The cosmetic outcome of breast reconstruction: reproducibility of different methods assessed by different professionals / Resultado estético após reconstrução mamária: reprodutibilidade de diferentes métodos avaliados por diferentes profissionais

Objective: To compare the reproducibility of different methods for assessing the cosmetic outcome of breast reconstruction, which was assessed by different health professionals. Methods: Photographs of 270 breast cancer patients who had been submitted to breast reconstruction of some type were included. A plastic surgeon, a resident in plastic surgery, two mastologists, two residents in mastology, and two psychologists performed the evaluation. The modified Garbay and Harvard scales and the objective BCCT. core software program were used. Cohen's Kappa and Spearman correlation coefficients were calculated. Results: The mean age of the patients was 55.7 (±11.1) years. Overall, 145 women (53.7%) underwent partial breast reconstruction and 125 (46.3%), total breast reconstruction. The mean follow-up time was 63.7±45.6 months. By applying the Harvard scale, the interobserver reproducibility among the different professionals was minimal; whereas the Garbay scale had no agreement. The correlations between the BCCT.core software program and the Harvard and modified Garbay scales were moderate. Conclusion: Correlations between both the modified Garbay scale and the Harvard scale and the objective (BCCT.core) test were moderate. There was less interobserver variability with the Harvard scale compared to the modified Garbay scale.

Objetivo: Comparar a reprodutibilidade de métodos diferentes de avaliação dos resultados estéticos de cirurgias reconstrutivas da mama, por avaliadores distintos. Métodos: Foram incluídas fotografias de 270 pacientes portadoras de neoplasia da mama que passaram por cirurgias reconstrutivas da mama. As notas da avaliação foram dadas por um cirurgião plástico, um residente em cirurgia plástica, dois mastologistas, dois residentes em mastologia e dois psicólogos. Foram utilizadas as escalas de Harvard e Garbay modificada e a nota objetiva do programa BCCT.core. Foram calculados os índice Kappa de concordância interobservador e de correlação de Spearman. Resultados: A média de idade das pacientes foi de 55,7 anos (±11,1). No geral, 145 (53,7%) mulheres foram submetidas a tratamento conservador com cirurgia oncoplástica e 125 (46,3%) passaram por mastectomia e reconstrução total. A média de tempo de seguimento foi de 63,7±45,6 meses. Para a escala de Harvard, houve uma reprodutibilidade interobservador razoável para os diferentes profissionais, enquanto na escala de Garbay, a reprodutibilidade foi pobre entre os profissionais. De forma geral, a nota dada pelo programa BCCT.core correlacionou-se moderadamente com a escala de Harvard e a de Garbay modificada. Conclusão: As escalas de Harvard e de Garbay modificada correlacionam-se igualmente de forma moderada com o teste objetivo (BCCT.core). A escala de Harvard tem menor variabilidade interobservador, se comparada com a escala de Garbay.

Influence of Body Image in Women Undergoing Treatment for Breast Cancer / Influência da imagem corporal em mulheres em tratamento contra câncer de mama

Abstract Objective The objective of this study was to investigate the self-esteem of women with and without breast cancer regarding their body image. Methods A quantitative, case-control study in which 90 women with breast cancer were evaluated in the case group, and 77 women without breast cancer in the control group. For data collection, the body satisfaction scale (BSS), a scale adapted and validated in Brazil, and the Rosenberg self-esteem questionnaire were used. For the statistical analysis of the data, the Statistical Package for the Social Sciences software (IBM-SPSS, Chicago, Il, US), version 16.0 was used. Results Compared with the women without breast cancer, those with breast cancer were more dissatisfied with body image related to appearance. Women undergoing neoadjuvant chemotherapy were more dissatisfied with their appearance compared with those with cancer who were not undergoing this treatment. Mastectomy also accounted for more dissatisfaction concerning appearance among women who underwent the procedure compared with the women who were submitted to breast-conserving therapy. Conclusion Women with breast cancer were more dissatisfied with their body image compared with those without breast cancer, particularly following mastectomy or during chemotherapy. The self-esteem was found to be negatively affected in patients who were dissatisfied with their body image.

Resumo Objetivo O presente estudo investigou a influência da imagem corporal na autoestima de mulheres em tratamento de câncer de mama. Método Estudo caso-controle. Para o grupo caso, foram avaliadas 90 pacientes em tratamento quimioterápico e cirúrgico; e para o grupo controle, 77 mulheres sem câncer de mama. Para a coleta de dados, foi utilizada a escala de satisfação com a imagem corporal (ESIC) e o questionário da autoestima de Rosenberg. Para a análise estatística dos dados, foi utilizado o programa Statistical Package of the Social Sciences (IBM-SPSS, Chicago, Il, EUA), versão 16.0. Resultados As mulheres com câncer de mama apresentaram maior insatisfação com a imagem corporal relacionada à aparência do que aquelas sem câncer de mama. Aquelas em processo de quimioterapia e as submetidas a mastectomia apresentaram mais insatisfação com a sua imagem corporal relacionada à aparência do que as mulheres submetidas à cirurgia conservadora, que apresentaram maior nível de satisfação. As mulheres submetidas a reconstrução mamária não apresentaram prejuízo na percepção da sua imagem corporal relacionada à aparência. Assim, a percepção da imagem corporal relacionada à aparência pode ser influenciada pela insatisfação em casos de pacientes submetidas a mastectomia ou a quimioterapia. Conclusão As mulheres com câncer de mama apresentaram maior insatisfação com a sua imagem corporal do que aquelas sem câncer de mama, sobretudo após mastectomia ou durante a quimioterapia. A autoestima foi negativamente afetada em pacientes insatisfeitas com a sua imagem corporal.

