Life After Mastectomy: Sex, Self-Image and Strategies for Coping

Learn ways to cope with body image and other issues—and rekindle intimacy with your partner.

Life After Mastectomy: Sex, Self-Image and Strategies for Coping

A woman’s breasts are one obvious sign of femininity and can be a source of great sexual pleasure for her and her partner. But when a woman is diagnosed with breast cancer and mastectomy is the chosen form of treatment, it can impact far more than her physical health. Her body image, ability to enjoy sex and the effect on her spouse or partner may become part of the equation, as well.

How can couples navigate these waters? We spoke with Julian Berrocal, MD, a breast surgeon at JFK Medical Center in Atlantis, Florida, about ways women can make decisions related to body image after mastectomy, along with ways to cope with the side effects of additional treatments.

Coming to terms with your body
“When a woman sees herself naked in front of a mirror with a surgical scar, it can change how she views herself,” says Dr. Berrocal. “Surgeons work hard to make incisions so that the scar is as hidden as possible, so that she’s not always reminded of cancer.”

But with mastectomy, such subtlety isn’t possible. As a result, some women have trouble accepting their appearance, even if their spouse reassures them that they love them just as they are. Women may doubt their attractiveness and sex appeal, affecting their desire for intimacy.

Take comfort in the fact that it’s normal to feel bouts of grief, anger and sadness. Allow yourself to experience these feelings—although at some point you’ll want to come to a place of acceptance so that you can focus on the things that bring you happiness. Remember that you’re stronger and wiser for having come through the treatment.

Breast reconstruction considerations
While not right for everyone, breast reconstruction, performed by a plastic surgeon, can help women regain confidence in the way they look along with other benefits, such as improved self-esteem, psychological health and their sense of sexuality.

Berrocal says that before breast cancer surgery, he typically discusses with patients possible breast reconstruction options. "'Going flat' is one option some patients choose,” says Berrocal, “and there’s no stigma in that.” There are few instances, Berrocal says, when an immediate reconstruction can’t be done at the same time as the surgery. In those cases a patient could opt for reconstruction at the completion of other cancer treatments.

In one study, published in the Journal of Clinical Oncology, researchers looked at the records of over 20,000 women from 1998 to 2007. Half of the women in the study were under age 51; half were older. The researchers found that on average 56 percent had opted for some type of breast reconstruction, with the rate rising in more recent years.

The Beauty of Tattoos
Some women who get reconstruction undergo tattooing to create a nipple and areola, says Berrocal. Others may choose other types of tattoos—beautiful works of art—etched over their breasts to feel more empowered and comfortable with their new appearance.

Other treatment issues
According to Berrocal, another part of what can impact a woman’s sex life is whether or not she needs additional treatment, such as chemotherapy and radiation. Fatigue, nausea and other symptoms could put sexual desire on the backburner.

“Some types of chemotherapy can put women in menopause prematurely,” he says. “This can lead to hot flashes and vaginal dryness.” Women who require “anti-estrogen” medications like tamoxifen—which must be taken for five to 10 years—may also experience hot flashes and loss of libido, among other symptoms.

"Vaginal lubricants can help with dryness,” says Berrocal. Since one function of estrogen is to create lubrication, applying an estrogen cream to the vagina can be helpful. Berrocal says that even though systemic absorption is low, some oncologists treating patients with estrogen-sensitive tumors want them to avoid even a small dose applied to the area, since estrogen can promote the development of tumors in some breast cancers.   

Staying connected with your partner
Berrocal says that a return to a pre-breast cancer sex life may take about a year or two, depending on treatment. Meanwhile, there are a variety of ways to maintain emotional intimacy, even if you don’t feel ready for sex:

  • Open and honest communication is key. Your partner may be uncertain about how to show affection—there may be fear of causing you pain—so it’s important to let your partner know what you’re thinking and how you’re feeling.
  • Simple cuddling, hugging and other signs of affection can go a long way in comforting each other and creating a safe space for these conversations until you feel ready to resume your sex life.

You may each have fears about what the future holds for your love life, especially if there were issues in the relationship before the surgery. If you find yourselves stuck or skirting around the sex issue, it may help to see a counselor to work through your concerns.

Looking ahead
“Surgeons are trained to talk about treatment and explain surgical options,” says Berrocal, but he notes that a patient shouldn’t hesitate to bring up problems and concerns about vaginal dryness, pain around the scars, or any other issues that could interfere with their sex life.

“Our focus is quality of life, and helping patients return to what it was before their cancer diagnosis,” he says. Open communication with your partner and your doctors can make it possible to enjoy intimacy again after a mastectomy.

Medically reviewed in July 2018.

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