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17-10-2017 | Breast cancer | Article

Body mass index (BMI), postoperative appearance satisfaction, and sexual function in breast cancer survivorship

Journal: Journal of Cancer Survivorship

Authors: K. E. Rojas, N. Matthews, C. Raker, M. A. Clark, M. Onstad, A. Stuckey, J. Gass

Abstract

Purpose

We sought to explore the correlation between BMI and postoperative sexual function, body image, and breast-specific sensuality before and after breast cancer surgery.

Methods

A cross-sectional survey of patients at least 1 year from surgery employed the Female Sexual Function Index (FSFI) and investigator-generated questions. Patients who underwent lumpectomy (L), mastectomy (M), and mastectomy with reconstruction (MR) were compared across three BMI groups: normal weight, overweight, and obese.

Results

Two hundred fifty-five patients underwent lumpectomy (L, n = 174), mastectomy (M, n = 22), or mastectomy with reconstruction (MR, n = 59). Median age was 57 (range 30–93) and median BMI was 28 (range 19–45). Obese and overweight women reported more appearance dissatisfaction (18.1 and 13.0%) than normal weight women (4.1%) (p = 0.01). Lower satisfaction was associated with increasing BMI within the MR group (p = 0.05). The obese group’s median FSFI score met criteria for sexual dysfunction (25.90, range 11.30–33.10). More overweight women reported their chest played an important role in intimacy before and after surgery, but a postoperative decline in the importance of this role was observed in all groups.

Conclusions

Greater post-treatment BMI is inversely related to postoperative appearance satisfaction, particularly in those undergoing mastectomy with reconstruction. The role of the breast in intimacy is greatest in overweight women, but decreases postoperatively in all BMI groups.

Implications for cancer survivors

Postoperative appearance satisfaction and sexual function seems to be correlated to post-treatment BMI, which highlights the need to encourage perioperative weight management for improved survivorship outcomes.

Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Female Breast Cancer, National Cancer Institute, DCCPS, Surveillance Research Program. www.seer.cancer.gov. Accessed 1 Oct 2016.

Mitchell N, Catenacci V, Wyatt H, et al. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–32.CrossRefPubMedPubMedCentral

Hewitt M, Greenfield S, Stovall E, editors. Institute of Medicine and National Research Council. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press; 2006. 10.17226/11468. Accessed April 1 2017

Amichetti M, Caffo O. Quality of life in patients with early stage breast carcinoma treated with conservation surgery and radiotherapy: an Italian monoinstitutional study. Tumori Journal. 2001;87:78–84.

Gorisek B, Krajnc P, Krajnc I. Quality of life and the effect on social status among Slovenian women after breast cancer treatment. J Int Med Res. 2009;37:557–66.CrossRefPubMed

Brandberg Y, Sandelin K, Erikson S, et al. Psychological reactions, quality of life, and body image after bilateral pro-phylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol. 2008;26:3943–9.CrossRefPubMed

Klaeson K, Berterö C. Sexual identity following breast cancer treatments in premenopausal women. Int J Qual Stud Health Well-being. 2008;3:185–92.CrossRef

Krueger D, Cash T, Pruzinsky T. Psychodynamic perspectives on body image. In: Body image: a handbook of theory, research, and clinical practice. New York: Guilford Press; 2004. p. 30–7.

Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94. https://doi.org/10.1111/j.1467-789X.2010.00805. CrossRefPubMed

10.

Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23:774–82. https://doi.org/10.1200/JCO.2005.04.036.CrossRefPubMedPubMedCentral

11.

Raggio G, Butryn M, Arigo D, et al. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health. 2014;29:632–50.CrossRefPubMedPubMedCentral

12.

Hoyt W, Kogan L. Satisfaction with body image and peer relationships for males and females in a college environment. Sex Roles. 2001;45:199–215.CrossRef

13.

Pujols Y, Meston C, Brooke S. The association between sexual satisfaction and body image in women. J Sex Med. 2010;7:905–16.CrossRefPubMed

14.

Gass J, Onstad M, Pesek S, et al. Breast-specific sensuality and sexual function in cancer survivorship: does surgical modality matter? Ann Surg Onc 2017;24:3133–40. https://doi.org/10.1245/s10434-017-5905-4.

15.

Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRefPubMed

16.

Baser R, Li Y, Carter J. Psychometric validation of the female sexual function index (FSFI) in cancer survivors. Cancer. 2012;118(18):4606–18.CrossRefPubMed

17.

Mohammedi J. The female sexual function index (FSFI): validation of the Iranian version. Payesh. 2008;7(3):269–78.

18.

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20.CrossRefPubMed

19.

Rowland J, Meyerowitz B, Crespi C, et al. Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Res Treat. 2009;118(1):99–111.CrossRefPubMedPubMedCentral

20.

Schover L, Baum G, Fuson L, et al. Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors. J Sex Med. 2014;11:3102–11.CrossRefPubMedPubMedCentral

21.

Acea Nebril B, Cereijo Garea C, Garcia Novoa A. Cosmetic sequelae after oncoplastic surgery of the breast: classification and factors for prevention. Cir Esp. 2015;2:75–83.CrossRef

22.

Tong W, Baumann D, Villa M, Mittendorg E, Liu J, Robb G, et al. Obese women experience fewer complications after oncoplastic breast repair following partial mastectomy than after immediate total breast reconstruction. Plast Recon Surg. 2016;137(3):777–91.CrossRef

23.

Levi J, Segal L, St. Laurent R, et al. The state of obesity: better policies for a healthier America. Trust for America’s Health. Robert Wood Johnson Foundation. September, 2014. https://www.rwjf.org/en/library/research/2014/09/the-state-of-obesity.html.