Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor globalt sett. År 2016 drabbades 7 500 kvinnor av bröstcancer i Sverige och av dessa avled 1400 kvinnor på grund av sjukdomen. Vidare behandlas 90 % av kvinnorna kirurgiskt och mastektomi, som primär kirurgisk behandling, ökar bland alla åldersgrupper. Ärret som blir kvar på kroppen är en ständig påminnelse om sjukdomen. Syfte: Att beskriva bröstcancerdrabbade kvinnors upplevelser efter genomgången mastektomi. Metod: En kvalitativ litteraturöversikt med induktiv ansats gjordes där 10 kvalitativa artiklar inkluderades. Resultat: Kvinnor upplevde på flera sätt att kroppen förändrades och att deras självbild påverkades. Förändringar i det sociala livet förekom och kvinnor upplevde ett behov av stöd. Vidare uppkom existentiella funderingar hos kvinnorna, som bland annat en förändrad syn på livet. Slutsats: Resultatet kan leda till att vårdpersonal, men också människor i samhället får en ökad kunskap och förståelse för kvinnor som genomgått en mastektomi. Som sjuksköterska är det viktigt att vara öppen för alla kvinnors upplevelser och tillämpa personcentrerad omvårdnad i bemötandet. / Background: Breast cancer is the most common form of cancer among women around the world. In 2016, 7 500 women in Sweden received the diagnosis and of these, 1 400 passed away. Of all women, 90 % is treated surgically, and mastectomy as primary treatment increases among all ages. The scar becomes a constantly reminder of the disease. Aim: To describe the experience of mastectomy as a treatment among women with breast cancer. Method: A qualitative literature review with inductive approach where 10 qualitative articles were included. Results: Women experienced that their bodies changed in many ways. Also, their body image was affected. Changes in their social life occurred and women experienced a need of support. Furtherly, existential questions appeared, such as seeing life in a new perspective. Conclusion: The result can lead to an increased knowledge in the society and health professionals which can lead to a better understanding for the women who had undergone a mastectomy. As a nurse it is important to respect every unique experience and apply person centered care in the treatment.

Made available in DSpace on 2016-12-23T13:46:57Z (GMT). No. of bitstreams: 1 Juliana Rodrigues Tovar.pdf: 1741530 bytes, checksum: 913d2b256e4e2c979121377774357410 (MD5) Previous issue date: 2013-03-27 / Introdução: A cirurgia conservadora já é considerada procedimento de escolha quando a mulher é acometida por um tumor em estágio inicial. Em consequência desta conservação do tecido mamário, a recorrência local do câncer é uma crescente preocupação. Objetivos: Descrever o perfil sociodemográfico e clínico das mulheres com recidiva local do câncer de mama, submetidas à cirurgia conservadora no Hospital Santa Rita de Cássia/Afecc, Vitória- ES, cadastradas no período de Janeiro de 2000 a Dezembro de 2010, examinar a associação entre as variáveis clínicas e sociodemográficas e a incidência de recidiva local e analisar a sobrevida livre da recidiva local dessas mulheres. Metodologia: Foram realizados dois estudos: o primeiro trata-se de um estudo de coorte retrospectiva e o segundo refere-se a um estudo de sobrevida com a utilização de dados secundários. A amostra compôs-se por 880 casos de mulheres com diagnóstico de câncer de mama e atendidas no Hospital Santa Rita de Cássia/Afecc. Utilizou-se o método Kaplan-Meier e o modelo multivariado de riscos proporcionais de Cox, enquanto testou-se a significância estatística pelo método log-rank. Resultados: A recidiva ocorreu em 60 pacientes (6,8%) e a média do tempo entre a cirurgia e a recidiva de 35,5 meses. Na análise multivariada do estudo de sobrevida livre de recidiva local, identificou-se relação de risco para a faixa etária até 39 anos (p=0,083 e HR=6,19), comprometimento positivo das margens cirúrgicas (p=0,001 e HR= 3,49) e Her-2 positivo (P=0,033 e HR=1,89). Conclusões: A seleção de cada paciente para a conduta mais adequada deve ser feita cuidadosamente, de forma a estabelecer as principais características sociodemográficas e clínicas que possam auxiliar na escolha do melhor tratamento. Do