Coping with
Appearance Changes
Contents
Introduction
What Is Body Image? 1
Body Image and Our Culture 3
Body Image and Breast Cancer 4
Breast Surgery 6
Radiation Treatment 7
Chemotherapy 8
Lymphedema 10
Body Image and Breast Reconstruction 11
Sexuality and Intimacy 13
Improving Your Relationship with Your Body 16
What Breast Cancer Survivors Have to Say About . . . 19
Resources 21
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Introduction
An important relationship in your life has likely changed since you were diagnosed with
breast cancer – your relationship with your body. This relationship is quite special,
private and may need some extra care and attention.
At some point during or after your cancer treatment, changes to your appearance will
likely upset you. This is entirely normal and experienced by nearly all breast cancer
survivors. Some women have a harder time than others dealing with appearance and
body changes. Some important questions to ask yourself right now are:
• Are you feeling concerned or uncomfortable about changes to your appearance
and body?
• Are you worried about upcoming changes to your body?
• Do you spend a lot of time thinking about changes to your appearance?
• Do you avoid certain activities because of concerns about your appearance?
Nearly all breast cancer survivors will answer “yes” to one or more of these questions.
This booklet is about breast cancer survivor’s unique struggles with their changed body
image and difficult emotions. We offer a variety of tips to help you cope and to achieve a
better relationship with your body.
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What Is Body Image?
The term “body image” means different things to different people. Body image is more
than just a mental picture of what you look like. It is more than thinking you look fat, that
your thighs are too big or that a certain outfit makes you look good. Body image refers to
the personal relationship you have with your entire body – the way you perceive, think
and feel about all aspects of your body and the way it functions.
If you are like most women, you tend to focus mainly on those aspects of your
appearance or your body that you dislike and pay little attention to those things you
appreciate and enjoy.
Stop for a moment and consider how the following aspects of your body image influence
the way you feel about yourself. Are you satisfied with any of these? Are you unhappy
with any of these?
• Height
• Weight
• Hair (color, thickness, texture)
• Facial complexion
• Flexibility
• Muscle tone
• Voice quality
• Appetite
• Physical coordination
• Energy level
• Arms
• Legs
• Buttocks
• Cheeks or cheekbones
• Appearance of eyes
• Teeth
• Sex drive/sexual activities
• Breasts/chest
• Feet
• Eyesight
• Hearing
• Nose
• Lips
• Ears
The most important thing to understand about body image is it is entirely subjective and
personal. This means it has nothing to do with what other people see or how they view
your body and the way it functions – it is entirely about what you think, feel and perceive.
The way you see your body is not necessarily the same as the way other people see
you. Do any of the following examples sound familiar? You have a friend who complains
about wanting to lose five to 10 pounds or more, but you think she looks great the way
she is. You are with a colleague who compliments you on your hairstyle or what you are
wearing, but you happen to think you do not look good at all that day.
What Affects Body Image?
The way you feel about your body can change based on what you are experiencing in
the moment. Some days we feel great about our bodies, yet at other times we are
unsatisfied or uncomfortable.
Imagine yourself in these scenarios:
• You make special plans to go to your favorite restaurant with family or friends. As
you are getting dressed, you put on your favorite outfit and feel the silky fabric
against your skin. How does this feel? You then eat a large meal and have
dessert, too. How does your body feel right after eating?
• You decide to plant some new flowers in the garden in the heat of the day. How
does your body feel while working outside? You go inside to clean up. How do
you feel after you have showered and put on fresh clothes?
• You go to an aerobics class that is particularly challenging. How does your body
feel during the rigorous workout? How do you feel afterward?
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As you can see, body image is quite complex and can be influenced by many things,
including:
• What you are wearing.
• How you are feeling physically.
• What you are doing.
• Who is with you.
Body image and your relationship with your body play an important role in your life –
both before and after your cancer diagnosis. It is important to keep in mind that women
without breast cancer often struggle with how they feel about themselves and their
appearance. Breast cancer and its treatment introduce additional challenges and
changes to your body that will require you to adapt and adjust over time. The process of
adapting to a changed body image can be different for each person.
When to Seek Additional Help
While all women with breast cancer experience some degree of distress related to their
diagnosis and treatment, there are times when you may need additional help coping with
changes to your body. If you find yourself having difficulty, you should consider talking to
a psychologist or counselor about your concerns. Remember, being concerned about
changes to your body is a normal part of this process. It is okay to ask for help and
support in coping with these changes.
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Body Image and Our Culture
How Does Our Culture Influence Our Body Image?
The way we judge our appearance and the way we feel about our body is largely
influenced by the cultural messages we see and hear each day. For example,
television, magazines, billboards and the Internet bombard us with images of thin
women, leading us to believe that having a “perfect body” means success, love and
happiness.
These types of messages tell us that we are valued for how we look rather than for our
intellect or personality. While it is difficult to avoid these messages, it is important to
realize most photographs are airbrushed or altered in some way. In addition, the body
sizes of most models and actresses are not attainable by most women and generally do
not reflect a normal, healthy female size.
The pursuit of the “perfect body” may lead you to feel self-critical and unattractive. It can
also lead to unsafe weight loss strategies and extreme exercise behaviors.
Ways to Challenge Harmful Cultural Messages about Appearance
Most women compare their bodies to those around them. When you do this, it is easy to
forget that your body is unique. You have a certain shape, size, weight and appearance
that is distinct only to you. Your body has a natural weight and shape that it will take
when you routinely exercise and eat a healthy diet.
