Bröstcancer är den vanligaste formen av cancer bland kvinnor där ca 8000kvinnor i Sverige insjuknar varje år. Mastektomi är en kirurgisk behandling avbröstcancer där hela bröstet opereras bort. Tidigare forskning visar att kvinnans bröst ärförknippat med femininitet, sexualitet, moderskap och attraktivitet och att bröstcanceroch dess behandling orsakar stort lidande för den drabbade. Sjuksköterskans arbete gårut på att främja hälsa, förebygga ohälsa samt lindra lidande. Syfte: Att beskrivakvinnors upplevelser efter mastektomi vid bröstcancer. Metod: En beskrivandelitteraturstudie baserad på elva artiklar med kvalitativ ansats. Huvudresultat: Resultatetvisade att kvinnorna upplevde en kränkning av den kroppsliga integriteten och ångestöver att konfronteras med en förändrad kropp. Att förlora brösten var för en del kvinnorförknippat med en sämre självbild och en förändrad identitet. För andra var bröstenförknippade med sjukdom och dessa kvinnor upplevde en lättnad av att brösten varborta. Kvinnornas förändrade relation till deras kroppar påverkade även deraskvinnlighet, sexlust och de intima relationerna med andra. Slutsats: Många kvinnorsom genomgått mastektomi upplevde ångest över en förändrad kropp medan vissaupplevde det som positivt att det sjuka var borta. Kvinnorna upplevde en sämresjälvbild, men även en förändrad identitet och relation till deras kroppar vilketpåverkade deras kvinnlighet, sexlust och intima relationer till andra. Det anses viktigtatt ha kunskap om dessa kvinnors upplevelser för att i det kliniska vårdarbetet kunna geen personcentrerad vård, rätt stöd och hjälp för dessa kvinnor. / Breast cancer is the most common form of cancer among women wereabout 8000 women in Sweden are diagnosed every year. Mastectomy is a surgicaltreatment of breast cancer where the entire breast is removed. Previous research showsthat women's breasts are associated with femininity, sexuality, maternity andattractiveness, and breast cancer and its treatment causes suffering to the patient.Nursing's work is focused on promoting health, preventing ill health and relievingsuffering. Aim: To describe women’s experiences after mastectomy due to breastcancer. Method: A descriptive literature study based on eleven articles with aqualitative approach. Results: The result showed that women experienced a violation ofthe bodily integrity and anxiety about confronting a changed body. The loss of breastswas for some women associated with a negative self-image and a changed identity. For others, the breasts were associated with disease and these women experienced a reliefthat the breasts were gone. The women's changed relationship with their bodies alsoaffected their femininity, sex drive and intimate relationships with others. Conclusion:Many women who underwent mastectomy experienced anxiety over a changed bodywhile some felt it was positive that the sickness was gone. The women experienced aloss of their self-image, but also a changed identity and relation to their bodies,affecting their femininity, sex drive and intimate relationships with others. It isimportant to have knowledge of these women's experiences in order to providepersonalized care, the right support and help for these women in the clinical care.

abstract: Prophylactic bilateral mastectomy (PBM) is the current recommended course of action for women with increased genetic risk for breast and ovarian cancer. Nevertheless, many receive negative feedback from family and friends surrounding the decision to undergo this surgery because they do not have cancer when the decision is made; this results in a limited support network for coping with their PBM. Low social support is associated with depression, negativity, and anxiety. Women who had a PBM, were currently undergoing or had completed reconstruction, and were in a committed romantic relationship at the time of the surgery were surveyed (N = 53). The hypotheses that women who received negative feedback about their decision to have a PBM would have poorer individual well-being, and that the use of a couples-based team approach would moderate these adverse effects were tested. Data analyses support the hypotheses that women in couples taking a team approach to PBM have better individual well-being. The effects of negative feedback from others about the decision to undergo a PBM on personal mental health were moderated by use of a couples-based team approach. Women who received negative feedback from multiple sources had better outcomes if they used a couples-based team approach. Many women have a preventative oophorectomy around the same time as their PBM. Menopause is associated with side effects such as increased vasomotor symptoms and decreased sexual functioning. The hypothesis that surgical menopause is related to declines in sexual satisfaction following PBM was also tested. Regression analysis revealed no relationship. This study indicates that women who experience social disapproval and lack collaborative support from their significant other may be at increased risk for poor individual well-being following PBM. / Dissertation/Thesis / Masters Thesis Psychology 2018