mesmo modo, a escolha da melhor técnica cirúrgica é fundamental no sentido de reduzir os gastos com tratamentos de resgate e diminuir o sofrimento físico e psicológico da mulher / Introduction: Conservative surgery is now considered the procedure of choice when a woman is affected by a tumor at an early stage. As a consequence of conservation of breast tissue, the local recurrence of cancer is a growing concern. Objectives: To describe the sociodemographic and clinical profiles of women with local recurrence of breast cancer, undergoing conservative surgery Santa Rita Hospital in Vitória, Espírito Santo State, Brazil, from January 2000 to December 2010, to examine the association between clinical and sociodemographic and the incidence of local recurrence and analyze local recurrence-free survival of these women. Method: Two studies were performed: the first one is a retrospective cohort study and the second refers to a survival study using secondary data. The sample consisted of 880 women. To estimate the survival period in general and by stratum, the Kaplan Meyer method was employed. The independent effect of variables was checked by Cox/ s model of multivariate proportional risk, while statistical significance was tested through the log-rank method Results: The breast recurrence occurred in 60 patients (6,8%) and the average time between surgery and recurrence of 35,5 months. In multivariate analysis, we identified hazard ratio for the age group up to 39 years (p=0.083 and HR=6.19), positive surgical margin involvement (p = 0.001 and HR = 3.49) and Her-2 positive (p=0.033 and HR=1.89). Conclusions: The selection of each patient to the most appropriate management must be done carefully in order to establish the main sociodemographic and clinical characteristics that might help to choose the best treatment. Similarly, the choice of the best surgical technique is essential to reduce spending on treatments rescue and decrease the psychological suffering of the patient

Made available in DSpace on 2015-05-14T13:16:40Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 894417 bytes, checksum: 3728c6fa4ba78da3d3577c603e2f91cf (MD5) Previous issue date: 2009-04-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The antineoplastic drugs used in systemic treatment of cancer by interfering with the mechanisms of survival, and cell migration proliferation. By systemic, these drugs can reach the central nervous system causing possible reactions in normal cells, including regions of the visual cortex, responsible for visual perception. The role of contrast sensitivity (FSC) has been used to characterize the process by which the visual system processes the information of the various frequencies of stimuli received by sensory stimuli perceived. So, this study aimed to investigate whether the agents of antineoplastic drugs can alter the sensory threshold in women that used for the systemic treatment of breast carcinoma, using the FSC as a tool. Respecting ethical aspects necessary to conduct the study, 20 volunteers participated in the tests, with normal or corrected visual acuity, ten users of antineoplastic drugs administered in six cycles of the FAC scheme - 5- fluorouracil, doxorubicin and cyclophosphamide (Experimental Group, EG) and ten volunteers without condition and without identifiable antineoplastics use of drugs (Control Group, CG). Measures of sensory threshold were performed at the Laboratory of Perception, Neuroscience and Behavior, using visual stimuli of spatial frequencies of 0.25, 1, 4 and 8 c/deg (cycle per degree of visual angle). The stimuli were generated in shades of gray and on a video monitor at 150 cm from the screen. It used to be an experimental design with repeated measures and put psychophysical forced-choice with two alternatives of choice. The procedure for measuring the sensitivity was the presentation of successive pairs of simple stimuli (test and neutral) and the volunteers were asked to choose among them always, that contained the frequency space. Three consecutive correct responses were necessary to reduce the amount of contrast in a indeed and an error to increase it (20%). Each frequency space was estimated twice for each