Do you think the only way you can be happy is to lose weight or change the way you
look? Think for a moment about what qualities you admire in a loved one or a good
friend. Is it how thin or attractive she is? Or is it her honesty, compassion, forgiveness
and support? When we focus on our body’s flaws, we often forget about all the good
qualities we have that others easily see.
Try these three tips to help challenge harmful cultural messages:
• Be more critical when you look at advertisements in magazines. Remind yourself
that many of these pictures are not real. They have been altered to make the
models look thinner and to remove “flaws” in their appearance.
• Take some time to reflect on the things you like or enjoy about your body rather
than focusing on all the things you do not like and want to change.
• Make a list of things you like about yourself that are not related to your
appearance.
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Body Image and Breast Cancer
Why Is It Common for Women with Breast Cancer to Have Body Image Concerns?
Every woman with breast cancer will experience changes to her body and to her
appearance. Many of these changes are necessary to treat your cancer and prolong
your life. Having concerns about these changes is completely normal and to be
expected.
One of the main reasons women find it hard to adjust to body image and appearance
changes is because breasts are a symbol of beauty and femininity in our culture. Having
your breasts removed or altered due to cancer treatment may cause you to feel less
attractive and less secure with your sexuality. Depending on the type of cancer and
treatment you have, you may experience a wide range of body changes. Some
appearance changes happen all at once, such as losing part or all of a breast during
surgery. Other appearance changes tend to happen more slowly. For example, radiation
and chemotherapy can cause side effects to occur over a period of many months. Some
changes are temporary, while others may be more long-lasting.
Each woman with breast cancer has her own unique reaction to body image changes.
Some women have many concerns about body image before treatment begins; others
do not have these concerns until during or after treatment is completed.
You may be surprised by which changes to your body and appearance bother you.
There is no right or wrong way to feel about the changes you experience; your feelings
are your own.
Preparing for Body Image Changes
Making decisions about breast cancer treatment can be hard. Many women are given
different surgical options, and each option can affect body image in different ways.
In addition to choosing the type of surgery, you may also need to consider radiation,
chemotherapy and reconstructive treatment. Having to make many of these treatment
decisions at once can be overwhelming. Reach out for support from family, friends and
your health care team.
Learn as much as you can about your treatment options so that you feel comfortable
making these decisions. It is important to understand how each treatment option might
affect your body.
What Body Image and Appearance Changes Should You Expect?
Before you choose or start treatment, it is important to talk with your health care team
about what types of body image and appearance changes to expect. They can best
explain what might happen based on your type of cancer and treatment plan.
Depending on the type of breast cancer you have, you may be able to choose which
type of surgery you prefer. Also, if you decide to have breast reconstruction, you may
have more than one option from which to choose. Your doctor will ask you to choose the
type of reconstruction you want and when you want to have it done.
Because there are so many decisions to make, many women feel overwhelmed and do
not want to ask questions about how treatment may affect their appearance. In
particular, they worry about being seen as “vain” or too focused on their looks.
Having concerns about how you look after treatment is perfectly normal. These concerns
are as important as those about treatment or cancer recurrence. It only becomes a
problem when your looks become more important than effectively treating your cancer. If
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you find yourself struggling with this, you may benefit from talking with a psychologist or
counselor about your concerns.
General Tips and Advice
The following information can help you better prepare for body image changes that may
result from cancer treatment.
Talk openly with your health care team about your concerns. Write down your specific
questions and bring them with you to your appointments. It may also help to bring a
family member or a friend with you. Some specific questions you may want to consider
asking include:
• How will this treatment affect the size and shape of my breasts?
• What type of scarring can I expect from this treatment?
• What will the scars look like just after surgery?
• How much can I expect the scars to fade over time?
• How much swelling will I have with this surgery? How will the swelling change or
improve over time?
• What kinds of changes can I expect if I have my lymph nodes removed?
• How might this treatment affect my weight?
• Will I lose my hair?
• How will this treatment affect the sensations in my breasts? Should I expect to
feel numbness or pain? How long do these effects typically last?
• What problems could affect the way my breasts will look?
• Ask yourself, what are your ultimate body image goals? Talk with your doctor
about whether these goals are realistic.
Be flexible. Prepare to adjust your expectations as you go through treatment.
Be patient. Your body needs time to heal and recover from treatment. Focus on and
appreciate small improvements. Do not be discouraged if you do not see improvements
right away. Expect changes, as the healing process can take many months.
Use reliable sources of information to help you prepare for treatment. Do not base your
treatment expectations upon what you have learned on the Internet or from other breast
cancer survivors.
Each breast cancer survivor has a unique body type and cancer experience. While it is
good to seek support and information from others, do not expect the same exact results.
“The day I was diagnosed, I stopped looking online. I stopped looking at the computer. I
think that helped me more because I got information from other people, but I didn’t go
actively googling my prognosis over and over again. It’s important to stop scaring
yourself because there’s too much information out there.”
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Breast Surgery
“My breasts played starring roles in some of the very best moments in my life –
discovering romance and sex in college, falling in love with my husband and becoming a
mom to my wonderful twin sons – and it was very, very hard to lose them.”
Nearly all women with breast cancer end up needing surgery to remove all or part of
their breast(s). No matter how much you prepare, you are likely to be anxious and feel
shocked and surprised when you see your breasts for the first time after surgery.
Many women have a picture in their mind of how they will look after surgery. You may
look better or worse than you thought, but probably not exactly like you expected. Every
woman reacts differently to the scarring and changes to her breast size and shape. It is
okay to be upset. Remember, how you feel will get better over time.
