Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study

doi:10.3969/j.issn.1674-8115.2021.12.008

Abstract

Abstract: Objective

·To study the recognization and attitudes regarding sex of the breast cancer patients who underwent breast reconstruction, and their experience of altered sexual status and their coping styles.

Methods

·The breast cancer patients who underwent breast reconstruction surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were selected as the study population through purposive sampling. The general information questionnaire was used to collect the basic information of the patients. A semi-structured in-depth interview on the experience of sexual status change and coping style after breast reconstruction surgery was conducted by using phenomenological research method. The data were analyzed according to seven steps of Colaizzi′s method.

Results

·A total of 12 respondents with a median age of 40 (28?51) years were included, all of whom underwent deep inferior epigastric perforator flap with an median postoperative duration of 17.5 months. Their sexual life and emotional experience could be summarized into 3 themes. ① The patients′ perceptions of changes in sexual life after breast reconstruction surgery: all the respondents had a good understanding of the importance of sex; most of the respondents could resume sexual life after completing adjuvant treatment for breast cancer; the altered body image and the impaired skin sensation resulting from breast reconstruction surgery affected the patients′ sexual experience. ② The patients′ response to the changes in sexual life after breast reconstruction: there was less communication about sex between the patients and their spouses; the patients actively initiated compensatory mechanisms to mitigate adverse sexual experience. ③ The patients′ need for support in resuming sexual life after surgery: the patients had a high demand for sexual health, but there was little communication between the doctors and the patients on sexual issues; the patients expected to receive professional information support through appropriate access.

Conclusion

·After breast reconstruction, the patients are relatively positive about sexual life and emotional experience, but lack of communication with their spouses and medical staff about sexual problems. Health care providers should effectively communicate, assess the patients′ sexual problems, and provide timely interventions in clinical work to improve their quality of life.

Key words: breast reconstruction, breast cancer, sexual experience, qualitative study

CLC Number:

R473.6

Lu GAN, Yu-fei JIN, Qing REN, Xiao-jing DONG, Nan ZHANG. Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1597-1601.

Figures/Tables 1

TrendMD

References 23

1	IARC. Latest global cancer data: cancer burden rises to19.3 million new cases and 10.0 million cancer deaths in 2020[R/OL]. [2021-03-27]. .
2	Kedde H, van de Wiel HB, Weijmar Schultz WC, et al. Sexual dysfunction in young women with breast cancer[J]. Support Care Cancer, 2013, 21(1): 271-280.
3	Panjari M, Bell RJ, Davis SR, et al. Sexual function after breast cancer[J]. J Sex Med, 2011, 8(1): 294-302.
4	张淑荣, 侯继凤, 赵新华. 乳腺癌术后形体改变导致性功能心理障碍的调查分析[J]. 承德医学院学报, 2004, 21(2): 181-182.
5	Platt J, Baxter NN, McLaughlin J, et al. Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort[J]. Plast Reconstr Surg, 2015, 135(3): 468e-476e.
6	van Mierlo DR, Lopez Penha TR, Schipper RJ, et al. No increase of local recurrence rate in breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction[J]. Breast, 2013, 22(6): 1166-1170.
7	Berbers J, van Baardwijk A, Houben R, et al. 'Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature[J]. Eur J Cancer, 2014, 50(16): 2752-2762.
8	Eltahir Y, LLCH Werners, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures[J]. Plast Reconstr Surg, 2013, 132(2): 201e-209e.
9	Ng SK, Hare RM, Kuang RJ, et al. Breast reconstruction post mastectomy: patient satisfaction and decision making[J]. Ann Plast Surg, 2016, 76(6): 640-644.
10	Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in US Breast reconstruction: increasing implant rates[J]. Plast Reconstr Surg, 2013, 131(1): 15-23.
11	Chen JJ, Huang NS, Xue JY, et al. Current status of breast reconstruction in Southern China: a 15 year, single institutional experience of 20 551 breast cancer patients[J]. Medicine (Baltimore), 2015, 94(34): e1399.
12	Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: a review[J]. Maturitas, 2010, 66(4): 397-407.
13	Colaizzi PF. Psychological research as the phenomenologists views it[M]//Valle RS, King M. Existential-phenomenological alternatives for psychology. New York: Oxford University Press, 1978: 48.
14	Leunissen T, de Boer M, van der Hulst R, et al. Exploring novel dimensions of body experience after breast reconstruction[J]. JPRAS Open, 2016, 7: 32-41.
15	Matthews H, Turner A, Williamson I, et al. 'It′s a silver lining': a template analysis of satisfaction and quality of life following post-mastectomy breast reconstruction[J]. Br J Health Psychol, 2018, 23(2): 455-475.
16	邓燕萍, 刘雅清, 吴美华. 女性乳腺癌患者配偶心理体验的质性研究[J]. 护理实践与研究, 2014(12): 94-95.
17	Kinsinger SW, Laurenceau JP, Carver CS, et al. Perceived partner support and psychosexual adjustment to breast cancer[J]. Psychol Health, 2011, 26(12): 1571-1588.
18	Rottmann N, Gilså Hansen D, dePont Christensen R, et al. Satisfaction with sex life in sexually active heterosexual couples dealing with breast cancer: a nationwide longitudinal study[J]. Acta Oncol, 2017, 56(2): 212-219.
19	高冰红. 认知干预联合家庭支持改善育龄期乳腺癌患者术后性生活质量的应用价值[J]. 社区医学杂志, 2018, 16(10): 69-71.
20	Hordern AJ, Street AF. Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs[J]. Med J Aust, 2007, 186(5): 224-227.
21	张骋姣, 潘令仪, 包家林, 等. 上海市年轻女性乳腺癌患者性功能障碍的横断面调查研究[J]. 中国性科学, 2018, 27(10): 141-147.
22	Carter J, Laechetti C, Andersen BL, et a1. Interventions to address sexual problems in people with cancer:American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline[J].J Clin Oncol, 2018, 36(5): 492-511.
23	Watson M, Kissane DW. 唐丽丽, 译. 癌症患者心理治疗手册[M]. 北京: 北京大学医学出版社, 2016: 207-218.