participant, generating 240 values of thresholds for contrast. The data were grouped into tables and spreadsheets in Microsoft Office sociodemographic profile of the second sample, the iron values of contrast for maximum and minimum frequency space for the two groups.The analysis of variance for measures spread showed a significant difference between the threshold contrast of EG and the CG (F (1,238) = 23.97, p<0001), in the other words, there was variation in contrast sensitivity between the groups. At the highest spatial frequency (8 cpg) women in the control group were 1.6 more sensitive than the experimental group, analyzing how the post-hoc Tukey test (p<0001). You can guarantee, then, that the variation in contrast sensitivity among women of EG and CG can be caused, possibly by using the FAC scheme administered for the treatment of breast carcinoma. Therefore, the hypothesis that women mastectomized when subjected to treatment with drugs antineoplastics may have changed their visual perception is confirmed and accepted. / As drogas antineoplásicas são utilizadas no tratamento sistêmico do câncer por interferir nos mecanismos de sobrevivência, proliferação e migração celular. Por via sistêmica, estas drogas podem atingir o sistema nervoso central causando possíveis reações em células normais, inclusive nas regiões do córtex visual, responsáveis pela percepção visual. A Função de Sensibilidade ao Contraste (FSC) tem sido utilizada para caracterizar o processo pelo qual o sistema visual transforma as informações das várias freqüências do estímulo sensorial recebido em estímulo percebido. Assim, o presente estudo teve como objetivo investigar se os agentes das drogas antineoplásicas podem alterar o limiar sensório em mulheres que a utilizaram para o tratamento sistêmico do carcinoma mamário, utilizando a FSC como instrumento. Respeitando os aspectos éticos necessários para a realização da pesquisa, participaram dos testes 20 voluntárias, com acuidade visual normal ou corrigida, dez usuárias de drogas antineoplásicas administradas em seis ciclos do esquema FAC - 5-fluorouracil, doxorrubicina (adriamicina) e ciclofosfamida (Grupo Experimental, GE) e dez voluntárias sem patologia identificável e sem uso de drogas antineoplásicas (Grupo Controle, GC). As medidas de limiar sensório foram realizadas no Laboratório de Percepção, Neurociências e Comportamento, utilizando estímulos visuais de freqüências espaciais de 0,25; 1; 4 e 8 cpg (ciclo por grau de ângulo visual). Os estímulos eram gerados em tons de cinza e apresentados num monitor de vídeo a 150 cm de distância da tela. Usou-se um delineamento experimental com medidas repetidas e o método psicofísico da escolha forçada com duas alternativas de escolha. O procedimento para medir a sensibilidade consistiu na apresentação sucessiva simples de pares de estímulos (teste e neutro) e as voluntárias foram orientadas a escolher sempre dentre eles, aquele que continha a freqüência espacial. Eram necessários três acertos consecutivos para diminuir a quantidade de contraste em uma unidade e um erro para aumentá-la (20%). Cada freqüência espacial foi estimada duas vezes por cada participante, gerando 240 valores de limiares de contraste. Os dados coletados foram agrupados em tabelas e planilhas do Microsoft Office segundo perfil sociodemográfico da amostra, valores de limiar de contraste máximos e mínimos por freqüência espacial para os dois grupos. A análise de variância para medidas repetidas mostrou diferença significante entre o limiar de contraste do GE e do GC (F (1,238) = 22,73; p<0,001), ou seja, houve variação na sensibilidade ao contraste entre os grupos. Na freqüência espacial mais alta (8 cpg) as mulheres do grupo controle foram 1,6 mais sensíveis do que o grupo experimental, analisado com o teste post-hoc Tukey (p<0,001). Pode-se afirmar, então, que a variação na sensibilidade ao contraste entre as mulheres do GE e GC pode ser causada, possivelmente, pelo uso do esquema FAC administrado para o tratamento do carcinoma mamário. Portanto, a hipótese levantada de que as mulheres mastectomizadas quando submetidas a tratamento com drogas antineoplásicas podem ter sua percepção visual alterada está confirmada e aceita.