Tips for Coping with Body Image Changes after Surgery
Right after surgery, view your breasts as soon as you are comfortable and ready. Try to
do this within the first few days of surgery or before you leave the hospital. The more
time you wait to see yourself, the more anxious you may become. Seeing yourself in the
early stages of recovery will help you better understand and appreciate the changes to
your appearance that will happen over time.
Understand that your appearance changes may be the most drastic immediately after
surgery. Try not to focus too much on how your breasts initially appear. Your
appearance will change over time. Remember that it can take months for some of the
swelling from your surgery to go away.
Take part in social activities as soon as you feel ready. Start slowly and allow yourself
time to adjust.
Consider how much information you want to share with others about your cancer and its
treatment. Be prepared to answer questions about how you are doing. You can share
whatever information you wish, including more or less detail. It is also okay to let people
know you would rather not talk about yourself.
“I would agree with looking in the mirror before you leave the hospital. It helped seeing
[my breasts] and getting some of the pain out and then going home. I think I gradually
got better because I knew what I was looking at.”
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Radiation Treatment
Radiation treatment may be part of your treatment plan after surgery. Radiation
treatment depends on many different factors, such as the type of cancer and response
to surgery.
Receiving radiation is painless, but over time, the treatment can cause discomfort and
can affect your appearance. You will not lose your hair unless you receive radiation to
the head.
Skin reactions are a common side effect of radiation treatment. These skin reactions
may occur in patches rather than across the entire breast. The skin treated with radiation
may become:
• Pink, red or tan, like sunburn.
• Flaky, dry or itchy.
• Sore and swollen.
During your treatment, you may also feel increasingly tired. This feeling can last for a
few weeks – even months after your treatment ends. Your health care team can talk with
you further about managing some of these side effects.
Try to be patient and flexible as you go through radiation treatment. Many of the side
effects are temporary and go away after treatment is finished. A long-lasting side effect
of radiation treatment is the breast(s) treated may become smaller and firmer. Your
breast can continue to have slight changes in its size, feel and skin color well after
treatment is completed.
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Chemotherapy
You might need chemotherapy before or after breast surgery. When, how much and how
often it is given will depend on the type of cancer you have.
Chemotherapy can be given in pill form by mouth, through an IV or through an implanted
port that is surgically placed under the skin of the chest.
Most women worry or feel nervous about the side effects of chemotherapy, which can
have significant short-term effects on the body and affect appearance. The side effects
that women tend to be most concerned about are:
• Hair loss.
• Weight changes.
• Nausea and vomiting.
• Pain.
• Fatigue.
It is important to understand how to cope with some of the common, short- and long-
term side effects of chemotherapy.
Hair Loss
Surprisingly, women have different reactions to hair loss. Some are devastated, while
others may be mildly upset. Some women are even curious about losing their hair to see
how it will grow back.
Hair will begin to grow back about two to three months after completing chemotherapy
and it may be a different color or texture. It often comes in gray and curly. Your hair
texture may return to normal over many months.
Wearing a head covering helps some women feel more comfortable, but this is a
personal choice. You may choose not to wear a head covering or only use one
sometimes. The decision is yours, and there is no right or wrong choice. Over time,
people will get used to your new “look.”
If you can, become familiar with options for wigs, hats and scarves before you begin
chemotherapy. Many women choose to buy products ahead of time so they feel more
prepared.
Some women cut their hair short once they start chemotherapy to ease their transition
for hair loss.
Some women choose to shave their head as they begin to lose their hair. This helps
them to feel more in control.
“Initially, with the wigs, I felt like I was covering something, like I was ashamed. I kind of
had that, ‘I can do it. I’m going to show the world that I can be bald and still be
beautiful.’”
“There’s just a lot of pity that comes with having a bald head. When I would put my wig
on people didn’t treat me any differently from any other person. I did an experiment
during the last round of chemotherapy. I put the wig on and went shopping. People were
rude to me, and I was like, ‘This is what it is like to be normal.’”
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“I planted flowers in October knowing that when they bloomed, I was going to get my
hair back. So that was in my head; knowing that there was going to be an end to this.”
Weight Gain
Even after treatment ends, many women find it hard to go back to their previous pre-
cancer weight. Chemotherapy can change your metabolism and cause a weight gain of
five to 10 pounds, even if you eat a healthy diet and are active.
It is okay and normal to be upset by weight changes, but it is also important not to
become overly focused or preoccupied with your weight.
Tips to help you cope with weight gain include the following:
• Wear comfortable clothes, and buy larger sizes if needed, because the fit and
comfort of your clothing is important. Also, try wearing materials that feel good
against your skin.
• Highlight aspects of your appearance that you like by using make up or wearing
jewelry or other accessories.
• Eat sensibly. Do your best to eat lean meats, fish, fruits and vegetables. Meet
with a dietitian or nutritionist for additional help. Do not become overly focused on
eating foods to promote weight loss. Instead, focus on eating a balanced diet.
• Do activities that you enjoy on a regular basis. Find ways to exercise that make
your body feel good. Talk to your doctor before starting any kind of exercise
program.
Menopause
Sometimes chemotherapy stops regular menstrual cycles temporarily or permanently.
Talk with your doctor about whether your chemotherapy might affect your menstrual
cycle.
Going through early menopause can be upsetting because of its own symptoms, such
as hot flashes, vaginal dryness and muscle or joint aches.
Fertility
If you are concerned about being able to have children after treatment, it is extremely
important for you to speak with a fertility specialist before you start treatment. A fertility
specialist will go over any options you may have to preserve your fertility and provide
counseling to assist you in making decisions about your treatment.
Because health insurance coverage varies from state to state, check with your health
insurance provider to find out if they pay for fertility procedures.