Orientador: Lígia Maria Kerr / Banca: Sergio Vicente Serrano / Banca: Angelo do Carmo Silva Matheus / Resumo: A mastectomia radical modificada ainda se constitui em um dos principais procedimentos cirúrgicos em mastologia. A principal complicação relacionada a cirurgia constitui o seroma axilar. O bisturi Harmônico, apesar de pouco difundido, foi descrito como um mecanismo para diminuir a formação do seroma axilar, associado a diminuição do tempo de utilização do dreno. Estudo prospectivo randomizado utilizando-se o bisturi harmônico ou o elétrico de pacientes submetidas a mastectomia radical no Hospital de Câncer de Barretos, no ano de 2008, sendo que a randomização ocorreu em função do índice de massa corpórea. As variáveis relacionadas às pacientes, às cirurgias e suas principais complicações pós operatórias (seroma, necrose de retalhos, hematomas e infecção) foram tabuladas e submetidas a análise estatística. Das 95 pacientes submetidas a mastectomia, em 49 foi utilizado o bisturi harmônico. A comparação entre os bisturis na realização da mastectomia radical mostrou diferença estatística na ocorrência da necrose de retalhos das cirurgias. Outras complicações (seroma, hematoma e infecção) não tiveram significância estatística. A utilização do bisturi harmônico em mastectomias radicais proporciona menor risco de necrose de retalhos. O tipo do bisturi utilizado não influencia na formação de seroma. O índice de massa corpórea, volume de drenagem ao sétimo dia pós-operatório e redução percentual da drenagem do 2° ao 7° dia pós-operatório são fatores independentes na formação de seroma. A utilização do bisturi harmônico proporciona diminuição significativa da necrose de retalho em relação ao bisturi elétrico. / Abstract: This randomized prospective study has the purpose of comparing the post-operative complication rates on the electric scalpel and the harmonic scalpel. The study was accomplished in the Hospital de Câncer de Barretos from January to November, 2008. The breast cancer patients with radical mastectomy proposal were randomized into two groups according to their body mass index (bmi): electric scalpel (46) and harmonic scalpel (49). The variables related to the patients, to the surgeries and its their post-operative main complications (seroma, flap necrosis, haematomas and infections), were tabulated and submitted to statistical analysis. The comparison between the scalpels on the radical mastectomy has show statistic difference on the occurrence of the flap necrosis on the surgeries. Other complications (seroma, haematoma and infection) have not had statistic significance). The usage of the harmonic scalpel in radical mastectomies provides smaller risk of flap necrosis in comparison with the electric scalpel. / Mestre

