Breast cancer is the leading cause of death in women ages 35-54. A research consensus has been published stating that breast conserving therapy or surgery (BCT/BeS) and mastectomy treatments for T1 breast cancers yield comparable recurrence and survival rates. Standards of medical practice for various diseases and conditions are known, but very little if any, information or research exists on individual hospital medical practice. This study focused on the grassroots level of health care by investigating local treatment protocols, patient/physician beliefs and actual treatments chosen concerning early diagnosis of breast cancer. / Ed. D.

Bakgrund: Bröstcancer är den vanligaste cancerformen i Sverige när det gäller cancerdiagnos hos kvinnor. Det är en livshotande diagnos som ofta behandlas med kirurgi i form av mastektomi. Mastektomi medför både psykisk och fysisk påfrestning på kvinnorna som kan ge upphov till lidande. Sjuksköterskan har ansvar för kvinnan och den personcentrerade vården där både psykiska, fysiska och sociala svårigheter ska uppmärksammas. Syfte: Syftet var att belysa kvinnors upplevelser av vårdprocessen i samband med mastektomi till följd av bröstcancer. Metod: En litteraturstudie baserad på kvalitativ forskning valdes som metod och analyserades systematiskt. Resultat: I resultatet framställs tre huvudteman med tillhörande subteman. Det första huvudtemat Ett förändrat liv med tillhörande subteman Den initiala reaktionen och Behov av stöd. Det andra huvudtemat Information och delaktighet med tillhörande subteman Individanpassad information och Delaktighet och påtryckning samt det tredje huvudtemat En förändrad livsvärld med subteman Förlust, sorg och rädsla och Acceptera det nya. Konklusion: Kvinnor som drabbas av bröstcancer, med efterföljande mastektomi, upplever känslor som kräver ökat stöd där vården behöver arbeta personcentrerat. Kvinnorna behöver känna delaktighet och trygghet i sin vård. Individanpassad information och närvarande vårdpersonal har positiv betydelse för vården av kvinnor efter mastektomi. / Background: Breast cancer is the leading cancer diagnosis amongst women in Sweden. Breast surgery referred to as mastectomy is the most common treatment for this life- threatening condition. A mastectomy is both physically and mentally challenging and as a result can lead to suffering. Nurses have a duty of care regarding individualised care and in the identification of physical, mental and social difficulties related to the diagnosis. Aim: The purpose of this study was to highlight women's experiences of the care process related to mastectomy due to breast cancer. Method: A qualitative literature review-based approach was chosen and the the literature was systematically analysed. Findings: The result identified three main themes with associated subthemes. The first main theme A changed life with associated subthemes The initial reaction and Need for support. The second main theme Information and participation with associated subthemes Individualised information and Participation and pressure, as well as the third main theme A changed lifeworld with subthemes Loss, grief and fear and Accept the new. Conclusion: Women who suffer from breast cancer, with a subsequent mastectomy, experience feelings that require increased support where care needs to be person-centred. These women need to feel participation and security in their care. Individualised information and high healthcare staff presence have a positive impact on the care of women after a mastectomy.

According to the 1 991 Annual Report of the Department of Health and Social Services of former Bophuthatswana, there were 364 reported malignant conditions found in women with cancer of the breast and cervix being the most prevalent. What causes great concern is t.he fact that patients present for the first time at health facilities during advanced stages of these diseases thus making the prognosis poor. Black patients in this study were found to present with cancer of the breast at an earlier age than their white counterparts. In addition to the above named problems, no facility exists for the treatment of cancer in the area of study and patients have to be referred to other areas. It was on the strength of the above observations that the researcher embarked upon this study to establish the effects of the diagnosis cancer and mastectomy on the victims. The aims of the study therefore were: to explore and describe the psycho-social effects of the diagnosis and treatment on Black women; develop guidelines for oncology nurses and doctors to assist with the adaptation of these patients to the diagnosis and treatment; and provide information that could lead to better training of oncology personnel as well as develop a proper support system to facilitate adjustment of the mastectomised patient to the disease and its treatment. Data were collected using the qualitative and quantitative approaches with individual in-depth interviews forming the main strategy. The findings revealed that the diagnosis cancer of the breast was equated with death among all respondents. The mastectomy added more stress for the patient, which was further compounded by chemo- and radiotherapy. The latter was described as causing more pain than the tumour itself. Problems experienced by the patients were reported to include: financial difficulties; general weakness; fear of recurrence and metastasis; concern for dependent children and fear of unemployment. All respondents in this study expressed the need for the formation of a voluntary care group, which could assist them with adaptation to the disease and its treatment. / Advanced Nursing Sciences / D. Lit. et Phil. (Advanced Nursing Sciences)