Other Possible Side Effects
Your fingernails and toenails may become brittle and sore from chemotherapy, but they
will return to normal once treatment ends. Other possible side effects, such as nausea,
vomiting, diarrhea, pain and mouth and throat sores, should also go away after
chemotherapy ends. Please talk to your health care team about side effects. There are
medicines and treatments that can help.
Keep in mind that everyone is different. Try not to worry ahead of time about the side
effects you might experience. Instead, focus on how you are feeling in the present
moment. Handle each side effect as it comes and speak openly with your doctor about
how your treatment is affecting you.
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Lymphedema
Lymphedema is a possible side effect for women who have had radiation treatment or
lymph nodes removed during surgery. Lymphedema is swelling that most often occurs in
the arms and legs, but it can affect other areas including the hands, fingers, chest and
back.
Lymphedema happens when the lymphatic system does not drain properly due to
disease or injury. The chances of experiencing lymphedema increase when a large
number of lymph nodes from the armpit are removed during surgery or treated with
radiation.
Just because you have had surgery and/or radiation therapy does not mean you will
experience lymphedema. It affects only a portion of women with breast cancer.
For those women with lymphedema, it can be very distressing. Lymphedema causes
mild to severe swelling as well as a feeling of tightness, heaviness or fullness in the arm
or hand and pain that can limit movement (in more severe cases).
Lymphedema can occur at any time following surgery. It may develop within months of
surgery or years after you have completed treatment. Some survivors experience
symptoms that come and go over time. It is important to talk with your health care team if
you experience any symptoms. While there is no “cure” for lymphedema, early treatment
can be more successful in helping you cope.
Tips for Coping with Lymphedema
You can do many things to help cope with and manage lymphedema. Medical treatment
can improve movement and reduce pain and swelling in the affected area. Treatment
can include skin care, massage, exercise, bandaging, compression garments, medicine
and/or surgery.
It helps to take part in activities that make you feel good about your body. Try to highlight
other aspects of your body that you enjoy and appreciate.
You can also choose to cover the affected arm with a decorative covering or wrap. There
are different commercial products available, such as slip-on sleeves with unique
designs. Some of these decorative sleeves provide compression to the arm, while others
can be used to decorate a compression garment or bandage.
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Body Image and Breast Reconstruction
Many women with breast cancer are able to have their breasts reconstructed. The doctor
may use breast implants, your own body tissue or both.
Reconstruction can restore your breast to a more normal shape, size and appearance
following breast cancer surgery. Some women choose to have reconstruction, while
others do not. Some women may not be candidates for the procedure. You might also
choose a different option, such as a breast prosthesis, which fits inside the bra to create
the look of a breast.
A federal law, the Women’s Health and Cancer Rights Act of 1998, requires most group
insurance plans to cover breast reconstruction and prostheses following surgical
treatment for your cancer. However, it is important to check with your health insurance to
determine what is covered by your individual policy.
When Are the Breasts Reconstructed?
When breast reconstruction happens right after breast cancer surgery, it is called
immediate reconstruction. When it takes place months or years later, it is called delayed
reconstruction.
Breast reconstruction is a process that can involve many surgeries and procedures over
many months up to a year. Usually the first surgery is the most involved; later surgeries
are mainly for minor corrections.
Often surgeries are performed on both breasts, even if only one breast had cancer, so
that the breasts will look similar. Your health care team will base the reconstruction plan
and surgery schedule on your specific treatment needs and body image goals.
At the end of the reconstruction process, some women choose to recreate a nipple and
areola (colored part around the nipple). To do this, the surgeon may use your own skin,
a portion of your nipple from your other breast or a 3-D tattoo.
Talk With Your Health Care Team about Your Options
Talk with your health care team about any concerns or questions you have about breast
reconstruction. When you meet with the surgeon, he or she will give you information
about your options.
Some women are disappointed when they learn they are not able to have a certain type
of reconstruction or are unable to have reconstruction at all. Many different things
determine which surgery options are right for you. Your health care team will explain why
some options may not be available.
You do not need to make a decision about your breast reconstruction the first time you
meet with the surgeon. Take time and think about your options. Do you want
reconstruction? What type of surgery do you want? When do you want to have the
surgery? How will the surgery affect the size, shape and feel of your breasts?
Be Realistic about Breast Reconstruction
Reconstructive breast surgery is not the same as cosmetic plastic surgery. Cosmetic
plastic surgery takes a normal part of the body and improves it based on a person’s
wishes.
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Reconstructive surgery is focused on correcting or restoring appearance to a part of the
body that has been damaged from an injury or an illness.
The goal of reconstructive surgery is to help you look as natural and balanced as
possible in your clothing. Understand that your reconstructed breasts will never be the
same as your natural breasts. The reconstructed breasts may be firmer, have scarring
from surgery, may lack sensation or may change in other ways.
Scars
Everyone heals differently, but you will have scars after surgery. These scars may fade
over time, but they will not completely go away. The scars may darken four to eight
months after surgery but then slowly fade and soften with time.
The area, type and amount of scarring depend on the types of surgeries you have had.
Reconstructive surgery does not remove mastectomy scars. When possible, the surgeon
will use the same incisions to help reduce scarring.
If you choose to use your own tissue for reconstruction, you will have scars at the area
where the skin is taken (such as from your back, abdomen or buttock). One of the most
common reconstruction options uses tissue from the abdomen; this leaves a scar that
runs across the abdomen from one side of the hip to the other. The scar is usually low
so that underwear or a bathing suit covers it.