INTRODUÇÃO: A mastectomia é um procedimento que pode gerar diversas repercussões tanto físicas quanto emocionais. Atualmente há uma tendência para que a reconstrução da mama seja realizada o quanto antes com o objetivo de amenizar o impacto psicológico da doença. Na literatura são escassos os estudos sobre os efeitos da mastectomia e da reconstrução mamária na postura. Ainda na literatura é possível observar que não há um consenso sobre a qualidade de vida, imagem corporal e autoestima em mulheres submetidas à mastectomia com e sem reconstrução da mama. OBJETIVO: Avaliar a postura, qualidade de vida, imagem corporal e autoestima em mulheres com mastectomia sem reconstrução e com reconstrução imediata da mama. METODOLOGIA: Participaram do estudo 76 mulheres com idade entre 35 e 70 anos diagnosticadas com câncer de mama e submetidas à mastectomia, sendo divididas em dois grupos: sem reconstrução da mama (MSR; n=38) e com reconstrução mamária imediata com retalho abdominal (M+RI; n=38). Para a avaliação da postura foram localizados e demarcados pontos anatômicos específicos para a obtenção de fotografias em vista anterior, posterior, lateral direita e esquerda. As fotografias foram analisadas pelo Software para Avaliação Postural (SAPO). Na avaliação da qualidade de vida foi utilizado o questionário Short- Form Health Survey; na imagem corporal o Questionário de Imagem Corporal após o Câncer de Mama e a autoestima foi avaliada pela Escala de Autoestima de Rosenberg. O nível de significância estabelecido foi de alfa= 0,05. RESULTADOS: Na avaliação postural o grupo MSR apresentou maior ângulo no alinhamento vertical do tronco, na vista lateral esquerda (4,2 vs. 3,1; p=0.05). Para as demais variáveis do alinhamento postural as diferenças não foram significativas. O grupo MSR apresentou na avaliação da qualidade de vida menor capacidade funcional (66,3 vs. 76,4; p=0,01). Na avaliação da imagem corporal e autoestima não foram encontradas diferenças estatisticamente significativas. CONCLUSÃO: As mulheres com mastectomia sem reconstrução mamária apresentam na vista lateral esquerda o ombro posicionado mais posteriormente em relação ao trocânter maior do fêmur, apontando para uma rotação de tronco e apresentam menor capacidade funcional na avaliação da qualidade de vida. Ter ou não realizado a reconstrução imediata da mama não comprometeu a imagem corporal e autoestima / INTRODUCTION: Mastectomy is a procedure that can generate diverse physical and emotional repercussions. Currently, there is a tendency to perform breast reconstruction as soon as possible in order to mitigate the psychological impact of the disease. There are few studies in the literature on the effects of mastectomy and breast reconstruction on body posture. However, it has been observed that there is no consensus regarding the quality of life, body image, and self-esteem of women undergoing mastectomy, with or without breast reconstruction. OBJECTIVE: The aim of this study was to evaluate posture, quality of life, body image, and self-esteem in women with mastectomy without reconstruction and with immediate breast reconstruction. METHODS: The study included 76 women, 35-70 years of age, who were diagnosed with breast cancer and underwent mastectomy. The women were divided into two groups: without breast reconstruction (MSR, n=38) and with immediate breast reconstruction with an abdominal flap (M+IR, n=38). To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior, and right and left side views. The photographs were analyzed using Postural Assessment Software (PAS/SAPO). The Short-Form Health Survey was used to assess quality of life, body image was assessed with the Questionnaire Body Image after Breast Cancer, and self-esteem was assessed with the Rosenberg Self-Esteem Scale. The significance level was set at alfa=0.05. RESULTS: A higher angle of vertical alignment of the trunk in the left lateral view was observed in the MSR postural assessment group (4.2 vs 3.1; p=0.05). Differences in the other postural alignment variables were not significant. Lower functional capacity in the quality of life assessment was also observed in the MSR group (66.3 vs. 76.4; p=0.01). No statistically significant differences were found in the body image and self-esteem assessments. CONCLUSION: In the left side view, women with mastectomy without breast reconstruction presented with the shoulder positioned more posteriorly in relation to the greater trochanter, indicating trunk rotation. In addition, they exhibited lower functional capacity in quality of life. Body image and self-esteem were not affected by whether or not breast reconstruction was performed

