be coping with scars, pain, weight gain or loss, hair loss or thinning, sexual side effects, lymphedema, or other changes.
In September, Living Beyond Breast Cancer expert Darah W. Curran, MSW, LCSW, answered your questions about body image and breast cancer. She addressed issues related to physical changes caused by breast cancer and its treatments, and how those changes affect the way you feel about yourself.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
Body image plays a significant role as you adjust to diagnosis, treatment, and survivorship! I often wish medical teams did a better job of normalizing this associated distress and loss for patients. One of the most common things we hear from breast cancer survivors is related to loss, like “I will never be the same and I am not sure how to manage those changes” or “What if my partner won’t find me attractive anymore?” or “I don’t find myself attractive anymore,” and yet we also sometimes hear, “I never knew I would feel sexy being bald” or “I have found a new confidence in my body.”
Chemotherapy, surgery, and radiation treatments for breast cancer can cause many changes that impact your view of yourself. Changes such as hair loss or weight gain may often be short-term, while surgery may lead to more permanent changes to the breast and skin. It is also important to recognize that body image is not only about appearance. It can also impact your identity, confidence, mood, self-esteem, sexuality and overall quality of life. When working with an individual struggling with her body image, I will explore what she expresses is most challenging to her. Then I work to determine concrete resources (wigs, scarves, prostheses, etc), but also focus psychosocial attention on the associated emotional distress and ways it can be better managed or decreased.
It is important to first choose a breast surgeon/plastic surgeon with whom you feel comfortable, even if that means scheduling several consults or second opinions. Additionally, it may be helpful to talk to other women who have had various types of reconstruction, to assist with decision-making. There are organizations that will link survivors with those newly diagnosed (Survivors Offering Support is one here in Virginia/DC).
Editor's note: LBBC's Breast Cancer Helpline can connect you with a woman who has had a certain type of breast reconstruction.
Many breast cancer organization websites also offer pictures or information on what to expect. Of course, there may be factors that limit your choices. If you do have multiple choices available, and you have researched those options and sought out second opinions, but continue to struggle with making a decision, I would encourage you talk to a counselor who specializes in cancer. It is important to make sure you know what questions to ask and what resources can give you reliable answers. Ultimately, it is often not about the right choice but the best choice for you. This is a very personal decision, whatever you decide, and I encourage you to keep looking forward rather than second-guessing past decisions, though I know that is easier said than done!
Initially, it is most important that you follow the recommendations provided by your plastic surgeon. For example, following guidelines for the removal of wound closure strips will help with healing. They should only be removed by the plastic surgeon or when they fall off.
Breast scars will fade and become less noticeable over time as the skin fully heals. I am not aware of any products that will make them go away, but using over-the -counter products such as vitamin E oil or Mederma may provide you with a sense of control and of contributing to the healing process. Massage in the product with circular motions using the pads of your fingertips. Some plastic surgeon offices will also offer products that advertise their scar-fading properties. Some women choose nipple tattooing and work with the tattoo artist to cover the scars the best they can with shading. It is always best to check with your plastic surgeon before using any products or undergoing any procedures.
Body image is recognized as a critical psychosocial issue for those affected by cancer and it is absolutely normal to focus attention on this piece, as it so greatly impacts quality of life. I don’t want you to continue to carry this burden of guilt around “feeling selfish” though! When you have these feelings of guilt, it is important to acknowledge them, but then make a conscious effort to let go of it. Tell yourself it is common to feel this way, and redirect thoughts to something that brings you happiness. In time, it generally becomes easier to deal with these negative emotions, or you may find they stop surfacing altogether! And remember, changes related to cancer and cancer-related grief are really normal, and support groups, counseling, time and other techniques can be helpful in learning to manage these thoughts and feelings.
I am so glad you asked this question! Communication around sensual and sexual intimacy, needs, and insecurities is so incredibly important, but is often avoided even with couples who have been together a long time! Physical changes, especially after breast surgery, can make some women less comfortable with their bodies. There may be a loss of sensation in the affected breast, and chemotherapy and other treatments can change hormone levels, which may affect your sexual interest, desire, and response. Your partner may worry about how to express love physically and emotionally after treatment. Opening a conversation about your concerns with your partner is an important first step, as it is the best way to examine and explore these feelings together. Reminiscing about the tender moments you have shared together can be a comfortable way to begin. Or starting the conversation with, “I am still working through a lot of the changes to my body. Would it be OK if I share some of the challenges with you? You don’t have to say anything, just listen and hold my hand.” Or prompt reassurances that you are needing to hear from your spouse. Intimacy after breast cancer can be a growth experience for couples, allowing your partner to become more aware of your needs!
It is very normal to feel increased anxiety when you are beginning the dating process again after treatment. Unknowns around when and how to disclose or how to respond in intimate situations can create significant distress. What is most important to remember is that you don't have to bring it up until you are ready and feel some emotional investment in the relationship. If you find it difficult telling a potential partner about your cancer, practice talking about it in front of a mirror or with a friend ahead of time. It may also help to reflect on how you think you would respond if the situation was reversed. What would be a helpful way for information to be presented to you? Often providing specific information about your physical and hormonal changes and what you may need in an intimate situation ahead of time can be helpful, so that your partner can better understand your needs. As you move on to becoming intimate with your partner, some women have found it helpful to wear lingerie and gradually work up to full exposure as this can help with feeling sexy, comfortable and attractive.
Your preferred type of head covering (or not wearing one at all!) is a very individual decision. It can be based on comfort (what feels good on your scalp), expense (wig prices range greatly) and appearance (what makes you look the best, or most like yourself). Wig salons offer both synthetic wigs, which are more affordable, and human hair wigs, which are much pricier but often look more natural. Go into a salon and play with different lengths, styles, colors and material to find what works best for you! The American Cancer Society offers free wigs and, depending on your proximity to one of their offices, they have a wig studio where you can try many free options. Scarves and hats can be fun, affordable fashion statements as well. Something as simple as a “beanie” can be comfortable and warm while covering below the hairline on your neck and ears.
“Chemo curls” are very common as hair begins to grow back in after chemotherapy. Women who have always had soft, straight hair can be in for quite a shock when learning to manage coarse curls and changes in texture! Sometimes the hair's color can come in as a different shade as well. There is no set timeline, as it significantly differs from person to person, but, yes, the majority of women and men find their curls “tame” and familiar textures return after a period of months.
In the Washington D.C. metropolitan area, Inova Schar Cancer Institute's Life with Cancer program serves as a resource for therapists who specialize in the impact of cancer, treatment and survivorship, regardless of where a patient received treatment. If you live elsewhere, I would ask your oncology practice if there are therapists in your community with whom they have professionally interacted or if they have names of therapists who patients have recommended to them. If you are contacting therapists recommended by your insurance company, ask them whether they specialize in cancer, chronic illness, or self-esteem/body image issues. Whoever you choose, make sure he or she is someone with whom you will feel comfortable sharing what is most challenging to you with regards to your body image. This is important so that you can both work towards establishing a plan for decreasing associated distress that is specific to your needs.
The decision around breast surgery and reconstruction is a very personal one. It is important for each woman to first determine her individual goals and expectations. Does reconstruction help achieve these goals? Another key aspect for a woman to consider is the current importance her breasts have with regards to how they aid in her sense of femininity, sexuality and body image. Reconstruction can certainly help maintain some sense of that normalcy, but for some women, this is not as important. Whatever the decision, a woman who has prioritized what is important to her can ultimately work towards healing and self-acceptance post-surgery.