Some women develop excess scar tissue called “keloid” scarring at the incision site. If
this happens, ask your doctor about possible treatment options.
“The scars may be permanent, but they start fading away. Both the emotional and
physical scars will fade.”
Changes to Breast Symmetry
The goal of reconstruction is to have your breasts look balanced and natural in clothing.
Depending on the type of reconstruction you choose, it may take several surgeries and
many months – or even longer – to have breasts that are similar in size and shape. You
should not expect that your breasts will be perfectly matched at the end of your
treatment. Your surgeon will try to make them look as even and as matched as possible.
Changes to Breast and Nipple Sensation
Many different things influence whether the breast area will maintain sensation after
surgery. Do not expect to have the same sensation in a reconstructed breast as with a
natural breast. If you have a nipple recreated during the reconstructive process, your
nipple will not have sensation or respond to stimulation
Surgery Risks
Your health care team will go over all of the possible risks related to your surgery. Being
aware of possible problems before they happen can help you cope with them if they
occur.
Although rare, some problems require removal of an implant or tissue that was used to
reconstruct the breast. This means you may be without a breast mound for a period of
time. If this occurs, you may be able to start the reconstruction process again after
waiting a few months. Later, you might be able to have the same type of reconstruction
or you might need a different type.
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Sexuality and Intimacy
Your breasts may be a part of what makes you feel feminine and sexy. Therefore,
changes to your breasts can affect how you see yourself sexually. Treatment can result
in other changes, such as early menopause, that might also affect how you view yourself
as a sexual person.
Many women fear that their partner will find them less attractive after cancer treatment.
They may also fear that treatment will have long-term effects on their sexuality. These
concerns are normal and can be overcome.
What is Sexuality?
Sexuality is more than just having sex with a partner. Your sexuality is the unique way in
which you express your desire for closeness. There is no normal sexuality or sex life
because different people value different aspects of intimacy. However, it is normal for
sexuality to change with age and with different stages of life.
As you go through breast cancer treatment, your sex life is likely to change at least
temporarily. You may not feel as free or spontaneous as before, or you may feel less
confident in your body. You may have side effects that decrease your desire, sexual
arousal and energy.
The recovery process is different for every woman, and returning to a normal sex life
may take some time.
Common Difficulties with Sex after Treatment
Loss of breast sensation. For some women, caressing of the breasts or nipples is an
important part of their lovemaking. After surgery, your breasts may feel different to you.
In some women, the nerve that runs through the breast tissue supplying sensation to the
nipple is cut or affected in some way.
Even if you did not have a surgery to remove your nipple, the sensation may be different.
This could lessen the amount of pleasure you feel when your breasts are touched.
Sometimes breast sensation comes back over time, but it is usually not the same as
before treatment. Keep in mind that for some women breast sensation may not come
back at all.
Menopausal symptoms. Some types of chemotherapy and hormonal therapy lead to
early menopause. You may notice changes, such as hot flashes and vaginal dryness,
that make it harder to enjoy physical closeness and sexual activity. You may feel as
though you are “getting old” or have other upsetting thoughts about these changes.
There are many ways to treat menopausal symptoms caused by chemotherapy and
hormonal treatment. Vaginal moisturizers and lubricants can help relieve discomfort and
pain caused by dryness. Low doses of estrogen and non-hormonal medications can also
be used to treat some menopausal symptoms.
Low sexual desire. If you have been sexually inactive for a period of time, you may have
less sexual desire than in the past. Even after you have begun to feel well in other
respects, you might find it hard to become interested in sex again. Feeling sexual desire
may be especially difficult if you are worried about what sex will be like or what your
partner might think of you.
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Dealing with Sexual Problems after Treatment
Sexual problems after cancer treatment tend to last for a long time if they are not
addressed. One of the most important steps you can take to deal with a sexual problem
is to talk about it with your partner. Talking with your partner can help correct
misunderstandings and find common ground. However, this can be uncomfortable at first
if you are not used to discussing your sex life.
If treatment has affected your ability to feel breast or nipple sensations, you may no
longer enjoy having this part of your body touched. If your treatment has only affected
one breast, you may wish to continue breast touching on the other side. You might also
explore other areas of your body where you enjoy being touched.
You might think about what sex means to you and the role it plays in your life: What
have you liked and disliked about sex in the past? What do you miss about your
sexuality? How would you define a “good” sex life?
The three tips below may help you with sexual arousal:
• Set aside time with your partner to caress parts of your body other than your
breasts. Try new positions during sexual activity; this may help if you feel
discomfort from surgery scars.
• Tell your partner what feels good and what does not feel good.
• Place your hand on top of your partner’s hand and guide where you want to be
touched and what feels good to you.
“Certainly at the beginning of treatment my husband was afraid to get intimate with me.
He thought I was sick and wouldn’t necessarily be interested, but he also thought that I
was fragile. We talked about that, and I said, ‘On the contrary, I really need you to love
me and hold me and treat me as normal as you can because that could be a problem for
how I feel about myself.’”
Tips for Single Women
If you are single or in a new relationship, you may worry that breast cancer will affect
intimacy with a new romantic partner. Although you may be nervous, it is possible to
develop a loving relationship and feel confident about being intimate with another
person. Finding a supportive partner is important.
Think about the following three tips:
• Use positive body language. Make eye contact with others, smile and laugh to
show someone you enjoy his or her company.
• Position your body in ways that make you feel secure and comfortable. Try to sit
or stand in ways that make you feel sexy and confident.
• Try to maintain a sense of humor and a strong attitude. If you feel uncomfortable
during intimate moments, speak up. If you feel “out of practice,” laugh about it
and become intimate with your new partner slowly.