No.	Age/year	Surgical approach	Course after operation/month	Treatment stage	Adjuvant therapy	Education	Marriage	Fertility status	Employment	Q1	Q2	Q3
A	51	DIEP	16	Completed	C+T	College	Yes	None	Yes	Yes	Yes	No
B	37	DIEP	17	Completed	T+R	College	Yes	1	Yes	Yes	Yes	No
C	44	DIEP	23	Completed	E	College	Yes	1	Yes	Yes	No	No
D	50	DIEP	19	Completed	C+T	Master	Divorced	1	Yes	Yes	No	No
E	40	DIEP	17	Completed	‒	Master	Yes	2	Yes	Yes	Yes	No
F	30	DIEP	16	E	C+E	College	Yes	1	No	Yes	No	No
G	49	DIEP	20	E	E	College	Yes	1	No	Yes	Yes	No
H	32	DIEP	16	E	E	College	Yes	None	Yes	Yes	Yes	No
I	40	DIEP	20	E	C+T+E	College	Yes	1	Yes	Yes	No	No
J	31	DIEP	18	Completed	C+T	College	Yes	1	Yes	Yes	Yes	No
K	28	DIEP	21	E	E	Master	Yes	1	Yes	Yes	Yes	No
L	42	DIEP	14	Completed	C+T	High school	Yes	1	No	Yes	No	No

No.	Age/year	Surgical approach	Course after operation/month	Treatment stage	Adjuvant therapy	Education	Marriage	Fertility status	Employment	Q1	Q2	Q3
A	51	DIEP	16	Completed	C+T	College	Yes	None	Yes	Yes	Yes	No
B	37	DIEP	17	Completed	T+R	College	Yes	1	Yes	Yes	Yes	No
C	44	DIEP	23	Completed	E	College	Yes	1	Yes	Yes	No	No
D	50	DIEP	19	Completed	C+T	Master	Divorced	1	Yes	Yes	No	No
E	40	DIEP	17	Completed	‒	Master	Yes	2	Yes	Yes	Yes	No
F	30	DIEP	16	E	C+E	College	Yes	1	No	Yes	No	No
G	49	DIEP	20	E	E	College	Yes	1	No	Yes	Yes	No
H	32	DIEP	16	E	E	College	Yes	None	Yes	Yes	Yes	No
I	40	DIEP	20	E	C+T+E	College	Yes	1	Yes	Yes	No	No
J	31	DIEP	18	Completed	C+T	College	Yes	1	Yes	Yes	Yes	No
K	28	DIEP	21	E	E	Master	Yes	1	Yes	Yes	Yes	No
L	42	DIEP	14	Completed	C+T	High school	Yes	1	No	Yes	No	No

