1
|
Wood Matabele KL, Nkana ZH, Seitz AJ, Edalatpour A, Mahajan AY, Poore SO. From Tip of Brush to Tip of Knife: The Relationship Between Post-mastectomy Breast Reconstruction and the Classical Arts. Aesthet Surg J 2024; 44:716-721. [PMID: 38323872 DOI: 10.1093/asj/sjae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
Breast reconstruction is highly complex, requiring navigation of not only clinical and operative realities, but of patient expectations as well. The authors sought to identify historical art pieces that exhibit breast asymmetries and deformities for comparison with photographs of breast reconstruction patients seen at the clinic of the senior author (S.O.P.) to demonstrate that achievement of perfect breast cosmesis is challenging in both breast reconstruction and in the classical arts. Open access libraries and Creative Commons images were reviewed to identify appropriate works of art from various time periods and geographic locations. Following artwork selection, photographs of breast reconstruction patients were reviewed and paired with selected artworks exhibiting cosmetically similar breasts. A total of 8 pieces of selected historic art were found to have at least 1 matching patient photograph, with 9 correlative patient photographs ultimately chosen. Common breast asymmetries and deformities identified included ptosis, asymmetric chest wall placement, asymmetric nipple placement, and absence of the nipple. This review identified diverse artworks of varying styles spanning vast expanses of both geography and time that exhibited breast deformities and asymmetries commonly encountered in patients seeking revision of breast reconstruction. This underscores that creating the cosmetically ideal breast is difficult both in the operating room and the art studio. Importantly, the authors emphasized that the arts frequently celebrate that which is considered beautiful, although to the trained eye of a plastic surgeon that which is considered beautiful is often classified as dysmorphic or asymmetric.
Collapse
|
2
|
Liu YT, Khan NH, Nicklaus KM, Moix MKB, Liu C, Reece GP, Francis AM, Roubaud MJ, Markey MK. Undergarment Needs and Challenges for Breast Cancer Survivors: A Qualitative Study. RESEARCH SQUARE 2024:rs.3.rs-4307935. [PMID: 38766077 PMCID: PMC11100881 DOI: 10.21203/rs.3.rs-4307935/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose Breast cancer surgery, even with reconstruction, can make it difficult for patients to find a bra that fits properly, is comfortable, and meets their aesthetic standards. We explored breast cancer survivors' experiences with bras over time to identify preferences, needs, and challenges throughout their journeys. Methods Fifteen women who had undergone mastectomy and either delayed or immediate breast reconstruction participated in the study. Focus groups were conducted to explore the participants' current experiences with bras. They were also prompted to recall their experiences before mastectomy and immediately after reconstruction. The discussion included bra materials, styles, construction techniques, color, quality, and price. Results Thematic analysis generated five major themes: "Sense of normalcy and personal well-being," "Struggles immediately following surgery," "Transitions in bra experiences and preference," "Practicality with outfit," and "Association between quality and price". Conclusion Breast cancer survivors' well-being is linked to their experiences with bras and the associated purchasing process, and bra needs change throughout the cancer care journey. Survivors' experiences with bras impact their sense of normalcy and sense of control over significant bodily changes arising from cancer and its treatment. The study underscores the importance of future research on examining the relationship between survivors' quality of life and garment experiences, including factors such as color choices, closure options, and adjustability for individual needs.
Collapse
Affiliation(s)
| | | | | | | | - Chi Liu
- Apparel and Art Design College, Xi'an Polytechnic University
| | | | | | | | | |
Collapse
|
3
|
Kenig N, Monton Echeverria J, Chang Azancot L, De la Ossa L. A Novel Artificial Intelligence Model for Symmetry Evaluation in Breast Cancer Patients. Aesthetic Plast Surg 2024; 48:1500-1507. [PMID: 37592148 DOI: 10.1007/s00266-023-03554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) is a milestone for human technology. In medicine, AI is set to play an important role as we progress into a new era. In plastic surgery, AI can participate in breast symmetry assessment, which until now has been mainly subjective, allowing for inconsistencies. This study aims to improve this evaluation process by integrating a novel trained neural network with the breast symmetry calculator, BAS-Calc. MATERIALS AND METHODS We combined the BAS-Calc tool with a custom-made neural network trained to automatically detect key features of the breast. This integrated system was tested on 81 images of patients who had undergone breast reconstruction post-breast cancer treatment. Its performance was evaluated against two human observers using statistical analysis. RESULTS Our model successfully detected 399/405 (98.51%) of landmarks. Spearman and Pearson correlation indicated a strong positive relationship while Cohen's kappa demonstrated moderate to strong agreement between human observers and AI model. Notably, the average calculation time for the AI was 0.92 seconds, 16 times faster than the 14.09 seconds for humans. CONCLUSIONS Our AI model successfully calculated breast symmetry from images of patients who had undergone reconstructive oncological breast surgery, demonstrating high correlation with human assessments and a markedly reduced processing time. As AI continues to evolve, it is poised to become a pivotal tool in Medicine. Therefore, it is crucial for medical professionals to proactively engage in implementing AI technologies safely and effectively. Further studies are required to broaden our understanding and maximize the potential benefits in this area. Takeaway bullet points Artificial intelligence (AI) is an upcoming force to be reckoned with. AI should find its way into practical applications in plastic surgery. AI can be applied to improve patient care and evaluate aesthetic results. In this work, we present a novel AI model that automatically evaluates breast symmetry. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Nitzan Kenig
- Department of Plastic and Reconstructive Surgery, Albacete University Hospital, Albacete, Spain.
