Speech by Laurel’s Surgeon

Marie F. Pennanen, M.D., F.A.C.S.

I am so pleased to be part of such an artistic, creative event. It is inspiring to see women who face breast cancer with grace, strength and optimism, and transform it into an opportunity to create something generous and beautiful.

The number of women in the US who are diagnosed annually with breast cancer has been steadily decreasing since its peak in 1999. Breast cancer mortality has been steadily dropping by 2% per year since 1990. The 5 year survival for breast cancer has increased from 18% without treatment to 40% with surgery alone in the early 20th century, to 90% with modern multidisciplinary therapy in the 21st century.  In the United States, there are almost 3 million women living after breast cancer treatment, the majority of whom are cancer free.

The increasing number of breast cancer survivors means that many women have to adjust to life after breast cancer surgery and therapy. The more effectively we treat breast cancer, the more we will need to consider the psychosocial ramifications of such treatment.

Since the earliest recorded times to the present day, breasts have been intimately associated with femininity, motherhood, sexuality, and self-image. For just as long, alterations in the normal appearance of the breasts have affected body image and self-esteem. In the 5 century BC, Herodotus wrote that Atossa the Persian queen, “had a tumor upon her breast…and so long as it was small, she concealed it and said nothing to anybody, because she was ashamed…”  

Treatment- related effects on physical appearance, such as changes, reconstruction or removal of the breast are distressing. Not only does a woman have to come to terms with a breast cancer diagnosis and all its health implications, but she must also come to terms with an altered body image. This may lead to self-consciousness about her appearance, which in turn can lead to increased anxiety, depression, and a loss of self-esteem.  

For patients newly diagnosed with breast cancer, an increase in self-consciousness about appearance correlates with an increase in depression and anxiety. These effects on psychological function and body image reach their lowest point 1 month after surgery and then gradually improve, so that many are back to baseline in one year. Breast cancer survivors had significantly more feelings of self-consciousness and dissatisfaction when dressed for years after treatment. Body image is worse for women who have a mastectomy (even with reconstruction)and/or who have to change their wardrobe because of their cancer surgery. This could be in part because of a lack of clothing options tailored to the needs of women after breast cancer surgery.

An almost universally expressed goal for women after breast cancer is “returning to normal.”  This has several aspects: a return to normal health, normal activities, normal appearance and a normal self. This can mean trying to look the way one did before, trying to restore the sense of femininity and self they had before their treatment. Many women express the desire to look normal to others in clothes. For others, it’s defining a new normal for themselves. Achieving normalcy is seen as a way to become cancer-free.

One factor which significantly affects the adjustment to treatment related changes in physical appearance is the effort an individual makes to be and feel attractive. On the surface this may seem superficial, but it’s actually a very healthy adaptive mechanism. Breast cancer patients actively engaging in efforts which made them feel good about their appearance have better social and psychological quality of life and lower levels of depression. In the early post-operative period, appearance management might be a strategy to attain a certain degree of control over changes in body image. This feeling of increased control has a positive effect on psychological and emotional adjustment during a time when so many significant aspects of life and treatment are beyond one’s control. When a woman with breast cancer exercises control over any aspect of her care, psychological adjustment is better.

Breast cancer survivors who actively pursue a positive appearance have fewer problems with persistent body image changes. Doctors and nurses should discuss the effects of treatments on appearance and ways to manage changes in body image, consider involving psychologists and other mental health professionals, recommend support groups, and encourage patients to implement behaviors to improve or maintain their sense of physical attractiveness. This isn’t being vain, it’s being healthy.

Look Good…Feel Better, a program to help women with cancer improve their appearance and self image really has it right.  

One researcher pointed out that clothing is the first link between an individual’s physical self and society and that the appropriate selection of apparel can enhance mood and self-image.   A majority of the women in this study expressed dissatisfaction with available clothing after mastectomy. Check any breast cancer blog, and the advice about what to wear after surgery is “big baggy men’s button down shirts.” This study assessed the effect of specially designed apparel on satisfaction and self-esteem in women who have had mastectomies. Apparel satisfaction was higher after using products specifically designed for women who have undergone a mastectomy. And these were relatively modest adaptations of camisoles, bras and swimwear, nothing close to the quality, practicality and beauty of the Alloro    Collection. Appearance, comfort and fit were the most important apparel attributes. They concluded that apparel can play an important role in the transition and adjustment of women after breast cancer surgery.

