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Breast-Specific Sensuality and Sexual Function in Cancer Survivorship: Does Surgical Modality Matter?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

More early-staged breast cancer patients are choosing mastectomy. No studies have addressed breast-specific sensuality (BSS), defined as the breast’s role during intimacy. We explored BSS among women undergoing lumpectomy (L), mastectomy alone (M), or with reconstruction (MR) and analyzed the association of surgical modality with sexual function.

Methods

Women undergoing breast cancer surgery between 2000 and 2013 were eligible for survey using investigator-generated questions and the Female Sexual Function Index (FSFI). Demographic and surgical data were collected by chart review. The Kruskal–Wallis test was used to analyze FSFI scores, and χ 2 or Fisher’s exact tests were used for categorical data.

Results

Of 453 invited participants, 268 (59%) completed the survey. Of these, 69.4, 22.4, and 8.2% underwent L, MR, or M, respectively. The importance of the breast/chest wall during intimacy declined significantly regardless of surgical modality (L 83–74%, p = 0.0006; M 95–47%, p = 0.003; MR 93–77%, p = 0.002). No difference in sexual function was found between L, MR, and M (median FSFI score 28.2, 27.5, 25.9, respectively; p = 1.0). Comparing L versus MR, higher FSFI scores resulted with appearance satisfaction (29.0 vs. 22.6 p = 0.002) and preserved BSS as pleasurable breast caress (28.8 vs. 26.5, p = 0.04) and the breast as part of intimacy (28.8 vs. 24.8, p = 0.1).

Conclusions

Breast cancer surgery is associated with lowered BSS. However, BSS and appearance satisfaction scores are better for L and appear to correlate with improved sexual function postoperatively. These data may guide surgical counseling and contribute to survivorship outcomes.

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References

  1. Fisher B. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–1241.

    Article  PubMed  Google Scholar 

  2. Veronesi U. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–1232.

    Article  PubMed  Google Scholar 

  3. Kummerow KL. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.

    Article  PubMed  Google Scholar 

  4. Rutter CE. Growing use of mastectomy for ductal carcinoma-in situ of the breast among young women in the United States. Ann Surg Oncol. 2015;22(7):2378–2386.

    Article  PubMed  Google Scholar 

  5. Rosenberg SM. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–381.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fisher CS. Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. Ann Surg Oncol. 2012;19(10):3246–3250.

    Article  PubMed  Google Scholar 

  7. Fancher TT. A woman’s influence to choose mastectomy as treatment for breast cancer. J Surg Res. 2009;153(1):128–131.

    Article  PubMed  Google Scholar 

  8. Matsen CB et al. Skin flap necrosis after mastectomy with reconstruction: a prospective study. Ann Surg Oncol. 2016;23(1):257–64.

    Article  PubMed  Google Scholar 

  9. El-Tamer MB et al. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schover, L.R et al. (1995) Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer. 1995; 75(1):54–64.

  11. Avis NE, Crawford S, Manuel J. Psychosocial problems among younger women with breast cancer. Psychooncology. 2004;13(5):295–308.

