1. Yeong-Yuh Juang M.D. Consultation-Liaison Psychiatric Service Department of Psychiatry, Chang Gung Memorial Hospital at Linkou 12.Nov.2011 16th RRI Conference

2. What Is Body Image ？

3. Venus with a Mirror, by Titian, ca. 1555

4.  How you see yourself when you look in the mirror or when you picture yourself in your mind.  What you believe about your own appearance (including your memories, assumptions, and generalizations).  How you feel about your body, including your height, shape, and weight.  How you sense and control your body as you move.

5.  Diagnosis and treatment of breast cancer can affect psychological, sexual and physical functioning to a great extent  QoL includes, the patients’ subjective view of their  physical, social, emotional and cognitive functioning  psychological parameters of fear, body image, satisfaction with health care towards the cosmetic result of the surgical treatment

6. women treated with mastectomy  felt less attractive  more self-conscious,  did not like their overall appearance,  dissatisfied with their scar  avoided contact with people Journal of Clinical Psychology in Medical Settings. 16(4):311-21, 2009.

8.  Patients underwent mastectomy showed a significantly less favorable body image compared with those treated with BCT  Stage I was associated with the most favorable body image, stage IIIB with the least favorable.  Younger patients reported a better cosmetic result, compared with older patients.  Patients with a disease-free interval <1 year reported a significant better body image than patients with a longer disease-free interval Annals of Oncology 14: 1064–1071, 2003

9.  mastectomy patients had significantly lower body image, role, and sexual functioning scores and their lives were more disrupted than BCT patients.  Even patients > or =70 years of age reported higher body image and lifestyle scores when treated with BCT.  Body image, sexual functioning, and lifestyle disruption scores did not improve over time. Breast Journal. 10(3):223-31, 2004

10.  Body image was an important factor in treatment decisions for 31% of women.  Women selecting conservative therapy often have a more positive body image than do those undergoing mastectomy  Women who received breast conservation had better body image 2 years after treatment  body image, in turn, predicted 2-year mental health J Clin Oncol 2004;22:4002-4009. Cancer 2010;116;3549–57.

11.  body image was related to perceived losses and influences.  Losses included missing body parts (mastectomy), loss of menses, loss of sexual sensation, and ultimately, loss of womanhood (perceived femininity)  “influences” related to the quality of relationships before the diagnosis of cancer and the amount of control and information the patient had

12.  evidence suggests that changes in body image after breast cancer and its treatment may have direct effects on sexuality, sexual response, sexual roles, and relationships.  Most studies have found that survivors who had a good sexual relationship before therapy continued to have a satisfying relationship after surgery for breast cancer. AJN 2006 (106), No. 3 Supplement 32-38.

13.  Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis.  Half of the pt experienced at least one problem much of the time.  Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction  poorer mental health, lower self-esteem, and partner's difficulty understanding one's feelings. Psycho-Oncology. 15(7):579-94, 2006

14.  Women's depressive symptoms and men's marital satisfaction predicted women's self- acceptance,  but not women's perceptions of their partners' acceptance of their appearance.  Female's relationship satisfaction and perspective on common dyadic coping predicted women's perceptions of their partner's acceptance of their appearance Psycho-Oncology. 19(10):1061-8, 2010 Oct.

15.  Understanding and support from the partner were also critical for the survivor to be able to obtain and maintain healthy sexual roles and relationships.  A baseline assessment is critical in developing a plan to address the sexual and emotional needs of a person with cancer and her partner.  Working with a couple, facilitate an effective dialogue between them and explore strategies to minimize the impact on their current relationship AJN 2006 (106), No. 3 Supplement 32-38.

16.  dream of a wonderful future  unexpected reality  struggling to accept  balancing vanity with life priorities  coming to terms: no regret Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010

17.  Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations.  This ambivalence, combined with a culture that  values selflessness and  the placement of family first,  resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. Fang et al. Cancer Nursing, Vol. 33, No. 5, 2010

18.  need more preoperative information about what changes in body image to expect after surgery  a mastectomy proved to be associated with higher body shame and less satisfaction with appearance  breast conserving surgery is associated with a better body image, because of their less mutilating effects European Journal of Oncology Nursing 14 (2010) 263-270

19.  efforts to improve physical attractiveness to provide women with a sense of control over their appearance changes, can lead to lower levels of depression later on.  psycho-educational group intervention ： Addressing intimacy and partner communication  The sexual life reframing program focused on the physical, psychological, and relational aspects of sexual health elements, H. Sackey et al. EJSO 2010;36:756-762. Cancer Nursing 2011;34(2): 142-149.

20.  increase hope and therefore the support for the psychosocial adjustment of patients should play a vital role in increasing their quality of life.  Beauty treatment  physical exercise significantly improve psychosocial wellbeing, individual body image, and physical fitness.  treated for depression  Surgical intervention Asian Pacific Journal of Cancer Prevention, Vol 12, 2011 Onkologie 2011;34:248–253

21. Thank you for your attention !