Estudo exploratório, descritivo, com abordagem qualitativa, que teve como objetivo analisar a influência de um núcleo de reabilitação para mastectomizadas na vida das mulheres que o frequentam e identificar quais tipos de mudanças ocorreram em suas vidas. Participaram 13 mulheres com idade entre 49 e 82 anos, que frequentavam o grupo de reabilitação há no mínimo três meses. Os dados foram obtidos por meio de entrevistas, com perguntas abertas. Procurou-se identificar unidades temáticas pela Análise de Conteúdo, nas seguintes categorias: 1. Deparando-se com uma nova realidade; 2. Encontrando uma forma de enfrentamento da nova realidade; 3. Mudando comportamentos e maneiras de pensar. Os resultados mostraram que após terem sido encaminhadas ao serviço de reabilitação, as mulheres começaram a entender que havia uma forma de enfrentar, com um pouco menos de sofrimento, a dura realidade de ter câncer de mama, uma doença estigmatizante, que lhes gerava dúvidas e medos em relação ao presente e ao futuro. A frequência ao serviço de reabilitação fez com que elas se descobrissem como membros do grupo e acolhidas, tanto pelas outras mulheres como pelos profissionais; sentiram nestes últimos uma verdadeira preocupação em atender todas as suas necessidades físicas, emocionais e psicossociais. Compartilharam experiências, compreenderam a importância de dividir seus problemas com o grupo, conseguiram pedir e oferecer ajuda. Encontraram um grupo de \"iguais\", e sentiram-se à vontade para compartilhar experiências, criar novas amizades e até mesmo uma \"nova família\". Conseguiram ressocializar-se. Reconheceram-se mais fortes para enfrentar o câncer, sentiram que podiam melhorar e que podiam e deviam participar de sua reabilitação, chegando a modificar comportamentos e maneiras de pensar sobre a doença e suas consequências, sobre as pessoas e sobre si mesmas. Reconheceram o serviço de reabilitação, ou seja, o grupo de mulheres e profissionais, como o grande responsável pelas mudanças positivas que ocorreram em suas vidas; conseguiram lidar melhor até mesmo com as questões da própria finitude e manifestaram a apropriação do senso crítico, quando propuseram, ainda que de forma discreta, algumas sugestões para aprimoramentos na assistência oferecida pelo serviço. O serviço de reabilitação é o lugar onde encontram ânimo para seguir a vida, com segurança para rir e chorar, falar e calar, ouvir e ser ouvida, sem reprimendas. Consideram um privilégio poder desfrutar de tudo o que serviço oferece, inclusive atividades de lazer e sem gastos financeiros. Fazer parte desse grupo significou para as participantes deste estudo um presente de Deus, a chance de vislumbrar uma nova vida. / Exploratory, descriptive, qualitative approach, which aimed to examine the influence of a full mastectomy rehabilitation group in women who lives attend it and identify what kinds of changes in their lives. Participants included 13 women aged between 49 and 82 years who attended the rehabilitation group for at least three months. Data were obtained through interviews with open questions. We sought to identify thematic units through content analysis, the following categories: 1. finding a new reality, 2. finding a way to face the new reality; 3. changing behavior and way of thinking.The results showed that after being sent to rehabilitation services, women began to understand that there was a way to deal with a little less suffering, the harsh reality of having breast cancer, a stigmatizing disease, they generated questions and fears about the present and the future. Attendance at the rehabilitation service meant that they were discovered as members of the group and accepted by both other women and professionals, experienced in the last a genuine concern to meet all their physical, emotional and psychosocial factors. Shared experiences, understood the importance of sharing their problems with the group, could ask for and offer help. They found a group of \"equal\" and felt free to share experiences, new friendships and even a \"new family\". They managed to re-socialize. Acknowledged to be stronger to cope with cancer, they felt they could improve and that could and should participate in them rehabilitation, getting to change behaviors and ways of thinking about disease and its consequences, about people and about themselves. Acknowledged the service of rehabilitation, the group of women and professionals, as largely responsible for the positive changes occurring in their lives got better even with the issues of their own finitude and expressed the appropriation of critical sense, when they proposed , albeit discreetly, some suggestions for improvements on the care offered. The rehabilitation service is the place where they find the courage to follow the life safely to laugh and cry, talk, listen and be heard without reprimand. They consider it a privilege to enjoy all that service offers, including leisure activities and no financial expenditure. Being part of this group has meant to the participants in this study a godsend chance to glimpse a new life.