    Article  PubMed  Google Scholar 

  12. Knobf MT. The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nurs. 2001;24(3):201–210; quiz 210–1

    Article  CAS  PubMed  Google Scholar 

  13. Wilmoth MC. The aftermath of breast cancer: an altered sexual self. Cancer Nurs. 2001;24(4):278–86.

    Article  CAS  PubMed  Google Scholar 

  14. Fobair, P et al. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579–94.

    Article  PubMed  Google Scholar 

  15. Speer JJ et al. Study of sexual functioning determinants in breast cancer survivors. Breast J. 2005;11(6):440–7.

    Article  PubMed  Google Scholar 

  16. Meyerowitz BE et al. Sexuality following breast cancer. J Sex Marital Ther. 1999;25(3):237–50.

    Article  CAS  PubMed  Google Scholar 

  17. Ganz PA et al. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501–14.

    Article  CAS  PubMed  Google Scholar 

  18. Ganz PA et al. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol. 1999;17(8):2371–80.

    Article  CAS  PubMed  Google Scholar 

  19. Thors CL, Broeckel JA, Jacobsen PB. Sexual functioning in breast cancer survivors. Cancer Control. 2001;8(5):442–8.

    Article  CAS  PubMed  Google Scholar 

  20. Rowland JH et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422–9.

    Article  CAS  PubMed  Google Scholar 

  21. Ganz PA et al. Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst. 2004;96(5):376–87.

    Article  PubMed  Google Scholar 

  22. Engel J et al. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3):223–31.

    Article  PubMed  Google Scholar 

  23. Pozo C et al. Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol. 1992;10(8):1292–8.

    Article  CAS  PubMed  Google Scholar 

  24. Yurek D, Farrar W, Andersen BL. Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol. 2000;68(4):697–709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Perez M et al. Changes in sexual problems over time in women with and without early-stage breast cancer. Menopause. 2010;17(5):924–37.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Aerts L et al. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast. 2014;23(5):629–36.

    Article  CAS  PubMed  Google Scholar 

  27. Rivadeneira, D.E et al. Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J. 2000;6(5):331–335.

    CAS  PubMed  Google Scholar 

  28. Petit JY et al. When mastectomy becomes inevitable: the nipple-sparing approach. Breast. 2005;14(6):527–31.

    Article  CAS  PubMed  Google Scholar 

  29. Gerber B et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238(1):120–7.

    PubMed  PubMed Central  Google Scholar 

  30. Wang F et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21(10):3223–30.

    Article  PubMed  Google Scholar 

  31. Didier F et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118(3):623–33.

    Article  CAS  PubMed  Google Scholar 

  32. Levin R. The breast/nipple/areola complex and human sexuality. Sex Relation Ther. 2006;21(2):237–49.

    Article  Google Scholar 

  33. Levin R, Meston C. Nipple/breast stimulation and sexual arousal in young men and women. J Sex Med. 2006;3(3):450–4.

    Article  PubMed  Google Scholar 

  34. Turnbull OH et al. Reports of intimate touch: erogenous zones and somatosensory cortical organization. Cortex. 2014;53:146–54.

    Article  PubMed  Google Scholar 

  35. Robinson VC. Support for the hypothesis that sexual breast stimulation is an ancestral practice and a key to understanding women’s health. Med Hypotheses. 2015;85(6):976–85.

    Article  CAS  PubMed  Google Scholar 

  36. Rosen, R 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.

    Article  CAS  PubMed  Google Scholar 

  37. Baser RE, Li Y, Carter J. Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer. 2012;118(18):4606–18.

    Article  PubMed  Google Scholar 

  38. Mohammedi J. The Female Sexual Function Index [Fsfi]: Validation of the Iranian version. Payesh. 2008;7(3):269–78.

    Google Scholar 

  39. 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):1–20.

    Article  PubMed  Google Scholar 

  40. Bartula I, Sherman KA. The Female Sexual Functioning Index (FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support Care Cancer. 2015;23(9):2633–41.

    Article  PubMed  Google Scholar 

  41. Meyer-Bahlburg, H.F., Dolezal C., The female sexual function index: a methodological critique and suggestions for improvement. J Sex Marital Ther. 2007;33(3):217–24.

    Article  PubMed  Google Scholar 

  42. Hayes RD. Assessing female sexual dysfunction in epidemiological studies: why is it necessary to measure both low sexual function and sexually-related distress? Sex Health. 2008;5(3):215–8.

    Article  PubMed  Google Scholar 

  43. (SEER), N.C.I. Cancer Stat Facts: Female Breast Cancer 2013; https://seer.cancer.gov/statfacts/html/breast.html.