Influence of Body Image in Women Undergoing Treatment for Breast Cancer.

Objective The objective of this study was to investigate the self-esteem of women with and without breast cancer regarding their body image. Methods A quantitative, case-control study in which 90 women with breast cancer were evaluated in the case group, and 77 women without breast cancer in the control group. For data collection, the body satisfaction scale (BSS), a scale adapted and validated in Brazil, and the Rosenberg self-esteem questionnaire were used. For the statistical analysis of the data, the Statistical Package for the Social Sciences software (IBM-SPSS, Chicago, Il, US), version 16.0 was used. Results Compared with the women without breast cancer, those with breast cancer were more dissatisfied with body image related to appearance. Women undergoing neoadjuvant chemotherapy were more dissatisfied with their appearance compared with those with cancer who were not undergoing this treatment. Mastectomy also accounted for more dissatisfaction concerning appearance among women who underwent the procedure compared with the women who were submitted to breast-conserving therapy. Conclusion Women with breast cancer were more dissatisfied with their body image compared with those without breast cancer, particularly following mastectomy or during chemotherapy. The self-esteem was found to be negatively affected in patients who were dissatisfied with their body image.

Indicadores de insatisfação relacionados à imagem corporal em pacientessubmetidas à mastectomia / Dissatisfaction indicators related to body image in patients submitted to mastectomy

Apesar dos avanços no tratamento do câncer de mama, a mastectomia continua sendo bastante utilizada, podendo prejudicar a condição emocional e social da mulher, em decorrência da alteração de sua imagem corporal. Este estudo teve como objetivo levantar dados científicos sobre indicadores de insatisfação relacionados à imagem corporal de mulheres com mastectomia. Foi realizada uma revisão de literatura de artigos internacionais nas bases do PubMed no período de 2003 a 2012. Foram avaliados 232 artigos e selecionados 10 estudos. Foram utilizados os descritores “breast cancer” associado à “body image” e a “mastectomy”. Foram incluídos estudos com mulheres mastectomizadas que abordassem o termo “imagem corporal”, incluindo-se pesquisas quantitativas e qualitativas. Os resultados dos dez estudos selecionados mostraram que, na avaliação pós-operatória de câncer de mama, as mulheres mastectomizadas apresentaram níveis mais elevados de estresse em relação à imagem corporal e relataram a insatisfação com a aparência de suas mamas. Os indicadores de insatisfação relacionados à imagem corporal em pacientes submetidas à mastectomia são: vergonha de não terem uma mama, insatisfação com a sua aparência física, estresse, baixa autoconfiança, além de se sentirem menos atraentes sexualmente.

Despite advances in breast cancer treatment, mastectomy continues to be widely used. However, this practice may have a negative effect on women’s emotional and social conditions due to changes in their body image. The objective of the present study was to conduct a literature review of indicators related to dissatisfaction in body image of women submitted to mastectomy. A search was performed in PubMed to identify relevant articles published in the international scientific literature between 2003 and 2012 using the keywords “breast cancer” in association with “body image” and “mastectomy”. Ten of the 232 papers evaluated were selected for inclusion. Both quantitative and qualitative studies involving mastectomized women and dealing with the term “body image” were included in the review. The results of the ten studies selected for inclusion show that, in the post-operative evaluation of breast cancer, mastectomized women had higher stress levels with respect to body image and reported being dissatisfied with the appearance of their breasts. The indicators related to body image dissatisfaction in patients submitted to mastectomy are: shame of not having a breast, dissatisfaction with their physical appearance, stress, low self-confidence, besides feeling less sexually attractive.

Investimento corporal e o funcionamento sexual em mulheres no pós-cirúrgico de câncer de mama / Body investiment and sexual performance in women with post surgery of breast cancer

O presente trabalho busca investigar a autoimagem e a sexualidade em mulheres portadoras do Câncer de Mama. Para isso, utilizou-se de marcos teóricos sob o estudo da representação do câncer, a origem do câncer, a autoimagem e sexualidade. Participaram da pesquisa 61 mulheres com câncer de mama do Hospital das Clínicas/UFG que já foram submetidas à cirurgia de mastectomia, quadrantectomia e reconstrução com idade entre 30 e 80 anos. Foram aplicados dois questionários BIS e FSFI. A análise de dados foi obtida pelo SPSS versão 12.0 com o nível p < 0,05 e p < 0,01. Os dados mostram que a sexualidade destas mulheres deixa de funcionar durante o tratamento, mais especificamente, após serem submetidas à cirurgia. Já o investimento da imagem corporal ainda continua em alta.(AU)

This study investigated the self-image and sexuality in women with breast cancer. For this theoretical frameworks used in the study of the representation of cancer, the origin of cancer, self-image and sexuality. Participated in the research 61 women with breast cancer at the Hospital das Clinicas / UFG who have already undergone surgery to mastectomy, quadrantectomy and reconstruction aged 30 to 80 years. Two questionnaires were completed FSFI and BIS. The data analysis was obtained by SPSS version 12.0 at the level p < 0.05 and p < 0.01. The data show that the sexuality of these women go crashing during treatment, more specifically, after being subjected to surgery. Already the investment body image still remains high.(AU)