- Department of Plastic Surgery, Albacete University Hospital, Albacete, Spain.
| | - Javier Monton Echeverria
- Department of Plastic and Reconstructive Surgery, Albacete University Hospital, Albacete, Spain
- Department of Anatomy, Medical School of University of Castilla-La Mancha, Albacete, Spain
| | - Luis Chang Azancot
- Department of Plastic and Reconstructive Surgery, Albacete University Hospital, Albacete, Spain
| | - Luis De la Ossa
- Department of Computer Engineering, University of Castilla-La Mancha, Albacete, Spain
| |
Collapse
|
4
|
Lu YH, Wang F, Rothchild E, Greige N, Mehta K, Weichman KE, Ricci JA. Visual Perception of Breast Free Flap Size Is Influenced by Radiation Changes of Surrounding Tissue. J Reconstr Microsurg 2024; 40:30-39. [PMID: 36928906 DOI: 10.1055/a-2056-1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Microsurgical reconstruction for bilateral mastectomy defects after unilateral radiation often results in asymmetry, despite both flap tissues never being radiated. METHODS Photos of 16 patients who received prior radiation to one breast and underwent bilateral abdominal free flap reconstruction were taken postoperatively. Layperson and expert assessment were attained via online crowdsourcing and a panel of attending surgeons and senior residents. Stratification by interflap weight differences was done for subanalysis. RESULTS A total of 399 laypersons responded, with the majority (57.3%) reporting that the radiated breast appeared smaller than the nonradiated breast. When the photos were stratified by interflap weight differences, the photos with the radiated side flap weight over 3% more than nonradiated side were significantly more likely to be perceived by laypersons as the same size (odds ratio [OR] = 2.7; p < 0.001) and of similar aesthetic (OR = 1.9; p < 0.001) when compared with photos with same-sized flaps. Of the expert responses (n = 16), the radiated side was perceived as smaller 72.3% of the time and the nonradiated side appeared more aesthetic 52.7% of the time. Contrary to layperson responses, the experts tend to report the radiated side as smaller despite varying flap weight. Interestingly, expert raters were significantly more likely to rate the flaps of equal aesthetics when the radiated side has a flap larger by 3% or more (OR = 3.6; p < 0.001). CONCLUSION Higher aesthetic scores were noted when larger flaps were inset to the radiated envelope by both laypersons and experts, suggesting potential technical refinement in reconstructive outcomes.
Collapse
Affiliation(s)
- Yi-Hsueh Lu
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Fei Wang
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Evan Rothchild
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicolas Greige
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Karan Mehta
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Katie E Weichman
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Joseph A Ricci
- Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
5
|
Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4861. [PMID: 36910732 PMCID: PMC9995106 DOI: 10.1097/gox.0000000000004861] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 03/11/2023]
Abstract
Although autologous free-flap breast reconstruction is the most durable means of reconstruction, it is unclear how many additional operations are needed to optimize the aesthetic outcome of the reconstructed breast. The present study aimed to determine the average number of elective breast revision procedures performed for aesthetic reasons in patients undergoing unilateral autologous breast reconstruction and to analyze variables associated with undergoing additional procedures. Methods A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center. Results Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m2) increase in a patient's body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures. Conclusions Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.