A cada dia sÃo realizadas mais reconstruÃÃes imediatas da mama pÃs-tratamento do cÃncer. Para as mastectomias radicais, hà vÃrias tÃcnicas consagradas. Na quadrantectomia, as opÃÃes de reparaÃÃo do defeito vÃo do fechamento primÃrio à utilizaÃÃo de tÃcnicas de cirurgia plÃstica redutora. Para os tumores dos quadrantes externos, nÃo havia opÃÃo para a rotaÃÃo de todo o mÃsculo LatÃssimo do dorso, que usualmente excede ao necessÃrio à reparaÃÃo do volume perdido. Na literatura, hà poucos trabalhos sobre a reconstruÃÃo pÃs-quadrantectomia e nenhum quando o assunto à quadrantes externos. Aqui à descrita uma tÃcnica que originalmente se propunha a possibilitar a reposiÃÃo do volume perdido nas quadrantectomias dos quadrantes externos de mamas pequenas, mas que se mostrou Ãtil tambÃm em casos de mamas mÃdias e em lesÃes que avanÃavam à regiÃo subareolar. A tÃcnica consiste na dissecÃÃo do segmento lateral do mÃsculo L. do dorso por um prolongamento da incisÃo para a retirada da lesÃo, no mesmo decÃbito dorsal, seguida de sua rotaÃÃo e modelagem para reparar o defeito decorrente da extirpaÃÃo do cÃncer. AlÃm da diminuiÃÃo do tempo cirÃrgico, em muitos casos, torna-se desnecessÃria a segunda cirurgia. Vinte e uma mulheres foram submetidas à quadrantectomias de quadrantes externos, seguidas da reconstruÃÃo aqui descrita. Para a avaliaÃÃo do mÃtodo, cada resultado teve atribuÃdo um escore a volume, forma, simetria e alteraÃÃes do complexo arÃolopapilar (CAP), da cicatriz e da superfÃcie do quadrante operado. A nota mÃdia foi 7,048, equivalente ao conceito âBâ, mostrando a viabilidade do mÃtodo. / Nowadays more and more immediate breast reconstructions following post cancer treatment are carried out. In the case of radical mastectomy there are a lot of recognized techniques. In the quadrantectomy, the options of defect repairing range from the primary closing to the utilization of reducing plastic surgery techniques. In the case of tumors of the external quadrants there was no option for the rotation of all the LatÃssimo do dorso muscle, which usually exceeds the necessary to repair the volume lost. In the literature there are few works about the post quadrantectomy reconstruction and no one when it deals with external quadrants. Here the technique described originally proposed to make possible the replacement of the volume lost in the quadrantectomies of the external quadrants of small breasts, but it also showed to be useful in cases of medium breasts and in lesions which move towards to the subareolar region. The technique consists in the dissection of the lateral segment of the LatÃssimo do dorso muscle by prolonging the incision to withdrawal the lesion, in the same dorsal decubitus, followed by its rotation and modeling in order to repair the defect arising out of a cancer removal. Besides the time reduction of the surgery, in many cases it is not necessary a second surgery. Twenty-one women were submitted to quadrantectomies of external quadrants followed by the reconstruction described here. In order to evaluate the method, to each result a score was attributed to volume, form, symmetry, CAP, scar and surface. The average grade was 7.048, equivalent to grade B which confirms the viability of the method.

Purpose: The aim of this study was to develop a method of measuring changes in the skin microcirculation and skin dose for mastectomy patients in connection with the radiation treatment. The distribution of the skin dose, its dependence on the energy of the beam, field geometry and bolus material and the accuracy of the given skin dose in the treatment planning system were studied. Finally, the correlation between the given dose and the changes in skin microcirculation was evaluated. Methods: Skin dose was measured using GafChromic EBT3 films. To evaluate the impact of different energies and field geometry measurements on a PMMA phantom were done. Dose measurements were done using an anthropomorphic phantom and in patients. The measured skin doses were compered to the doses calculated using the treatment planning system. Before and after treatment, skin blood perfusion was measured using laser speckle contrast imaging. In connection with the last measurement also methyl nicotinate was used to increase the perfusion for the measurement. Results: The measurements on the PMMA-phantom indicate that a larger photon energy results in a lower dose to the skin, but a higher exit dose. Furthermore a more oblique angle results in a higher skin dose and a larger field size also results in an increased skin dose. The patient measurements showed that the skin dose was significantly different in different areas of the irradiated field. The highest dose was measured in the area in which a bolus was applied. All patients showed a significant increase in skin blood of the perfusion within the irradiated area. The comparison between the measured doses and the doses calculated using the treatment planning system shows an underestimation of the skin dose by the treatment planning system depending on the incident angle and the presence of bolus material. Conclusion: The distribution of the skin dose during breast cancer radiotherapy in mastectomy patients is heterogeneous with the highest dose in the area of the mastectomy scar, due to the presence of bolus material. A correlation can be noticed between the changed in microcirculation and the radiation dose to the skin. Estimation of the skin dose using the treatment planning system is inaccurate, but film doseimetry offers an easy-to use method to accurately measure the dose to different areas of the irradiated skin.