[1]	Tian-hao ZHOU, Zhao-chen XIN, Shao-qian DU, Yuan CAO, Jing-xuan XU, Zeng-hong LAO, Hong-xia WANG. Establishment and optimization of co-culture technology for breast cancer organoids [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1017-1024.
[2]	Yan-jie JI, Hao LUO, Hai-yan CAI, Xin-yu LIU, Shi-jia JIN, Shen-yue SU, Han-zhang XU, Hu LEI, Ying-li WU. Inhibition of CDDO-ME on ubiquitin-specific protease 2a activity and cell proliferation in triple negative breast cancer cells [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1025-1032.
[3]	Cheng-zhi WANG, Hua-yun DENG, Zhi PANG, Lei HUANG. Mechanism of MUC1 in the pathogenesis of HER2-positive breast cancer [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(7): 839-848.
[4]	Jia-ling ZHANG, Feng-chun ZHANG, Ying-chun XU. Research progress in the systemic treatment for breast cancer with brain metastasis [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 671-677.
[5]	Yan-yun HAO, Si-hui YÜ, Jing LU, Xiang GU, Fan ZHANG, Jin-ke CHENG, Tian-shi WANG. Role of SIRT3 SUMOylation deficiency in the proliferation and chemotherapeutic sensitivity of breast cancer cells MCF7 [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1557-1563.
[6]	Xiao-jun ZHAO, Zhi-gang QIAO, Ting-yu LIANG, Yan-ling AN. Expression of breast cancer susceptibility gene 1 protein in brain gliomas and its influence on the sensitivity of temozolomide [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(1): 118-122.
[7]	CHEN Si, LIU Chun-liang, ZHAO Qian, SUN Hai-peng, LIU Yun-xia. Identification of hub genes and key pathways in breast cancersurvival-based bioinformatics analysis [J]. , 2020, 40(3): 294-.
[8]	YE Xin, ZHOU Xiao-yun, YANG Li, WANG Jie, HE Qi. Analysis of clinicopathological features and prognosis of young patients with breast cancer in different age groups [J]. , 2020, 40(3): 351-.
[9]	CHENG Long, XU Wu-qin, ZHANG Peng, HUANG Jian-jun, LI Xiao-ning. Effect of miR-27a down-regulation on proliferation, migration and invasion in triple-negative breast cancer cells [J]. , 2020, 40(2): 188-.
[10]	ZHANG Feng-chun, ZHANG Shuo-yuan, CHEN Tian-en, XU Ying-chun. Clinical application of PD-1/PD-L1 to prognosis prediction and treatment of triple-negative breast cancer [J]. , 2020, 40(1): 128-.
[11]	HE Qin, ZHANG Wei-bin, SHEN Yu-hui. Establishment of a prognostic scoring model for the breast cancer patients with spinal metastasis [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(09): 1243-1248.
[12]	LIU Jie, QIU Xiao-chun. Research hotspots and trends of breast cancer stem cells [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(07): 881-888.
[13]	LU Yu-jie, JIN Ze-yu, LI Ya-fen, SHEN Kun-wei, CHEN Wei-guo, CHEN Xiao-song. Receptor status testing and its influence on following treatment selection in breast cancer patients with loco-regional recurrence [J]. , 2019, 39(9): 1071-.
[14]	GU Xiao-ping1, CHEN Meng-ping1, LIANG A-juan2, LIU Yun-xia1, SUN Hai-peng1, HUANG Ying1. Regulation of mitochondrial carrier SLC25A13 on breast cancer cell cycle in vitro [J]. , 2019, 39(8): 848-.
[15]	SUN Xiao-yin, ZHUANG Zhi-gang, FU Yun, CHENG Xiao-lin. Analysis of X-ray signs and postoperative pathological features of breast cancer [J]. , 2019, 39(4): 398-.