Collapse
|
6
|
Sampathkumar U, Bui T, Liu J, Nowroolizarki Z, Bordes MC, Hanson SE, Reece GP, Markey MK, Merchant FA. Objective Analysis of Breast Symmetry in Female Patients Undergoing Breast Reconstruction After Total Mastectomy. Aesthet Surg J Open Forum 2022; 5:ojac090. [PMID: 36654970 PMCID: PMC9836330 DOI: 10.1093/asjof/ojac090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Satisfaction with the breast aesthetic outcome is an expectation of breast reconstruction surgery, which is an integral part of cancer treatment for many patients. We evaluated postreconstruction breast symmetry in 82 female patients using distance and volume measurements. Objectives Clinical factors, such as reconstruction type (implant-based and autologous reconstruction), laterality, timing of reconstruction (immediate, delayed, and sequential), radiation therapy (RT), and demographic factors (age, BMI, race, and ethnicity), were evaluated as predictors of postoperative symmetry. Matched preoperative and postoperative measurements for a subset of 46 patients were used to assess correlation between preoperative and postoperative symmetry. Methods We used standardized differences between the left and right breasts for the sternal notch to lowest visible point distance and breast volume as metrics for breast, positional symmetry, and volume symmetry, respectively. We performed statistical tests to compare symmetry between subgroups of patients based on reconstruction type, laterality, timing, RT, and demographics. Results Overall, reconstruction type, reconstruction timing, and RT were observed to be factors significantly associated with postoperative symmetry, with implant reconstructions and immediate reconstruction procedures, and no RT showing better postoperative breast volume symmetry. Subgroup analyses, for both reconstruction type and laterality, showed superior volume symmetry for the bilateral implant reconstructions. No correlation was observed between preoperative and postoperative breast symmetry. Demographic factors were not significant predictors of postreconstruction symmetry. Conclusions This comprehensive analysis examines multiple clinical factors in a single study and will help both patients and surgeons make informed decisions about reconstruction options at their disposal. Level of Evidence 3
Collapse
Affiliation(s)
| | - Thao Bui
- Department of Engineering Technology, University of Houston, Houston, TX, USA
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhale Nowroolizarki
- Department of Engineering Technology, University of Houston, Houston, TX, USA
| | - Mary Catherine Bordes
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Summer E Hanson
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Fatima A Merchant
- Department of Computer Science, University of Houston, Houston, TX, USA
| |
Collapse
|
7
|
Comparison of Body Image and Body Exposure During Sexual Activity and Sexual Assertiveness Among Mastectomized Women with/Without Mammaplasty and Mammaplasty Volunteer Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-117172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Mastectomy can change body image and affect the sexual activities of patients. Breast reconstruction is a way to reduce the sexual damage caused by mastectomy. Objectives: The present study aimed to compare body image and body exposure during sexual activity and sexual assertiveness among mastectomized women with/without mammaplasty and patients with cancer who volunteered for mammoplasty. Methods: This causal-comparative study was performed on the statistical population of mastectomized women with/without mammaplasty and patients who volunteered for mammoplasty within the age range of 25 - 55 years in Tehran, Iran, in 2018. The sample consisted of 37 women with mastectomy, 28 mastectomized women who volunteered for mammoplasty, and 31 women who underwent mammaplasty after mastectomy. The subjects were selected through convenience sampling in Tehran. All participants were asked to complete the Assessment of Body-Image Cognitive Distortions Questionnaire, the Body Exposure during Sexual Activities Questionnaire, and the Hurlbert Index of Sexual Assertiveness. The data were analyzed by analysis of variance using version 20th of SPSS software. Results: In terms of body-image cognitive distortions, there was no difference between the three groups. The women who underwent mammaplasty had less body exposure during sexual activity than patients who volunteered for mammoplasty (P < 0.01); however, there was no difference between the mastectomized patients and patients who underwent mammaplasty. Exposure to the body or anxious attentional focus on the body during sexual activity was reported frequently less in mastectomized women than in mammaplasty volunteers (P < 0.01). The sexual assertiveness of women who underwent reconstructive surgery was more than mastectomized women and volunteer patients for reconstructive surgery (P < 0.01). The mastectomized group had more sexual assertiveness than patients who volunteered for mammoplasty (P < 0.01). Conclusions: The results support the hypothesis that the issue of body image and its relationship with different aspects of sexual function is complex and requires considering different personality traits and factors as moderators. The importance that a woman places on the breast as a symbol of femininity and sexuality is one of the aforementioned factors. The purpose of reconstruction from the patient’s point of view and the importance that a woman gives to her appearance are other components that should be considered before proceeding with mammoplasty.
Collapse
|
8
|
Williams T. Addressing Body Image After Reconstructive Surgery in Adult Patients with Cancer. PLASTIC AND AESTHETIC NURSING 2022; 42:217-225. [PMID: 36469393 DOI: 10.1097/psn.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Body image or how a person views their body and the way it functions ultimately influences their quality of life and functional well-being in their daily environments. The changes to appearance or to body structures and functions that occur as a result of cancer and its treatment can cause individuals to become dissatisfied with their body image where maladaptive emotions, thought processes, and behaviors develop and may lead to deleterious consequences including social avoidance and isolation. Although reconstructive surgery is restorative in nature, it does not guarantee the mitigation of body image dissatisfaction when treating adults with cancer. The majority of adults who undergo reconstructive surgery for the treatment of cancer demonstrate some level of body image dissatisfaction during or after the reconstructive process. Therefore, a need exists for nurses and other oncological team members to recognize and address body image dissatisfaction and the detrimental emotional and behavioral consequences associated with it. This article provides guidance for nurses to address body image by understanding the effects of cancer and its treatment on body image, by recognizing the impact of reconstructive surgery on body image when treating cancer in adults, and by integrating body image assessment and interventions into practice.