Bakgrund​: För kvinnor är bröstcancer den vanligaste cancerformen i världen. Bröstcancer behandlas ofta genom mastektomi. En mastektomi innebär ett kirurgiskt ingrepp där hela eller delar av bröstet opereras bort. Förlusten av en kroppsdel påverkar människan både fysiskt och psykiskt. Syfte:  Syftet med litteraturöversikten var att belysa kvinnors upplevelser efter mastektomi som behandling av bröstcancer.   Metod: Litteraturöversikt baserad på tio kvalitativa artiklar som valdes utifrån relevans till syftet. Artiklarna hittades i Cinahl Complete, Pubmed och Science Direct, genom sökningar inom årspanet 2009-2019. Fribergs metod användes för att granska artiklarnas resultat. Likheter och skillnader delades in i teman. Resultat: Resultatet av litteraturöversikten presenteras i 4 teman ​Upplevelser av kvinnlighet, ​ Fysiska kroppsförändringar som upplevs av den subjektiva kroppen, Upplevelsen av stöd som främjar adaption ​ och ​Upplevelsen av inre adaptiva processer. Diskussion: Kvinnors upplevelser av sina förändrade kroppar diskuterades. Författarna använde sig av Callista Roys adaptionsmodell för att få en djupare förståelse hur människan behöver anpassas sig till nuvarande livsomständigheter för att kunna hantera sin livssituation. Förlust av bröst innebär fysiska kroppsförändringar, förändrad psykologisk och kvinnlig identitet. / Background​: Breast cancer is the most common form of cancer among women worldwide. Breast cancer is often treated through a mastectomy, involving a surgical procedure where either the whole or part of the breast is removed. The loss of a body part affects a person both physically and mentally.  Aim: The aim of of this literature review was to explore women’s experiences after having a mastectomy as treatment for breast cancer. Method: The​ ​literature review was based on ten qualitative articles selected based on relevance to the aim. The articles were found in Cinahl Complete, Pubmed and ScienceDirect, through searches within the 2009-2019 year span. Friberg's method was used to review the articles' results. Similarities and differences were divided into themes. Results: The results of the literature review were presented in four main themes. The four main themes included ​Experiences of femininity ​ , ​The physical body changes as experienced by the subjective body ​ , ​Experience of support that promotes adaptation ​ and ​The experience of an internal adaptive process. Discussion: Women's experiences of their changed bodies were discussed. The authors used Callista Roy's adaptation model to gain a deeper understanding of how humans need to adapt to their current living conditions in order to manage their life situation. The loss of a breast involved physical and mental changes and adjusting to these difficulties may be difficult for the woman.

Introduction: To save lives, mastectomy is an essential intervention, but it can also causephysical and psychological trauma. An important step in restoring breast cancer patient’squality of life is to offer reconstruction. Immediate breast reconstruction (IBR) is thealternative that provides highest patient-reported life quality post surgery. However, not allpatients are suitable for the procedure, besides surgical contraindications; both patient’s andsurgeon’s opinion on surgery may influence the frequency.Data from 2016 revealed low frequency of IBR in the County of Örebro, below nationaltargets. Since then, improvement work has been implemented to improve frequency.Aim: To investigate the current frequency of IBR in 2018 and compare with data from 2016.Method: Data on mastectomy and IBR frequency in breast cancer patients was extractedfrom casebooks. Patients with male gender, neoadjuvant radiotherapy and other purposes forsurgery than cancer were excluded. Using SPSS statistics, population characteristics wascompared between IBR and mastectomy alone patients, and with data from 2016.Results: It was evident that the frequency of IBR 2018 (12.66 %) was higher than in 2016(4.85 %), which match our hypothesis. Further, there was no significant difference incharacteristics between the mastectomy alone and IBR group except for “waiting time forsurgery”, “discussion at MDK on IBR” and “age”.Conclusion: IBR surgeries have increased since 2016. Future focus to improve frequencyshould be on shortening the waiting time and addressing patient’s opinion on surgery, asseveral patients declined.

ABSTRACT Background: Breast cancer is the most common type of cancer that affects women in Sweden and in the world. The primary treatment is surgery, so called mastectomy. These big changes in the life situation creates suffering for the patient because the existence is being threatened, violated or reprobated. Aim: The aim of this study was to describe how mental wellness, body image and self-esteem as well as sexuality and relationships effects of undergoing mastectomy. Method: A descriptive literature study of qualitative articles with a qualitative approach. Results: Women who have undergone a mastectomy go through many different conditions and emotions that will affect their mental health in the short term but also in the long term. Depending on one's condition and where one has come in life, mental health is affected in different ways. The breast is someone that women described as femininity, beauty and motherhood. The loss of the breast meant the loss of being a complete woman, these negatively affect the women's mental wellness, body image and self-esteem as well as sexuality and relationships, which has led to a life of mental illness. Conclusion: Women who have undergone mastectomy experience an affected mental wellness, body image and self-esteem as well as sexuality and relationships. It is mainly the woman's mental well-being that is negatively affected, but as time passes after the operation, an improvement takes place. Characteristic of the study was how the women experienced feelings of fear and anxiety and that their close relationships with partners and relatives were also negatively affected.

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