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-31T13:39:32Z No. of bitstreams: 1 liviafabianasaco.pdf: 1876242 bytes, checksum: ce10c4b3fb80afca690072dcda3c42d6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-02T12:29:25Z (GMT) No. of bitstreams: 1 liviafabianasaco.pdf: 1876242 bytes, checksum: ce10c4b3fb80afca690072dcda3c42d6 (MD5) / Made available in DSpace on 2016-07-02T12:29:25Z (GMT). No. of bitstreams: 1 liviafabianasaco.pdf: 1876242 bytes, checksum: ce10c4b3fb80afca690072dcda3c42d6 (MD5) Previous issue date: 2012-03-29 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Multiplicadas desordenadamente, as células cancerosas transformam-se e transformam o ser habitável – o câncer de mama é uma patologia que cada vez mais invade nosso tempo e nossos sentidos. O investimento, nesta pesquisa, refere-se à constituição físico-funcional/social e simbólica da mulher pós-diagnóstico de câncer à terapêutica e a produção de seus efeitos de sentidos do/no funcionamento físico discursivo do ser com câncer de mama. A partir da análise de materiais orais e funcionais, buscamos compreender a constituição do sujeito por meio da relação linguagem/câncer, ou seja, entender, discursivamente, de que maneira esse sujeito envolvido com a doença se significa e/ou é significado; em que medida a passagem pela doença produz novas formas de significação, novas organizações do dizer, novos processos de identificação, outras modalidades de subjetivação. A partir do contexto teórico da Análise de Discurso, situamos esta pesquisa em duas (principais) reflexões. A primeira versa sobre o que é o câncer e o processo de transformação físico-funcional que a clínica do tratamento pressupõe. A segunda reflexão diz respeito ao processo discursivo nas etapas do diagnóstico à terapêutica. Os resultados demonstram alterações físico-funcionais (limitação de movimentos e de força muscular) pós-procedimento cirúrgico, influenciando diretamente no processo de identificação e subjetivação na constituição dessa outra mulher, agora afetada pelo câncer de mama. Depreendemos também, nos discursos, o reconhecimento dos exercícios físicos como proposta de apoio terapêutico e mecanismo de reinserção social. O conhecimento reunido neste trabalho reforça a importância do entendimento das peculiaridades do tratamento representativo em cada mulher, necessário para a condução das atividades pela equipe dos profissionais que estão inseridos nesse contexto. / Randomly multiplicated, the cancer cells change themselves and change the habitable being – the breast cancer is a pathology that is growing bigger and getting more space in our time and on our senses. The goal in this paper refers to the physical-functional, social and symbolical constitution of the post-diagnostic women, until the treatment and the production of its effects on the breast cancer patients and their physical functions’ senses. Starting from the analysis of oral and functional materials, we try to understand the constitution of the subject through the relation language/cancer, that is, to understand discursively how this subject, involved with the disease, signifies and/or is signified; in which way the disease diagnostic produces new ways of signifying, new organizations of saying, new identification processes and other subjectivation modalities. From the historical context of Discourse Analysis, we situate our paper with two (main) reflections. The first one, on how the cancer acts and the physical-functional transformation process that the clinical treatment suggests. The second reflection is about the discursive process in the phases of the diagnosis to the treatment. The results demonstrate post-surgical procedure’s physical-functional alterations (such as low mobility and loss of muscular strength), which directly influences identification and subjectivation processes in this new woman, now affected by the disease. We also comprehend in these discourses the recognition of physical exercises as support proposal for the treatment and social reintegration mechanism. The knowledge reunited in this paper reinforces the meaning of understanding the peculiarities on each representative treatment for every woman, which is necessary for the professional team to conduct their activities in this context.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-03-16T19:42:05Z No. of bitstreams: 1 Sandra Regina Terra Campos Nicolau.pdf: 1208261 bytes, checksum: 81fbc9b2ad89c7f1b2ea23193db1dd4c (MD5) / Made available in DSpace on 2017-03-16T19:42:05Z (GMT). No. of bitstreams: 1 Sandra Regina Terra Campos Nicolau.pdf: 1208261 bytes, checksum: 81fbc9b2ad89c7f1b2ea23193db1dd4c (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / Objetivos: descrever as atividades de cuidado de enfermagem prestadas às mulheres submetidas à mastectomia; discutir os resultados na perspectiva do cuidado ético e estético em saúde; e elaborar uma ação educativa visando à discussão do modo de cuidar da equipe de enfermagem e a aplicação dos cuidados diretos e indiretos à paciente. Método: estudo descritivo e exploratório de abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada e observação de campo. Os sujeitos do estudo foram os profissionais que compõem a equipe de enfermagem da unidade da clínica cirúrgica feminina de um hospital universitário