Many single women are not sure when to tell a new partner about their cancer history.
One suggestion is to tell your partner after you have gotten to know one another, but
before you become physically intimate. Whatever you choose, pick a comfortable time
and a private place.
Tell your partner only what you are comfortable discussing at first. Allow your partner to
ask questions, and then ask questions about what he or she is feeling. Be open and
honest.
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While a partner can provide wonderful support and guidance throughout your recovery
process, you are responsible for your own self-confidence. Only you can allow yourself
to feel truly attractive and desirable.
Tips for Women in a Relationship
If you are in a serious relationship or are married, you and your partner may feel tension
about sex and intimacy. Your partner may also have a hard time adjusting to your body
changes. Talk about these concerns with each other, and try to make positive changes
to your sex life if needed.
Think about the following tips:
• Express your feelings and concerns, but don’t assume that you know what your
partner is thinking or feeling. Avoid blaming and accusations. For instance, rather
than say, “You never touch me anymore,” instead try, “I miss the way we used to
touch.”
• If you and your partner are not having sex, you should continue other forms of
affection and intimacy. For example, go on dates, cuddle, kiss, hold hands and
talk. Try to plan intimate activities where there is no pressure for sex.
• When you are ready to have sex again, you may need more time to get “in the
mood.” If you are feeling unattractive or uneasy, try wearing something that
makes you feel sexy or comfortable, such as your favorite lingerie or nightgown.
Set aside a time when you can be relaxed and are unlikely to have interruptions.
• Pick a time of day when you have the most energy, and be patient with one
another. Whether you and your partner have been together for one year or 30
years, rebuilding intimacy can be a long, slow process. Deal with one issue at a
time, and do not assume to know the other person’s feelings.
Talk With Your Health Care Team about Sexual Problems
Your health care team can direct you to specialists who have knowledge and training in
helping people with sexual desire, arousal and painful intercourse. You may benefit from
supportive counseling, vaginal lubricants and/or moisturizers, medicines or medical
devices.
Sexuality is an important part of your overall health and well-being. It deserves attention
and proper care.
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Improving Your Relationship
With Your Body
How often do you judge, criticize or complain about your body?
If you are like most women, you do this more than you would like. You may voice these
complaints in your head or aloud to others. You may have had negative thoughts and
feelings about your body long before breast cancer, and you may find these thoughts
hard to control or change. Breast cancer and its treatment may have strained your
relationship with your body even more.
Look at the demands and expectations you are placing on your body, and ask yourself
whether you are being realistic and fair. Do you strive to look like other women who have
a different body type? Do you strive to look the way you did five or ten years ago? Are
you placing unrealistic demands on your body to look the way it did before having breast
cancer? Any of these things increase the chance that you will feel dissatisfied with your
body.
Suggestions for How to Improve Your Relationship with Your Body
Be kind to yourself when having negative thoughts and feelings about your body. It is
okay to not like things about the way you look sometimes.
Even though you accept your body, you do not have to like everything about your body
or feel satisfied with the way you look. Having a healthy body image means that you are
aware of what you like and dislike but are willing to accept yourself “as is.”
Make an effort to replace critical thoughts about your body with neutral and objective
statements about the way you look. Ask yourself, “is there a way I can think or say things
differently so that I am more fair and accurate?” For example, instead of “my breasts
look abnormal,” you could say, “I have scars on my breasts from surgery. One breast is
smaller, but my friends cannot tell the difference. I must notice changes more than other
people do.”
Find ways to exercise that you enjoy and make your body feel good. Plan exercise for a
time when you are more likely to do it. If you have certain physical limits due to treatment
or recovery, do things that are comfortable and easy. For example, try light stretching,
beginners’ yoga or walking. You might already be doing things to help promote fitness
and health, such as physical therapy and eating a healthy diet. Use exercise to help you
manage stress and improve your mood.
Do activities that enhance your senses. This is called sensory awareness and can
include getting a massage, enjoying nature, taking a bath, wearing soft or silky clothing
and being intimate with a loved one.
Take time to focus on your clothing, hair, make-up and jewelry; this can be fun and
enjoyable. If this takes up too much time during your day or causes you stress, place
more emphasis on other activities.
Recognize your efforts because improving your body image can be challenging.
Compliment yourself for the ways you become more accepting of your body.
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Consider these questions:
• In what ways can you spend more time trying to nurture and appreciate your
body?
• In what ways can you compliment your body?
• What kinds of things can you do to help yourself feel better about your body?
Increasing Your Confidence
At some point, many people feel self-conscious about the way they look and worry about
what other people think. Having breast cancer can increase the discomfort you feel in
social situations, particularly during the early stages of your recovery from treatment.
You may find that you worry about the following:
• What are other people thinking about how I look?
• How much are they going to stare at my breasts or notice changes to my
breasts?
• What are they going to ask me? How will I respond?
Try the following tips to feel better when spending time with others:
• Resume social activities as soon as you are physically able to do so. The longer
you wait to be around other people, the more anxious you may feel. Start with a
small group of close family and friends. When you feel comfortable, slowly
increase the contact you have with others in different settings.
• Use nonverbal communication, such as eye contact, smiling, nodding your head
and having good posture to help you build more confidence.
• When it comes to your cancer and treatment, discuss only what makes you feel
comfortable. Direct the conversation away from yourself. Ask about the other
person, change the topic or discuss a shared interest.
• Do not assume what other people are thinking and how they feel about you. You
cannot read people’s minds, so you have no way of knowing what they are
thinking about your appearance, if they are thinking about it at all.