Collapse
Affiliation(s)
- Tish Williams
- Tish Williams, OTR, is a senior occupational therapist, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
9
|
"My body…tends to betray me sometimes": a Qualitative Analysis of Affective and Perceptual Body Image in Individuals Living with Endometriosis. Int J Behav Med 2022:10.1007/s12529-022-10118-1. [PMID: 36074337 PMCID: PMC9454389 DOI: 10.1007/s12529-022-10118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
Background Endometriosis is a chronic reproductive disease manifesting in physical symptoms including pain, abdominal swelling, altered bowel and bladder function, and fatigue. These symptoms potentially threaten body image regarding subjective perceptions of functional, appearance, and sensory aspects of one’s body. The aim of this study was to qualitatively understand how endometriosis impacts on affective and perceptual aspects of body image. Method Participants (N = 40) were recruited through endometriosis consumer organizations. In an online survey, participants completed demographic and health history questions, then provided written narratives about body image–related impacts of their endometriosis in response to open-ended questions. These data were thematically analyzed using the template approach. Findings The majority of participants (Mage = 28.3 years) were employed part-time, diagnosed on average for 4.2 years, and reported pelvic pain and bloating, fatigue, and nausea symptoms. Thematic analysis yielded three themes including My Body is a Barrier, Needing to Hide Myself, and Body as Healer and Teacher, all of which reflected affective and perceptual aspects of body image. Conclusion These findings highlight wide-ranging body image–related impacts of endometriosis, suggesting the need for targeted interventions to address these concerns.
Collapse
|
10
|
Weingarden H, Wilhelm S, Jacobs JM, Carrellas J, Cetrulo C, Austen WG, Colwell AS. Prospective examination of psychological risk and maintenance factors for body image distress after mastectomy with immediate breast reconstruction. Body Image 2022; 42:120-125. [PMID: 35691103 PMCID: PMC9398976 DOI: 10.1016/j.bodyim.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Reconstructive breast surgery aims to improve body image following mastectomy, yet many women experience ongoing body image distress (BID). The relationship between the esthetic outcome of reconstructive surgery with BID has been underexplored in mastectomy. This study aimed to assess whether reconstruction outcome following mastectomy is associated with post-surgery BID, and to examine potential psychological risk and maintenance factors for BID above reconstruction outcome. In 49 women undergoing mastectomy with immediate breast reconstruction, we prospectively assessed hypothesized pre-surgery psychological risk factors and post-surgery maintenance factors for post-surgery BID. Reconstruction outcome was assessed via blind surgeon ratings of post-surgery photographs. Surgeon-rated reconstruction outcome was uncorrelated with BID, or with patients' ratings of surgical outcome. Higher pre-surgery depressive symptoms and lower pre-surgery patient expectations for reconstruction predicted greater post-surgery BID, above reconstruction outcome. Post-surgery body checking also predicted greater BID, above reconstruction outcome. Results suggest that the medical team cannot assume their perception of reconstruction outcome matches the patient's view or degree of BID. If replicated, results point to potential psychological risk and maintenance factors that are stronger predictors of post-reconstruction BID, highlighting opportunities for light-touch prevention and intervention to reduce BID after mastectomy with breast reconstruction.
Collapse
Affiliation(s)
- Hilary Weingarden
- Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA 02114, United States.
| | - Sabine Wilhelm
- Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA 02114, United States.
| | - Jamie M Jacobs
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States.
| | - Julia Carrellas
- Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA 02114, United States.
| | - Curtis Cetrulo
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States.
| | | | - Amy S Colwell
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States.
| |
Collapse
|
11
|
Rasekh Jahromi A, Ranjbar A, Naseripour P, Rahmanian V, Jamali S. Body image and sexual function in women with breast cancer. SEXUAL AND RELATIONSHIP THERAPY 2022. [DOI: 10.1080/14681994.2022.2097212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Athar Rasekh Jahromi
- Department Obstetrics and Gynecology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Afsaneh Ranjbar
- Department of Physiology, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Vahid Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Safieh Jamali
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| |
Collapse
|
12
|
Wang H, Liu J, Bordes MC, Chopra D, Reece GP, Markey MK, Hoffman AS. The role of psychosocial factors in patients' recollections of breast reconstruction options discussed with their surgeons. Sci Rep 2022; 12:7485. [PMID: 35523931 PMCID: PMC9076612 DOI: 10.1038/s41598-022-11478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
A patient's comprehension and memory of conversations with their providers plays an important role in their healthcare. Adult breast cancer patients whose legal sex was female and who underwent treatment at the Center for Reconstructive Surgery at The University of Texas MD Anderson Cancer Center were asked to indicate which breast reconstruction procedures they discussed with their surgeon. We focused on the three most frequent responses: (a) participants who remembered discussing implant-based, tissue-based, and combination procedures; (b) participants who remembered only an implant-based option being discussed; and (c) participants who remember only a tissue-based option being discussed. We used multinomial logistic regression models to explore the psychosocial factors associated with patients' recollections of their breast reconstruction options after discussions with their reconstructive surgeons, controlling for medical factors that impact surgical decision-making. Our analyses identified body mass index, body image investment, and body image as statistically significantly associated with the reconstructive options that a participant recalls discussing with their surgeon. Our findings highlight body image investment and body image as important psychological factors that may influence what patients remember from consultations about breast reconstruction options.