da rede pública federal de ensino de Niterói/RJ. Os dados foram tratados por análise de conteúdo do tipo temática. Resultados: Da análise emergiram três categorias: O cuidado sensível: o afetivo e estético; Orientações para o autocuidado e; Cuidados de enfermagem no pós-operatório imediato de mulheres submetidas à mastectomia. Como produtos dessa pesquisa, foi criada a oficina solidária e um folheto informativo com orientações para a alta de pacientes. Conclusões: Este estudo teve como relevância a contribuição para uma prática assistencial humana e eficaz, e desenvolvimento do conhecimento da área da saúde da mulher em enfermagem oncológica, bem como contribuiu para o ensino e a pesquisa e inovação de cuidado / Objectives: to describe the nursing care activities provided to women undergoing mastectomy; discuss the results in the ethical and aesthetic care in health perspective; and develop an educational action aimed at discussion of ways to take care of the nursing staff and the application of direct and indirect care to the patient. Method: descriptive study of qualitative approach. Data were collected through semi-structured interviews and field observation. The study subjects were the professionals that make up the nursing staff of the surgical clinic female unit of a federal university hospital at Niterói / RJ. The data were analyzed by thematic content analysis. Results: by analysis three categories emerged: The sensitive care: the affective and aesthetic; Guidelines for self-care; Nursing care in the immediate postoperative women undergoing mastectomy. As products of this research, was created the joint workshop and a leaflet with guidelines for discharge from the hospital. Conclusions: The relevance of study was contribution to a humane and effective care practice, and development of knowledge of the health of women in oncology nursing, and contributed to the education and research and care innovation

M.A. / A diagnosis with cancer causes certain fears in a patient, as well as, their family. It activates intense emotional responses in everybody concerned. Reach for Recovery play a huge role in mastectomy patients and their family's lives. It is there to support the patient and to understand what the patient is experiencing. Reach for Recovery is a selfhelp group, functioning under the name of the Cancer Association of South Africa. The group was started in 1952 in the USA, at a time when there was a tendency to discourage patients from discussing their operations with other patients. Therese Lasser, a mastectomy patient, realized that not enough was being done for women whose life had changed dramatically in the span of a few hours. The goal of the study was to do training for Reach for Recovery volunteers. To assess if the Reach for Recovery volunteer is fulfilling in the need of the mastectomy patient. A qualitative approach, using an inductive strategy, was followed to achieve the aim of the study. Focus groups are being used to gather information about the functioning of the Reach for Recovery groups at present. Focus groups were held in the Far East Rand and the West Rand with the Reach for Recovery support groups. The purpose of the focus group was to identify the needs of the mastectomy patients, to enable the researcher to identify guidelines for the Reach for Recovery programme. A literature control was done after the central themes were identified. After having compared the results of the focus group with the relevant literature certain conclusions were drawn and recommendations made. In conclusion to this study, guidelines were designed to be used in the Reach for Recovery programme when the training is done.

Cancer is a life threatening and hope inhibiting disease. Furthermore, as in the case of breast cancer and the concomitant loss of an intimate body part, it is an identity threatening disease. The disease, the mastectomy, as well as the treatment place high demands on the process of hope for the whole family. In various ways, the family is constantly busy constructing a hopeful story for the future. Hope develops from a conjunction of a rich variety of factors that consciously or unconsciously have an influence on the process of hope. For the Christian, faith is first and foremost anchored in God and his Word. Our hope grows, in various ways, when our own story becomes one with God’s Story of Hope. Many people with cancer experience spiritual growth, a transformation of faith narratives, and get to know God in a way that would not have been possible in any other conditions. However, hope is not only spiritual hope. Hope also grows in relationships in a social constructionist process. The woman who had undergone a mastectomy and experiences unconditional acceptance in various ways of support by family members and friends, can, as a result, construct a hopeful story for the future. Acceptance of the inevitable that is happening to her, as well as the consequential self-acceptance, helps her to