A new systematic review of research has found that mastectomy, while a life-saving procedure for many women with breast cancer, is associated with a subsequent decline in sexual health and a more negative body image. The research, a comprehensive analysis of 20 studies, highlights the significant physical and emotional challenges women face after the removal of one or both breasts, and underscores the need for better preoperative counseling to manage patient expectations.
The study, presented at the American College of Surgeons Clinical Congress 2025, points to a critical gap in patient care: the absence of a standardized method for assessing a woman’s psychological and emotional readiness for the long-term consequences of mastectomy. Researchers noted that while the focus is often on the immediate medical outcomes of the surgery, the enduring effects on a woman’s quality of life, mental health, and psychosocial well-being are not always adequately addressed before the procedure. This can leave many women unprepared for the emotional and physical aftermath of the surgery.
Psychosocial Outcomes of Mastectomy
The systematic review, which examined nearly 3,000 studies before narrowing its focus to 20 that met specific criteria, found a clear trend of worsened psychosocial outcomes for women who underwent mastectomy. Fifteen of the 20 studies analyzed reported negative impacts in at least one psychosocial domain. The most commonly assessed areas were body image, sexual health or function, pain or physical function, and overall quality of life. Fewer studies looked at psychosocial health and patient satisfaction, indicating a need for a more comprehensive understanding of the patient experience.
A Lack of Standardized Assessment
A significant issue identified by the researchers is the wide variation in how post-surgical outcomes are measured. The 20 studies used 38 different patient-reported outcome measures (PROMs), with most of these measures being used in only a single study. This lack of a standardized approach makes it difficult to compare results across studies and to develop a clear, evidence-based understanding of the full range of challenges that women face. The authors of the review argue for the development of a validated screening tool to better prepare women for the realities of life after mastectomy.
Impact on Body Image and Sexual Health
The loss of one or both breasts can have a profound impact on a woman’s sense of self and her feelings of femininity. A study of breast cancer patients in Ghana found that 70% of women who had a mastectomy felt less feminine, and 63% reported a loss of self-confidence. These feelings can be compounded by the physical changes to a woman’s body, including scarring and the absence of a breast, which can lead to a distorted body image and a reluctance to engage in intimate relationships. The study also found that many women felt shy about their spouses seeing their mastectomy scars, and 41% believed their marriages had been negatively affected by the surgery.
Comparison with Other Surgical Options
Research has also shown that the extent of breast cancer surgery is directly related to the severity of the negative psychosocial outcomes. A study of young women with breast cancer found that those who underwent more extensive surgery, such as a bilateral mastectomy, had worse body image, sexual health, and higher levels of anxiety compared to those who had breast-conserving surgery or a unilateral mastectomy. While quality of life improved over time for all women in the study, those with more extensive surgery consistently reported more significant challenges in these areas.
The Importance of Preoperative Counseling
The findings from these studies highlight the critical need for comprehensive preoperative counseling that goes beyond the immediate medical risks and benefits of the surgery. Women considering a mastectomy need to be fully informed about the potential long-term impacts on their sexual health, body image, and overall quality of life. This counseling should include discussions about the emotional and psychological challenges they may face, as well as information about resources and support systems that can help them navigate these challenges. The development of a standardized screening tool, as recommended by the authors of the systematic review, could be a valuable first step in ensuring that all women are adequately prepared for the life-altering changes that can accompany a mastectomy.
The Role of Support Systems
For many women, the support of family, friends, and their community is essential to their recovery and well-being after a mastectomy. The study of Ghanaian breast cancer patients found that religion and faith played a significant role in helping women cope with the challenges of their diagnosis and treatment, with many women reporting that their belief in God was a source of strength and comfort. The study also found that professional counseling for both patients and their spouses can be beneficial in addressing the emotional and psychological impacts of the surgery.
Strategies for Improvement
In addition to improved counseling and support, the availability of affordable breast prostheses and breast reconstruction options can also play a role in helping women adjust to life after mastectomy. The Ghanaian study found that many women used breast prostheses to reduce attention to the absence of their breast and to improve their self-confidence and feminine appearance. While breast reconstruction is not as common in Ghana due to its high cost, it is an option that can help to restore a sense of wholeness and improve body image for some women.