• Your appearance is more of a concern to you than it is to other people. You
might focus on how you look while other people are busy feeling self-conscious
about themselves.
• The way you behave, not the way you look, influences people.
• Make the most of how you present yourself and your strengths. Wear clothes that
make your body feel good. Enhance the physical features of your body that you
enjoy or want to celebrate using clothing, accessories or make-up.
• Use humor to help you manage uncomfortable or awkward situations.
• Learn from situations that do not go well. Consider how you might approach
things differently in the future.
• Try volunteering as a way to get involved in social situations and in the
community. Being able to help and support others can be healing and fulfilling for
you.
Body Image Into the Future
Because breast cancer and its treatment can result in some long-lasting changes to your
body and appearance, it is not surprising that some women experience difficulties coping
with these changes long after treatment is completed. For some women, body image
issues may not even arise until after treatment is completed.
Try not to be too discouraged if you have concerns about changes to your body long
after you have completed treatment. It is never too late to work at having a better
relationship with your body.
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Achieving a Healthy Body Image Is a Journey, Not a Destination
With any journey, there are twists, turns, highs and lows. Do not expect to have the best
possible body image at all times. Achieving a healthy body image requires patience,
energy and effort. Remember to:
• Have compassion for yourself.
• Work at setting realistic goals and adjust your expectations as needed.
• Find things that you like about your body.
• Engage in activities that give your body pleasure and make you feel good.
If you find yourself struggling, you may want to talk with a psychologist or counselor
about your concerns. This added support can be helpful during treatment, whether you
have just been diagnosed, are in active treatment or are having problems post-
treatment.
“I think you need to be a little less critical of yourself, and recognize that your body got
you through breast cancer. Don’t be so hard on your body.”
“It helped a lot taking a look at myself for who I am now, and not who I think I’m going to
be – just accepting the moment.”
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What Breast Cancer Survivors Have
to Say About . . .
Body Image and Breast Cancer
“I think body image has a big, big definition. It probably means something different to
every person. I think people have body image issues before they come in to get treated
for breast cancer. And whatever issues they had with their body are enhanced or
multiplied when you go through breast cancer.”
Being Diagnosed With Breast Cancer
“I just needed to take it one day at a time. When you first get diagnosed with cancer, and
you go on the journey, and the different paths it takes, you just need to put one foot in
front of the other.”
“When you get diagnosed with cancer, all of a sudden everything is different, but people
don’t know unless you tell them. But everything in your whole life is different. You just
are questioning everything you do as you try to take on this very sudden shift in identity.
You don’t know what it means – to be – to have cancer. It’s strange.”
Treatment Decisions
“Having a contralateral prophylactic mastectomy was a very difficult decision. If I had to
say what’s been the hardest part of it, other than finding out you’ve got cancer, making
that decision was probably the hardest part.”
Loss of Breast Sensation
“One of the first reactions I had after surgery wasn’t visual. I had this place on my breast
that didn’t heal well. I was sitting on a chair and my husband was putting this cream on
me. I was talking or something and when I realized that he was putting it on me and I
didn’t feel it. That was very upsetting. My husband’s touching my breasts, and I don’t
even know it.”
“Some feeling in my breasts has come back – not a lot, but some.”
Scars
“To this day, I have a hard time focusing on the scars. I just don’t like to look at them.”
“These are battle scars. I have the scars to prove that I went to war, and I won the battle.
There is collateral damage that occurs, but we won the war, or we hope we did anyway.”
“You’ve got scars, but you look totally normal on the outside. Nobody would ever know it.
And you’re alive, and you’re thriving. I try to look at the big picture – the entire picture –
as opposed to just one piece of it. Do I do it all the time, and do it well, and consistently?
No. But, I try.”
Hair Loss
“Then you lose your hair. I think the hardest part is it’s a constant reminder that you are
really not well. And you can’t run from the fact that ‘I have cancer.’”
“I had a hard time with it – the hair growing back – and it was curly, and you go through
this awkward phase.”
“If you’re going to wear a wig, get your wig before you are going to lose your hair.”
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“When my hair was falling out in clumps, I went to the MD Anderson hair salon, and I
had them cut my hair. That was traumatic for me, but they had seen it (before). That
would have been a whole lot more traumatic for me if I did it at a regular salon, but every
woman is different.”
“Have a sense of humor. My husband has very little to no hair. I would tell him, ‘You
know, honey, you’ve got no hair, and you’re not going to get any, but mine’s going to
come back.’ And sure enough, mine did, and his didn’t.”
“Hair loss, as traumatic as it is, will come back. It will come back. Just have faith.”
“I shaved it as soon as I got home from MD Anderson. And they asked me back home
why I did it so early, but it was inevitable. It was going to happen, and I’m glad I did it.
And then when it actually did fall out completely, I didn’t even notice. It must have come
out in the middle of the night or in the shower or somewhere.”
Intimacy
“I have no feeling in my breasts – none whatsoever. Does it get in the way of intimacy?
No, I wish I could feel, but no biggie. I can feel my back and my neck, so you
compensate. That’s OK.”
“My husband thinks that I am beautiful, and I don’t quite get that, but I’m learning to
realize that there are just other parts of intimacy. We’ve gotten closer in other ways.
We’ve become extremely connected on a different level.”
General Tips and Strategies for Improving Body Image
“I’d encourage women to take pictures of themselves – pictures of the process, pictures
of their breasts and pictures of their hair growing back. That’s one of my real regrets
because I have no documentation of this. It sounds very odd, but I wish I would have
taken pictures so I could say, ‘OK, this is how far I’ve come.’”