Collapse
Affiliation(s)
- Haoqi Wang
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Catherine Bordes
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deepti Chopra
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aubri S Hoffman
- The Value Institute for Health and Care at Dell Medical School, The University of Texas at Austin, 1601 Trinity St. Bldg. B, StopZ1600, Austin, TX, 78712, USA.
| |
Collapse
|
13
|
Nicklaus KM, Gonzalez XT, Sachdev K, Liu J, Chopra D, Hoffman AS, Hanson SE, Markey MK, Reece GP. What Does "Dr. Google" Show Patients Searching for Breast Reconstruction Outcomes Photographs? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4331. [PMID: 35702539 PMCID: PMC9187202 DOI: 10.1097/gox.0000000000004331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Many women with breast cancer search the internet for photographs of their potential reconstruction outcomes, but little is known about the quality, variety, and relevance of images patients are viewing. Methods Breast reconstruction outcome photographs identified by a Google Images search were assessed based on the American Society of Plastic Surgeons/Plastic Surgery Foundation photographic guidelines. Information such as source metadata, breast reconstruction procedure information, and subject demographics was collected from the photographs. Additional analyses were conducted to assess whether nipple reconstruction or tattooing occurred and was disclosed, whether a symmetry procedure was performed and disclosed, and whether donor site scarring is visible in abdominal flap photographs. Results We acquired and analyzed 114 photograph sets. Although a variety of images were readily available, the majority of photograph sets did not follow photographic guidelines or provide sufficient information. Most photograph sets (60%) indicated symmetry procedures when a symmetry procedure was evident, but only 40% of photograph sets disclosed a nipple procedure when a nipple procedure was evident. Only 40% of abdominal flap photographs showed donor site scarring. Subject demographics were largely missing: 50% of photograph sets included subject age, 3% included race or ethnicity, and 12% included weight or BMI. Conclusions Although breast reconstruction outcome photographs shown by "Dr. Google" represent a variety of reconstruction types, they typically lack information that a patient needs to assess self-applicability. Patients may benefit from discussion with their healthcare team about the strengths and limitations of breast reconstruction outcome photographs available on the internet.
Collapse
Affiliation(s)
- Krista M Nicklaus
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Xiomara T Gonzalez
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Tex
| | - Koushalya Sachdev
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Deepti Chopra
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Aubri S Hoffman
- The Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, Tex
| | - Summer E Hanson
- Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences; Chicago, Ill
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| |
Collapse
|
14
|
Tan MYL, Onggo J, Serag S, Phan K, Dusseldorp JR. Deep inferior epigastric perforator (DIEP) flap safety profile in slim versus non-slim BMI patients: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2180-2189. [PMID: 35650004 DOI: 10.1016/j.bjps.2022.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 01/28/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE The complications of breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in non-slim patients are well recognized. However, the effects of this surgery performed on slim patients are yet to be consolidated. This study aims to compare the outcomes of performing DIEP flap breast reconstruction in slim and non-slim body mass index (BMI) patients. METHODS Meta-analysis was performed with a multi-database search (Cochrane, EMBASE, OVID Medline, PubMed, and Web of Sciences) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on 1 February 2021. Data from articles meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. RESULTS Seven studies were included, comprising 574 slim patients and 901 non-slim BMI patients who underwent autologous DIEP flap breast reconstruction. When comparing between the slim and non-slim groups, no statistically significant difference was found in terms of complete flap loss (OR=0.53, 95% CI: 0.11-2.68, p=0.44), partial flap loss (OR=0.92, 95% CI: 0.3-2.82, p=0.88), and fat necrosis (OR=0.91, 95% CI: 0.61-1.37, p=0.66). Similarly, in terms of general surgical complications, there was no statistically significant difference between groups in terms of all complications (OR=0.83, 95% CI: 0.45-1.51, p=0.54), abdominal wound healing complications (OR=1.01, 95% CI: 0.59-1.73, p=0.97), infections (OR=0.74, 95% CI: 0.41-1.37, p=0.34), and seroma (OR=0.89, 95% CI: 0.35-227, p=0.81). CONCLUSION There is no increased risk of postoperative complications in either group. DIEP flaps can be safely performed in slim patients, though higher quality research may be required to further confirm this.