Wearing beautiful feminine clothes designed with post-operative needs in mind is one way women can regain a sense of normalcy after breast cancer surgery.  This is exactly what Laurel and Christine are offering to women with breast cancer.

Marie F. Pennanen, M.D., F.A.C.S.
March 20, 2013



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Usha Chowdhary And Lenoraann Ryan

Psycho-Oncology 19: 959–966 (2010)
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Helena Moreira_, So´ nia Silva and Maria Cristina Canavarro

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The association between self-consciousness about appearance and psychological adjustment among newly diagnosed breast cancer patients and survivors: The moderating role of appearance investment
Helena Moreira∗, Maria Cristina Canavarro

A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease
Helena Moreira a,b,*, Maria Cristina Canavarro
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A Study of Body Image in Long-Term Breast Cancer Survivors
Christian A. Falk Dahl, StudPsychol1; Kristin V. Reinertsen, MD2,3; Inger-Lise Nesvold, PT, MHSci2,4; Sophie D. Fossa˚, MD, PhD2,5; and Alv A. Dahl, MD, PhD2,5
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Communication Between Breast Cancer Patients and Their Physicians About Breast-Related Body Image Issues
Mallory Cohen , BS
Rebecca C. Anderson , PhD
Kathleen Jensik , MSW
Qun Xiang , MS
Jessica Pruszynski , PhD
Alonzo P. Walker , MD
Plastic Surgical Nursing ❙ July-September 2012 ❙ Volume 32 ❙ Number 3

Breast Conservation Versus Mastectomy
Is There a Difference in Psychological Adjustment or Quality of Life in the Year After Surgery?
Patricia A. Ganz, MD,*,t C. Anne Coscarelli Schag, PhD,t$J. Jack Lee, PhD,§,I(
Margaref L. Polinsky, PhD,t and Shu-Jane Tan, MSII
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Role of Breast Reconstructive Surgery in Physical and Emotional Outcomes Among Breast Cancer Survivors
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Psycho-Oncology 20: 553–558 (2011)
Published online 31 May 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.1762
Understanding normality: a qualitative analysis of breast Cancer patients concepts of normality after mastectomy and reconstructive surgery
Sarah Denford1_, D. Harcourt2, L. Rubin3 and A. Pusic4

Journal of Surgical Oncology 2009;99:447–455
Quality of Life After Breast Cancer Surgery: What Have We Learned And Where Should We Go Next?
Barbara A. Pockaj, Md,1* Amy C. Degnim, Md,2 Judy C. Boughey, Md,2 Richard J. Gray, Md,1
Sarah A. Mclaughlin, Md,3 Amylou C. Dueck, Phd,4 Edith A. Perez, Md,5 Michele Y. Halyard, Md,6
Marlene H. Frost, Phd,7 Andrea L. Cheville, Md,8 and Jeff A. Sloan, phd

Quality of Life, Anxiety, and Oncological Factors: A Follow-Up Study of Breast Cancer Patients
Kristin Ha¨ rtl, Ph.D., Rebecca Schennach, M.D.
Marianne Mu¨ ller, Ph.D., Jutta Engel, M.D., M.P.H.
Hans Reinecker, Ph.D., Harald Sommer, M.D., Ph.D.
Klaus Friese, M.D.
(Psychosomatics 2010; 51:112–123)

Patricia A. Parker, PhD,1 Adel Youssef, MD,2 Sue Walker, RN,2
Karen Basen-Engquist, PhD, MPH,1 Lorenzo Cohen, PhD,1,3 Ellen R. Gritz, PhD,1
Qi X. Wei, MS,1 and Geoff L. Robb, MD
Annals of Surgical Oncology 14(11):3078–3089
DOI: 10.1245/s10434-007-9413-9

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