“It does help to laugh instead of taking everything so deep and serious. That was
important to me – making jokes at some of the things I couldn’t control.”
“I am in a place right now where I’m just grateful to be alive. I am healing both physically
and emotionally. I am done with my cancer, I hope, for good.”
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Resources
Resources at MD Anderson Cancer Center at Cooper include:
The Anderson Network
www.mdanderson.org/departments/andersonnet
800.345.6324
Through our partnership with MD Anderson Cancer Center in Houston, we are able to
connect our patients to The Anderson Network. It is a unique organization of current and
former patients and their caregivers. Volunteers provide support to patients and loved
ones through a national telephone network, a newsletter, an annual conference and
quality of life programs.
Behavioral Medicine
1.855.MDA.COOP (1.855.632.2667)
The Behavioral Medicine program provides short-term individual and group
psychotherapy to address body image issues as well as other cancer-related stressors.
Social Work
1.855.MDA.COOP (1.855.632.2667)
Our oncology social workers help patients and their families in eliminating or reducing
the psychosocial, emotional, financial or other barriers to care and recovery. Our
oncology social workers are trained to recognize the challenges in adjustment that often
accompany the diagnosis of cancer and assist our patients and their families in
managing distress. They are experts in linking patients to community resources.
Dr. Diane Barton Complementary Medicine Program
1.855.MDA.COOP (1.855.632.2667)
The events and activities offered through the Dr. Diane Barton Complementary Medicine
Program are designed to help reduce the pain and anxiety associated with cancer by
reducing stress, improving mood and enhancing overall health. The program offers a
variety of mind-body therapies, including yoga, massage, meditation, creative
expression, as well as discussion groups and activities, all led or performed by certified
therapists. All programs are free and are available at our Camden and Voorhees
campuses.
Additional Resources
American Cancer Society (ACS)
www.cancer.org
800.277.2345
The ACS offers access to a breadth of cancer information and educational materials
through their website, publications and toll-free information line. They also provide online
support groups for cancer survivors and their family members.
Look Good Feel Better
www.lookgoodfeelbetter.org
800.395.5665
The Look Good Feel Better program is a free program offered by the American Cancer
Society to help women offset appearance-related changes from cancer treatment. The
program provides education on beauty techniques to help enhance appearance and self-
image during treatment. Small group programs, one-on-one salon consultations and self-
help materials are available. Self-help materials are also available for men coping with
appearance-related changes free of charge.
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Tender Loving Care (TLC)
www.tlccatalog.org
800.850.9445
This “magalog” (magazine/catalog) combines helpful articles and information with
products for women coping with cancer treatment. TLC offers wigs, mastectomy forms
and products and a large selection of hats and head coverings.
American Society of Plastic Surgeons
www.plasticsurgery.org
847.228.9900
The patient and consumer section of the website provides before and after photos,
frequently asked questions and other educational information.
The Cancer Support Community
www.cancersupportcommunity.org
888.793.WELL
The Cancer Support Community has centers around the county that offer special groups
and wellness classes for cancer survivors and family members, and some online support
groups. Additional resources related to relaxation/visualization, stress management,
exercise and healing are also available.
Lance Armstrong Foundation
www.livestrong.org
855.220.7777
This nonprofit organization provides practical information and tools to help people with
cancer live life on their own terms. Specific information on coping with physical and
emotional effects of cancer and practical tips on adapting to body image changes are
available.
Living Beyond Breast Cancer
www.lbbc.org
1.888.753.LBBC
This is an educational and support organization. They provide special sections for newly
diagnosed, metastatic breast cancer, African-Americans, triple negative breast cancer
and young women. They have two annual conferences, one for all stages of breast
cancer and one for metastatic disease.
National Cancer Institute, Cancer Information Service
www.cancer.gov
800.4.CANCER
This service provides education about cancer prevention, risk factors, early detection,
symptoms, diagnosis and treatment. Information specialists can answer questions by
telephone, TTY, instant messaging and email. They also provide printed and electronic
NCI publications.
National Lymphedema Network and Hotline
www.lymphnet.org
800.541.3259
The National Lymphedema Network provides patients with information on the prevention
and management of primary and secondary lymphedema.
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People Living With Cancer
www.plwc.org
571.483.1780 or 888.651.3038
This patient information website of the American Society of Clinical Oncology (ASCO)
provides timely oncologist-approved information to help patients and families make
informed health care decisions. Specific information on coping with emotional and
physical matters is available.
Shop Well With You
www.shopwellwithyou.org
800.799.6790
The Shop Well With You website offers a number of resources, including articles on
body image and information on clothing-specific needs of cancer survivors. The site
provides general tips on fabrics, styles and cuts that offer the most comfort for specific
physical conditions, including mastectomy, lymphedema and post-surgical recovery. In
addition, contact information is provided for stores, catalogs and online retailers that
carry these clothing items.
Susan G. Komen for the Cure
www.komen.org
877.GOKOMEN (877.465.6636)
This is a grassroots network of breast cancer survivors and activists that provides up to
date information on breast cancer, a helpline and support for breast cancer research.
Y-ME National Breast Cancer Organization
http://www.y-me.org
800.221.2141
Y-ME is a national nonprofit organization that provides a hotline to give emotional
support and information about breast cancer. They provide a wealth of information in
English and Spanish through newsletters, publications and brochures. Y-ME also
maintains a “Wigs and Prosthesis Bank” and provides free products to women with
limited resources.
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MDAndersonCooper.org 1.855.MDACOOPER
(1.855.632.2667)
1063/5-16/BAR