Collapse
Affiliation(s)
- Michelle Y L Tan
- University of Adelaide Medical School, Adelaide, South Australia, Australia.
| | - James Onggo
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Saleh Serag
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin Phan
- Department of Plastic and Reconstructive Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - Joseph R Dusseldorp
- Department of Plastic and Reconstructive Surgery, Concord Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Tu PC, Wang MT. Appearance investment, coping strategies, and psychosocial adjustment in male patients with head and neck cancer. J Psychosoc Oncol 2022; 41:1-19. [PMID: 35057714 DOI: 10.1080/07347332.2021.2005735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: This study examined the interrelationships among two facets of appearance investment (self-evaluative salience and motivational salience), appearance-related coping strategies, and psychosocial adjustment in male patients with head and neck cancer following physical appearance changes.Methods: It adopted a cross-sectional design; 136 male patients with stage I-III head and neck cancer were recruited. Self-reported scales were used to assess physical appearance changes due to cancer surgery and treatment, appearance investment, coping strategies, psychological distress, and disease-specific quality of life. Data were analyzed using path analysis.Results: Results showed that self-evaluative salience was directly and negatively associated with psychosocial adjustment, and motivational salience was indirectly and positively associated with psychosocial adjustment through coping strategies of less avoidance and greater positive rational acceptance.Discussion: This study also provides important information regarding the possible pathways of appearance investment and coping strategies in the psychosocial adjustment of male patients with head and neck cancer.
Collapse
Affiliation(s)
- Pei-Chiung Tu
- Department of Psychology, Chung Yuan Christian University, Taoyuan City, Taiwan
| | - Mu-Te Wang
- Department of Psychology, Fo Guang University, Jiaosi, Taiwan
| |
Collapse
|
16
|
PSYChosomatic Medicine in ONcologIc and Cardiac Disease (PSYCHONIC) Study-A Retrospective and Prospective Observational Research Protocol. J Clin Med 2021; 10:jcm10245786. [PMID: 34945081 PMCID: PMC8709231 DOI: 10.3390/jcm10245786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).
Collapse
|
17
|
Williams T. Addressing Body Image After Reconstructive Surgery in Adult Patients with Cancer. Plast Surg Nurs 2021; 41:132-140. [PMID: 34463299 DOI: 10.1097/psn.0000000000000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Body image or how a person views their body and the way it functions ultimately influences their quality of life and functional well-being in their daily environments. The changes to appearance or to body structures and functions that occur as a result of cancer and its treatment can cause individuals to become dissatisfied with their body image where maladaptive emotions, thought processes, and behaviors develop and may lead to deleterious consequences including social avoidance and isolation. Although reconstructive surgery is restorative in nature, it does not guarantee the mitigation of body image dissatisfaction when treating adults with cancer. The majority of adults who undergo reconstructive surgery for the treatment of cancer demonstrate some level of body image dissatisfaction during or after the reconstructive process. Therefore, a need exists for nurses and other oncological team members to recognize and address body image dissatisfaction and the detrimental emotional and behavioral consequences associated with it. This article provides guidance for nurses to address body image by understanding the effects of cancer and its treatment on body image, by recognizing the impact of reconstructive surgery on body image when treating cancer in adults, and by integrating body image assessment and interventions into practice.
Collapse
Affiliation(s)
- Tish Williams
- Tish Williams, OTR, is a senior occupational therapist, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
18
|
Exploring partial intrinsic and extrinsic symmetry in 3D medical imaging. Med Image Anal 2021; 72:102127. [PMID: 34147832 DOI: 10.1016/j.media.2021.102127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022]
Abstract
We present a novel methodology to detect imperfect bilateral symmetry in CT of human anatomy. In this paper, the structurally symmetric nature of the pelvic bone is explored and is used to provide interventional image augmentation for treatment of unilateral fractures in patients with traumatic injuries. The mathematical basis of our solution is based on the incorporation of attributes and characteristics that satisfy the properties of intrinsic and extrinsic symmetry and are robust to outliers. In the first step, feature points that satisfy intrinsic symmetry are automatically detected in the Möbius space defined on the CT data. These features are then pruned via a two-stage RANSAC to attain correspondences that satisfy also the extrinsic symmetry. Then, a disparity function based on Tukey's biweight robust estimator is introduced and minimized to identify a symmetry plane parametrization that yields maximum contralateral similarity. Finally, a novel regularization term is introduced to enhance similarity between bone density histograms across the partial symmetry plane, relying on the important biological observation that, even if injured, the dislocated bone segments remain within the body. Our extensive evaluations on various cases of common fracture types demonstrate the validity of the novel concepts and the accuracy of the proposed method.
