Updated on May 19, 2022.
Having a mastectomy and reconstruction surgery as part of breast cancer treatment is a deeply personal decision. People with breast cancer often have a lot of research to do to get up to speed on their treatment options, side effects, pain management, and prognosis.
As surgery techniques have improved, there are also an increasing number of reconstruction options to consider, all designed to help recreate the look and feel of breasts. Those decisions can affect a person’s quality of life and self-conception after surgery.
How your body moves in the world, the way clothes fit, and how to plan an exercise routine after surgery are all part of the equation. So is sex. Not only is body image affected by breast cancer surgery, but so is sexual function. Some women may abruptly experience menopause symptoms due to certain surgeries and therapies, which can affect sexual wellness, both emotionally and physically.
How to navigate these waters? Julian Berrocal, MD, is a breast surgeon at Women’s Health and Healing of the Palm Beaches in Florida. He shares insights 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 always possible. As a result, some women have trouble accepting their appearance, even if their partner reassures them that they love them just as they are. Women may doubt their attractiveness and sex appeal, affecting their desire for intimacy.
Today show host Hoda Kotb spoke in May 2022 about her breast cancer journey and how she was horrified by her breast cancer scars following her 2007 mastectomy and reconstruction. Fifteen years later, as she related on air, she’s accepted her new body and feels better than ever.
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.
Breast reconstruction considerations
Although it’s not right for everyone, breast reconstruction can help women regain confidence in the way they look. It may come with other benefits, too, such as improvements in self-esteem and one’s psychological health and sense of sexuality. The procedure is typically performed by a surgical oncologist with a specialty in breast cancer.
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 should be no stigma in that.”
There are few instances, Berrocal adds, 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 a 2014 study published in the Journal of Clinical Oncology, researchers looked at the records of over 20,000 women undergoing mastectomy for breast cancer 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 Agency for Healthcare Research and Quality, meanwhile, reported in 2017 that in the 22 states studied, breast reconstruction after mastectomy rose 62 percent from 2009 to 2014.
The beauty of tattoos
Some women who get reconstruction undergo tattooing to create a nipple and areola, says Berrocal. The Vinnie Myers Team in Finksburg, Maryland, for example, are a family-owned tattoo shop that specializes in custom 3D nipple and areola tattoos. Myers was inspired to provide this service after his sister went through breast cancer treatment. His daughter Anna has followed in his tattooing footsteps.
Others may choose other types of tattoos—beautiful works of art—etched over their breasts or flat chests to feel more empowered and comfortable with their new appearance.
Other treatment issues
According to Berrocal, another aspect of breast cancer treatment that 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 back burner.
“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) and anastrozole may also experience hot flashes and loss of libido, pain during sex, headaches, and depression.
"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. The American College of Obstetricians and Gynecologists, meanwhile, supports the use of vaginal estrogen in breast cancer survivors. Your healthcare provider (HCP) can help advise on whether such treatments may be right for you.
Staying connected with your partner
A return to a pre-breast cancer sex life may take about a year or two, says Berrocal, 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 or join a support group to work through your concerns.
Looking ahead
“Surgeons are trained to talk about treatment and explain surgical options,” says Berrocal. But, he adds, 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 HCPs can make it possible to enjoy intimacy again after a mastectomy.
