Quality of Life, Self-Image, and Body Acceptance Among Mastectomized Women: A Questionnaire-Based Study in Maranhão, Brazil

To evaluate quality of life, body image, body acceptance, and sexuality among women after unilateral mastectomy, comparing those with and without breast reconstruction.

Analytical observational cross-sectional study.

The study included 100 women aged 18 years or older who underwent unilateral mastectomy for primary breast cancer and were recruited consecutively between January 2019 and February 2022 at two tertiary oncology referral hospitals. All participants were interviewed 3-6 months after their respective surgical procedure. Quality of life was assessed using the validated Portuguese version of the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-BREF). Body image, body acceptance, and sexuality were assessed using five study-specific, nonvalidated questions. Adjusted analyses were performed for the psychological WHOQOL-BREF domain and, post hoc, for reported change in sexual desire.

Of the 100 participants, 38 underwent breast reconstruction and 62 did not. Women with breast reconstruction had higher scores in the psychological, social relationships, and environment domains of the WHOQOL-BREF, whereas no differences were observed in the physical health domain or the two general items. After adjustment for age and adjuvant treatment, breast reconstruction remained associated with a higher psychological domain score. Body image and appearance differed significantly between groups, whereas self-satisfaction, acceptance of physical appearance, acceptance of bodily changes, and current sexual activity did not. A higher proportion of women with reconstruction reported a change in sexual desire after surgery; however, the direction of change was not assessed. Correlations between body image-related variables and quality-of-life domains were generally negligible or weak and were considered exploratory.

Breast reconstruction was associated with differences in selected psychological, social, and environmental dimensions of quality of life and in the WHOQOL-BREF item on body image and appearance, but not with physical health, the two general WHOQOL-BREF items, self-satisfaction, acceptance of physical appearance, acceptance of bodily changes, or current sexual activity. These findings highlight the multifactorial nature of psychosocial adaptation after mastectomy and the importance of comprehensive survivorship care.

These findings support individualized nursing assessment of psychosocial adaptation after mastectomy, including body image, sexuality, and quality of life, and may inform patient education, supportive referrals, and shared decision-making when discussing reconstructive options.

This study highlights psychosocial dimensions of survivorship that may be relevant to women after mastectomy and to nurses involved in psychosocial assessment, patient education, supportive care, and coordination of multidisciplinary services.

The study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data S1. STROBE checklist for cross-sectional studies (STROBE_checklist_cross_sectional.pdf).

Patients were not involved in the design, analysis, or interpretation of the study. They participated as study participants and provided data through the study-specific interviews and questionnaires.