establish a new identity. The ability to experience loss as only a small part of one’s self-identity is crucial for the process of emotional healing. During this process of healing, hope prospers. Positivism and hope are closely related and realism is always coupled with positivism. Hope is ingrained in reality. Positive, realistic people are able to make choices that will result in hope. In this freedom of choice lies the potential to transform a personal tragedy into a triumph. A viable system of belief with regard to the purpose of life of human existence, helps in creating a foundation of hope in a person’s life. The belief that a person’s existence is purposeful, despite the inevitable tragedies of life, equips the human being to live to the full, amidst tragedies. The return of a sense of humor is one of the most secure signs of a healthy recovery. Hope is stimulated within ourselves and others when we are able to laugh at ourselves and with others, amidst sad conditions. Reconstruction can be regarded as an aid in the process of growth of hope concerning the woman’s body image, providing her with feelings of balance and completeness, and enhancing her feeling of being a woman. Shared hope is one of the strongest sources of hope for people with cancer. To be able to talk to someone who had personally suffered from and outlived breast cancer has more value than merely taking note of the statistics of survivors. People suffering from cancer also experience oases of hope in things like a book that is significant to their situation, relationships, an unexpected meeting with a breast cancer survivor, or her work. Hope also becomes manifest in nature as a symbol of life and hope, in participation in research studies, in a reliable doctor. Even more hope will be established if all women have the privilege of having breast examinations performed at breast clinics where professional and sympathetic people can announce the diagnosis in cases where cancer is indeed diagnosed. Various treatment options can be discussed. Time can be made available to prepare the entire household and provide peace of mind for the children. / Thesis (PhD (Pastoral Family Therapy))--University of Pretoria, 2005. / Practical Theology / unrestricted

Introduction: The number of breast reconstructions after breast cancer is increasing over the years. This study evaluates complications in the first 30 days after breast reconstruction post mastectomy in different surgical techniques for patients with non-metastatic breast cancer. Methods: Retrospective cohort including patients who underwent breast reconstruction post mastectomy at the National Institute of Neoplastic Diseases (INEN) 2014-2018. Outcomes were immediate complications (first 30 days after surgery). Cumulative incidences were obtained. Association with clinical and demographic factors was evaluated using adjusted relative risk (aRR) obtained via Poisson Regression with robust variances. Results: 2092 patients had mastectomy at INEN during the study period, but only 271 underwent breast reconstruction. From them, 148 had complete data and fulfilled the selection criteria. Median age was 45 years old, 62.16% had overweight/obesity, and 35.85% had clinical stage III. 28.38% had immediate autologous reconstruction, 33.11% immediate prosthetic reconstruction, and 38.51% delayed reconstruction of any type. 48.65% had some surgical complication in the first 30 days, being the most frequent dehiscence (20.27%) and superficial infection (18.92%). Overweight/Obesity (aRR 1.96; 1.24-3.10) and having immediate reconstruction (aRR 1.54; 1.04-2.27) were associated to complications. Prosthetic technique use was protective (aRR 0.59; 0.40-0.85), as well as Neoadjuvant Chemotherapy (aRR 0.65; 0.42-0.99). Conclusions: The prosthetic surgical technique had less early complication incidence than the autologous one. On the other hand, immediate surgery after mastectomy was more likely to present complications compared with delaying. Variables as obesity, neoadjuvant therapy and ECOG intervened in the incidence of complications. / Introducción: El número de reconstrucciones mamarias post cáncer de mama ha ido en aumento. Este estudio evalúa las complicaciones en los primeros 30 días luego de reconstrucción mamaria post mastectomía para cáncer de mama no metastásico en sus diferentes técnicas quirúrgicas. Métodos: Cohorte retrospectiva de pacientes con reconstrucción mamaria post mastectomía en el Instituto Nacional de Enfermedades Neoplásicas (INEN) entre 2014-2018. Los desenlaces fueron las complicaciones quirúrgicas en los 30 días siguientes a la cirugía. Se obtuvieron incidencias acumuladas, y se evaluó su asociación con diversos factores clínico-demográficos mediante riesgos relativos crudos y ajustados (aRR) obtenidos vía Regresión de Poisson con varianza robusta. Resultados: De 2092 pacientes que tuvieron mastectomía en el INEN entre 2014-2018, solo 271 tuvieron reconstrucción mamaria. De ellas 148 tuvieron