  44. Hewitt M, Stovall E. From cancer patient to cancer survivor: lost in translation, 2006.

  45. Harris J. Diseases of the breast. Lippincott Williams & Wilkins, 2014.

  46. Langellier KM, Sullivan CF. Breast talk in breast cancer narratives. Qual Health Res. 1998;8(1):76–94.

    Article  CAS  PubMed  Google Scholar 

  47. Young I. Breasted experience: the look and the feeling philosphy and medicine. 1992;43:215–230.

    Google Scholar 

  48. Gilbert E, Usher JM, Perz J. Sexuality after breast cancer: a review. Mauritius. 2010;66:397–407.

    Google Scholar 

  49. Spence J. Cultural sniping: the art of transgression. London: Sage, 1995.

    Google Scholar 

  50. Moyer A. Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol. 1997;16(3):284–98.

    Article  CAS  PubMed  Google Scholar 

  51. Mock V. Body image in women treated for breast cancer. Nurs Res. 1993;42(3):153–7.

    Article  CAS  PubMed  Google Scholar 

  52. Kwait R, Pesek S, Onstad M, Edmonson D, Ghandi C, Raker C, Stuckey A, Gass J. Preserving sexual function in breast cancer survivorship: does surgical modality matter? Ann Surg Oncol. 2016;23:93–94

    Article  Google Scholar 

  53. Butler EC, Kwait R, Pesek S, Stuckey A, Gass JS. Appearance satisfaction in breast cancer survivorship: does time heal and does surgical modality matter? Poster Session presented at American Society of Breast Surgery Annual Meeting, Las Vegas, NV (2017)

  54. Peled AW et al. Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72(Suppl 1):S48–52.

    PubMed  Google Scholar 

  55. Schlenz I et al. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg. 2000;105(3):905–9.

    Article  CAS  PubMed  Google Scholar 

  56. Bresser PJ et al. Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg. 2006;117(6):1675–1682; discussion 1683–4.

    Article  CAS  PubMed  Google Scholar 

  57. Temple WJ et al. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol. 2006;24(21):3367–73.

    Article  PubMed  Google Scholar 

  58. Murthy V, Chamberlain R. Defining a place for nipple sparing mastectomy in modern breast care: an evidence based review. Breast J. 2013;9(6):571–81.

    Article  Google Scholar 

  59. Dossett L et al. Prospective evaluation of skin and nipple-areola sensation and patient satisfaction after nipple-sparing mastectomy. J Surg Oncol. 2016;114(1):11–6.

    Article  PubMed  Google Scholar 

  60. Khan A, Zhang J, Sollazzo V, Mohammed K, Gui G. Sensory changes of the reconstructed breast envelope after skin-sparing mastectomy. EJSO. 2016;42:973–9.

    Article  CAS  PubMed  Google Scholar 

  61. Peled AW et al. Patient reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander-implant reconstruction. Ann Plast Surg. 2014;72:276–80.

    Article  Google Scholar 

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Authors and Affiliations

  1. Breast Health Center, Women and Infants’ Hospital, Providence, RI, USA

    Jennifer S. Gass MD & Ashley Stuckey MD

  2. Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA

    Jennifer S. Gass MD

  3. Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Michaela Onstad MD

  4. St. Peter’s Hospital, St. Peter’s Health Partners Medical Associates, Albany, NY, USA

    Sarah Pesek MD

  5. Obstetrics and Gynecology, Women and Infants’ Hospital, Providence, RI, USA

    Kristin Rojas MD

  6. Department of Surgery, Greater Baltimore Medical Center, Towson, MD, USA

    Sara Fogarty DO

  7. Gynecologic Oncology, Women and Infants Hospital, Providence, RI, USA

    Ashley Stuckey MD

  8. Division of Research, Women and Infants’ Hospital of Rhode Island, Providence, RI, USA

    Christina Raker ScD

  9. Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA

    Don S. Dizon MD

  10. Harvard Medical School, Medicine, Boston, MA, USA

    Don S. Dizon MD

Authors
  1. Jennifer S. Gass MD
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  2. Michaela Onstad MD
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  3. Sarah Pesek MD
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  4. Kristin Rojas MD
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  5. Sara Fogarty DO
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  6. Ashley Stuckey MD
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  7. Christina Raker ScD
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  8. Don S. Dizon MD
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Correspondence to Jennifer S. Gass MD.

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Gass, J.S., Onstad, M., Pesek, S. et al. Breast-Specific Sensuality and Sexual Function in Cancer Survivorship: Does Surgical Modality Matter?. Ann Surg Oncol 24, 3133–3140 (2017). https://doi.org/10.1245/s10434-017-5905-4

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  • DOI: https://doi.org/10.1245/s10434-017-5905-4

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