On Tuesday May 14, 2013 starlet Angelina Jolie, known as much for her beauty as for her support of a number of international humanitarian causes, announced she received a preventative double mastectomy to reduce her risk of developing breast cancer. The actor has a defective gene, BRCA1, which doctors told her had increased her risk of developing breast cancer to 87%, and her risk of ovarian cancer, the disease that killed her mother at the age of 56, to 50%, she wrote in the New York Times yesterday. Health campaigners praised her decision to go public with the news, which she said was prompted by a desire to encourage other women to get gene-tested and to raise awareness of the options available to those at risk.
Embedded in the op-ed article, Angelina answered questions about how the decision to have surgery impacts her children and her self esteem. She wrote “I can tell my children that they don’t need to fear they will lose me to breast cancer.” She goes on, “It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.”
Like Angelina, research on self esteem and body image following a double mastectomy has found for the majority of women there is no evidence of significant mental health or body image problems following Bilateral Prophylactic Mastectomy (BPM).
In a study by Hopwood et al, researchers found twenty-one percent of women reported no negative change in body image following surgery. The majority of changes reported were of minor degree. The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self-consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over three years. A minority of women had more serious psychological or body image concerns, often these were in relation to surgical complications. Further psychological or psychiatric intervention was helpful in these cases.
Other research on adjustment to BPM identifies that adjustment seems to be most impacted by three primary areas of interest: satisfaction or regret following the surgery; psychological or psychosocial functioning following the surgery; and predictors of quality of life for those women undergoing the procedure. Anxiety (particularly associated with fear of cancer), body image concerns, satisfaction with cosmetic outcome, early postoperative complications and discomfort, and level of support are factors that contribute these areas. Birmingham Maple Clinic therapist, Linda Diaz adds the element of adjustment that is different in the case of adjusting to an elective mastectomy from a cancer diagnosis is the feature of control. She says “When you are choosing elective surgery you have the element of control. Control over when you plan the surgery, time to talk to significant others, opportunity to be discerning about whom to share with if at all.” Linda adds “Having support and the ability to talk with people to share their experience is critical.”
Angelina Jolie’s article punctuates that she feels supported by her spouse and family, satisfied with her decision, and is not questioning her body image or femininity – all traits indicative of a successful adjustment to an elective mastectomy. If you have had a risk-reducing double mastectomy or are considering the procedure but are experiencing anxiety, self-esteem issues, or a feeling that you are not supported by your family, you may find value from speaking to a therapist. The abovementioned research confirms psychological treatment can be helpful when a person is having emotional, psychological, or social difficulty following mastectomy surgery. To speak with a supportive therapist at Birmingham Maple Clinic call (248) 646-6659 or visit www.birminghammaple.com.
Hopwood, P., Lee, A., Shenton, A., Baildam, A., Brain, A., Lalloo, F., et al. (2000). Clinical follow-up after bilateral risk reducing (“prophylactic”) mastectomy: Mental health and body image outcomes. Psycho-oncology, 9, 462–272.
Metcalfe, K.A., Esplen, M.J. Goel, V., & Narod, S.A. (2005). Predictors of quality of life in women with a bilateral prophylactic mastectomy. The Breast Journal, 11, 65–69.