datos completos y cumplieron los criterios de selección. La mediana de edad fue 45 años, 62.16% tuvieron sobrepeso/obesidad, y 35.85% tenían estadio clínico III. El 28.38% tuvieron reconstrucción inmediata autóloga, 33.11% reconstrucción inmediata usando prótesis, y 38.51% reconstrucción tardía. El 48.65% de los pacientes experimentó alguna complicación en el mes siguiente post cirugía, siendo las complicaciones más frecuentes dehiscencia de sutura (20.27%) e infección superficial (18.92%). Obesidad (RR 1.96; 1.24-3.10), y tener Técnica Inmediata (RR 1.54; 1.04-2.27) se asociaron a más complicaciones. Uso de Técnica Protésica fue protector (RR 0.59; 0.40-0.85), así como también Quimioterapia Neoadyuvante (RR 0.65; 0.42-0.99). Conclusiones: La técnica quirúrgica protésica tuvo menos probabilidades de presentar complicaciones que la autóloga. Asimismo, la cirugía inmediata presenta más probabilidades de presentar complicaciones que la diferida. Las variables como obesidad, terapia neoadyuvante y ECOG intervienen en la presentación de complicaciones. / Tesis

Background: Breast cancer is the most common type of cancer among women and every year 8000 people in Sweden gets diagnosed. Today eight out of ten breast cancer patients survive and the survival rates increase every year. However, breast cancer is still the type of cancer with the highest death rate among women besides lung cancer. During a mastectomy the whole breast is surgically removed. The changes in appearance and body image after mastectomy can lead to psychological, emotional and sexual consequences that may have a change in quality of life among these patients. Aim: The purpose of this study was to explore women’s experiences of body image, quality of life, psychological- and sexual health after mastectomy due to breast cancer as well as to compare these expieriences between women who have and have not undergone breast reconstruction after mastectomy. Method: A literature review based on 18 scientific articles. Searches in Pubmed resulted in thirteen studies of quantitative design and five with qualitative design. Resultat: Four main themes were identified. Depression &amp; Anxiety which described that mastectomized women showed greater symptoms of depression and anxiety compared to women who had undergone breast conserving surgery. In Body Image the women reported a negative change in body image post mastectomy. Sexuality showed that many women experienced that the mastectomy affected their sexual relations and partnerships. Lastly, in the theme Quality of life women declared a decreased self- esteem, emotional stability and social functioning negatively affecting quality of life. Conclusion: The experiences of mastectomy varies and are highly individual. However, many women experiences negative consequences following mastectomy. It is therefore important for nurses and other health workers to be aware of how mastectomy can affect patients in order to give an optimal care and support. / Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor och varje år får fler än 8000 en bröstcancerdiagnos i Sverige. Överlevnaden i Sverige är åtta av tio drabbade och antal dödsfall minskar varje år. Trots detta är bröstcancer, efter lungcancer, den cancerform som orsakar flest dödsfall bland kvinnor. Vid mastektomi avlägsnas hela bröstet, vilket leder till en kroppslig förändring. Detta kan påverka kvinnor i olika aspekter såsom den psykiska hälsan, kroppsbild, sexualitet och livskvalitén. Syfte: Syftet med föreliggande studie var att undersöka kvinnors upplevelser av kroppsbild, livskvalité, sexuella-och psykiska hälsa efter att ha genomgått en mastektomi samt jämföra upplevelserna av kroppsbild, livskvalité, sexuella-och psykiska hälsa mellan kvinnor som genomgått en mastektomi och kvinnor som genomgått en bröstrekonstruktion. Metod: Studien genomfördes som en allmän litteraturöversikt. Databasen PubMed användes för informationssökning. Urvalet resulterade i tretton kvantitativa och fem kvalitativa artiklar. Resultat: Huvudteman som presenterades var depression &amp; ångest som visade att kvinnor efter en mastektomi uppvisade en högre grad av depressions-och ångestsymptom än kvinnor som genomgått en bröstrekonstruktion. Kroppsbild redogör att kvinnor hade sämre självbild efter att ha opererat bort bröstet än innan operationen. Sexualitet klargör att kvinnors sexuella- och partnerrelationer påverkades negativt på grund av det förändrade kroppsutseendet. Livskvalité, beskriver att kvinnor hade sämre självförtroende, emotionell stabilitet samt social funktion vilket orsakade en sämre livskvalité Slutsats: Kvinnors erfarenheter och upplevelser efter genomgången mastektomi är högst individuella och varierande. Resultatet i denna studie belyser dock många negativa erfarenheter och välbefinnande. Forskning inom området ger sjuksköterskor och annan vårdpersonal kunskapen om hur psykosocialt och emotionellt lidande pre- och postoperativt kan förebyggas i samband med mastektomi.