Collapse
|
19
|
Clarke A, Paraskeva N, White P, Tollow P, Hansen E, Harcourt D. PEGASUS: the Design of an Intervention to Facilitate Shared Decision-making in Breast Reconstruction. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:508-518. [PMID: 31994007 PMCID: PMC8099795 DOI: 10.1007/s13187-019-01656-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies have found varying levels of satisfaction after breast reconstruction surgery with a substantial group of patients reporting some level of regret about their decision. The variable outcomes reported by women undergoing breast reconstruction surgery suggest a role for improved pre-operative communication and shared decision-making (SDM) between patient and health professional. Pragmatic approaches such as decision aids have been evaluated, but the aim of the Patient Expectations and Goals Assisting Shared Understanding of Surgery (PEGASUS) intervention is to facilitate closer interaction between the patient and clinical team. PEGASUS is a standardised two-stage process, in which patients' goals are first elicited, ranked in importance and recorded before being used to frame discussion and decision-making with the surgeon managing care. Following the Medical Research Council (MRC) model, feasibility and acceptability studies have already been reported and a 4-year multicentre randomised controlled trial of 180 participants is underway, (completion 2020). This paper therefore focuses on the design of the intervention itself, in line with recent advice that interventions, in comparison with evaluations, commonly lack a theoretical base and are often under reported. We report a retrospective application of the Capability, Opportunity, Motivation-Behaviour (COM-B) model to provide explicit detail of each step in the intervention design. This is intended to facilitate replication by other clinicians and to provide systematic guidance for others wishing to develop PEGASUS as a strategy for implementing SDM in other clinical populations. Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.
Collapse
Affiliation(s)
- A. Clarke
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - N. Paraskeva
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. White
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. Tollow
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - E. Hansen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK
| | - D. Harcourt
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| |
Collapse
|
20
|
Mace S, Collins S, Speer S. Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction? Health Expect 2021; 24:209-221. [PMID: 33517586 PMCID: PMC8077149 DOI: 10.1111/hex.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/30/2020] [Accepted: 09/06/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Breast asymmetry is a common post-operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions. OBJECTIVE To examine clinical communication about breast symmetry in real-time consultations in a breast cancer clinic. DESIGN Seventy-three consultations between 16 clinicians and 47 patients were video-recorded, transcribed and analysed using conversation analysis. RESULTS In most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient. CONCLUSION Current clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient's individual stance on breast symmetry, and optimize doctor-patient alignment.
Collapse
Affiliation(s)
- Stephanie Mace
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Collins
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Susan Speer
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| |
Collapse
|
21
|
Nicklaus KM, Bui T, Bordes MC, Liu J, Chopra D, Hoffman AS, Reece GP, Hanson SE, Merchant FA, Markey MK. Goldilocks Principle: Preference for Change in Breast Size in Breast Cancer Reconstruction Patients. Front Psychol 2021; 12:702816. [PMID: 34539505 PMCID: PMC8446205 DOI: 10.3389/fpsyg.2021.702816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Patients' preferences regarding changing or maintaining their breast size after mastectomy and reconstruction are important but understudied determinants of post-surgical satisfaction and quality of life. The goal of this study was to identify factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction at The University of Texas MD Anderson Cancer Center in the United States from 2011 to 2014. The average age of participants was 45.7 ± 9.1 years. At baseline, mean average breast volumes were 755.7 ± 328.4 mL for all women (n = 48), 492.3 mL ± 209.3 for 13 women who preferred to be "bigger than now," 799.2 mL ± 320.9 for 25 women who preferred to remain "about the same," and 989.3 mL ± 253.1 for 10 women who preferred "smaller than now." Among the 23 women who preferred to change their breast size, 19 desired to shift toward the mean. Women with the smallest and largest 20% of baseline breast size were more likely to desire a change toward the mean (p = 0.006). Multinomial logistic regression models found average breast volume and satisfaction with breast size to be the most important factors associated with preferences for changing or maintaining breast size for women undergoing breast reconstruction. This study provides preliminary evidence for a "Goldilocks principle" in women's preferences for breast size change in the context of breast reconstruction, and identifies hypotheses for future studies of the associations among preference for change in breast size, preference achievement, and post-reconstruction body image.
Collapse
Affiliation(s)
- Krista M. Nicklaus
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thao Bui
- Department of Engineering Technology, University of Houston, Houston, TX, United States
| | - Mary Catherine Bordes
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Deepti Chopra
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aubri S. Hoffman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory P. Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Summer E. Hanson
- Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Fatima A. Merchant
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States
- Department of Engineering Technology, University of Houston, Houston, TX, United States
| | - Mia K. Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Mia K. Markey,
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Body image is a critical psychosocial issue for patients with cancer, because of the profound effects the disease and its treatment can have on appearance and bodily functioning. Adverse psychological effects of body image changes associated with cancer include debilitating levels of anxiety, social avoidance, depression, problems with intimacy and impaired sexuality, and feelings of shame/inadequacy. The construct of body image is increasingly recognized as complex and multifaceted from an embodied lens, creating more meaningful and efficacious interventions. Although there is some evidence now for in-person interventions, more research is needed in online and in-person interventions, particularly beyond what has been demonstrated in breast cancer. There is also need to address concerns around the practical and psychosocial barriers that can diminish access to, and participation in such individual or group interventions. Internet-based interventions offer opportunity for greater access to tailored psychosocial care. RECENT FINDINGS An emerging conceptualization of body image for cancer patients is discussed. Internet-delivered interventions targeting body image are outlined; the majority are pilot trials and those developed for breast cancer patients. Challenges found in online interventions are also discussed. SUMMARY Internet-delivered body image interventions would benefit from a broader conceptualization of body image, greater methodological rigor, and investigations focused on a broader range of cancer populations, beyond patients with breast cancer. Future research is needed to develop, test, and identify who can benefit from online interventions within cancer care.
Collapse
|
23
|
Esplen MJ, Warner E, Boquiren V, Wong J, Toner B. Restoring body image after cancer (ReBIC): A group therapy intervention. Psychooncology 2020; 29:671-680. [PMID: 31984589 DOI: 10.1002/pon.5304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Body image (BI) remains a significant survivorship challenge among breast cancer (BC) survivors. We describe an 8-week group intervention-restoring body image after cancer (ReBIC)-developed to target BI distress for BC survivors. METHODS The intervention was informed by interviews with BC survivors and by a descriptive, exploratory approach which adapted guided imagery exercises to address BI. Educational material was selected to address sociocultural factors that may contribute to BI distress and affect adjustment. Videotape reviews and content analyses further refined the intervention. RESULTS The intervention incorporates three active components: psychotherapeutic group principles; guided imagery exercises to address BI; and psychoeducation on relevant socialization factors and gender-based messages internalized by women in Western society. The therapeutic group was a supportive and effective way to assist BC survivors to gain insight on BI impacts, their histories, and relevant sociocultural factors contributing to BI distress. The group also facilitated the working through of grief over multiple losses. Guided imagery was well-received, and appeared to help survivors identify negative and emerging self-schema, as well as facilitate new self-views. Specific themes included negative emotions associated with an altered body and self, grief and loss, isolation, difficulties with sexual intimacy, relationship challenges, and uncertainty around sense of self and future. CONCLUSION An empirically tested group therapy intervention is described and has implications for survivorship programs to help address BI-related challenges. Future work could consider testing a similar approach tailored for other cancer populations.
Collapse
Affiliation(s)
- Mary Jane Esplen
- de Souza Institute, University Health Network, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jiahui Wong
- de Souza Institute, University Health Network, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Toner
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Jarry JL, Dignard NAL, O'Driscoll LM. Appearance investment: The construct that changed the field of body image. Body Image 2019; 31:221-244. [PMID: 31653567 DOI: 10.1016/j.bodyim.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/14/2019] [Indexed: 01/07/2023]
Abstract
In the mid-1990s, Thomas F. Cash developed the construct of appearance investment and an instrument to measure it, the Appearance Schemas Inventory (ASI). This was followed by a significant revision of this measure, the ASI-R. This instrument distinguished two dimensions to appearance investment, one referring to engagement in behaviours meant to improve appearance esthetics, and one referring to the importance of appearance for self-definition. The construct of appearance investment and its measurement gave rise to a new area of research that widened our understanding of body image beyond the ubiquitous construct of satisfaction. In this paper, we review the literature on appearance investment and offer conclusions based on the different study designs in which either the ASI or ASI-R were used. This is followed by general conclusions about the current state of the research on appearance investment, and future directions to improve our understanding of the factors contributing to the development of excessive investment in appearance.
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Psycho-oncology has completed 25 years. There is growing recognition of the psychosocial needs of persons living with cancer and the role of sociocultural factors in addressing the needs. This review addresses the research in developing countries relating to distress associated with living with cancer and psychosocial care. RECENT FINDINGS There is growing recognition of the emotional needs, understanding of the sociocultural aspects of the emotional responses of persons, caregivers, role of resilience and posttraumatic growth and spirituality in cancer care. Psychosocial aspects of cancer are largely influenced by social, economic, cultural, religious and health systems. A number of innovative approaches to care like use of yoga, financial and material support and involvement of caregivers have been implemented. A positive development is the increasing professional attention to document and develop innovative care programmes. SUMMARY A significant proportion of the general population are living with cancer. There are significant psychosocial needs largely influenced by social, economic, cultural, religious aspects of the communities. There are a wide range of interventions from self-care to professional care to address the needs. In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.
Collapse
|