According to the 1 991 Annual Report of the Department of Health and Social Services of former Bophuthatswana, there were 364 reported malignant conditions found in women with cancer of the breast and cervix being the most prevalent. What causes great concern is t.he fact that patients present for the first time at health facilities during advanced stages of these diseases thus making the prognosis poor. Black patients in this study were found to present with cancer of the breast at an earlier age than their white counterparts. In addition to the above named problems, no facility exists for the treatment of cancer in the area of study and patients have to be referred to other areas. It was on the strength of the above observations that the researcher embarked upon this study to establish the effects of the diagnosis cancer and mastectomy on the victims. The aims of the study therefore were: to explore and describe the psycho-social effects of the diagnosis and treatment on Black women; develop guidelines for oncology nurses and doctors to assist with the adaptation of these patients to the diagnosis and treatment; and provide information that could lead to better training of oncology personnel as well as develop a proper support system to facilitate adjustment of the mastectomised patient to the disease and its treatment. Data were collected using the qualitative and quantitative approaches with individual in-depth interviews forming the main strategy. The findings revealed that the diagnosis cancer of the breast was equated with death among all respondents. The mastectomy added more stress for the patient, which was further compounded by chemo- and radiotherapy. The latter was described as causing more pain than the tumour itself. Problems experienced by the patients were reported to include: financial difficulties; general weakness; fear of recurrence and metastasis; concern for dependent children and fear of unemployment. All respondents in this study expressed the need for the formation of a voluntary care group, which could assist them with adaptation to the disease and its treatment. / Advanced Nursing Sciences / D. Lit. et Phil. (Advanced Nursing Sciences)

A dor após o tratamento por câncer de mama é comum, pode ter várias causas, este sintoma caracteriza-se por redução funcional e emocional importante. Objetivo: Descrever a dor em mulheres com câncer de mama, identificar fatores de melhora e piora da dor, avaliar a interferência da dor na vida das mulheres, caracterizar e localizar a dor de mulheres submetidas ao tratamento por câncer de mama. Métodos: A amostra constituiu de 30 mulheres submetidas ao tratamento por câncer de mama, freqüentando um núcleo de reabilitação durante o período de fevereiro a agosto de 2008, e que responderam a um formulário acerca da doença, do tratamento e da dor. Foi aplicado o Inventário Breve de Dor (IBD) e o Questionário de McGill Br-MPQ e uma imagem para identificar o local o da dor. Resultados: A maioria das mulheres tinha idade superior a 50 anos, era casada, raça branca, católica, e do lar/dona de casa. Em relação ao tipo de cirurgia e a lateralidade observase uma distribuição equitativa entre mastectomia total e quadrantectomia, e lado direito e esquerdo, respectivamente. A maioria das mulheres realizou esvaziamento axilar, além de radioterapia e quimioterapia. A dor teve início após a cirurgia da mama em 46,7% das mulheres, com freqüência diária e constante, interferindo no humor e no sono das mulheres entrevistadas. Os movimentos relacionados ao aumento da dor foram alcançar, empurrar, apoiar e puxar. A maioria das mulheres relatou a prática de massagem para alívio da dor.. A dor após o tratamento por câncer de mama foi caracterizada como latejante, que irradia, que repuxa, chata, incômoda, que prende e deixa tensa. As alterações emocionais aumentaram a dor em (43,3%) das mulheres, o descansar/relaxar diminuiu a dor para metade e a maioria delas referiu suportar as dores. O local mais escolhido pelas mulheres para identificar a dor foram a região torácica superior e o braço entre linha do cotovelo e altura axilar na vista frontal da imagem. Conclusão: os dados apontam que a dor é um sintoma importante nas mulheres após o tratamento por câncer de mama, e esta deve ser valorizada por profissionais de saúde que as acompanham, são necessários mais estudos que possam elucidar questões como fatores osteomioarticulares e evolução do sintoma no pré e pós operatório. / Introduction: Pain after breast cancer treatment is common, may have several causes, this symptom is characterized by an important reduced functional and emotional . Objective: To describe the pain in women with breast cancer, identify factors of improvement and worsening of pain in the lives of women, identify and locate the pain of women undergoing treatment for breast câncer. Methods: The sample consisted of 30 women undergoing treatment for breast cancer, attending a rehabilitation center during the period February to August of 2008, and responding to a form of the disease, treatment and pain. The Brief Pain Inventory (IBD) and the McGill Questionnaire - MPQ-Br - were applied and an image to identify the location of the pain. Results: Most women were aged over 50 years, were married, white, Catholic, and housewife. Regarding the type of surgery and laterality there is an equitable distribution between total mastectomy and quadrantectomy, and right and left side, respectively. Most women held axillary dissection, and radiotherapy and chemotherapy. The pain began after the breast surgery in 46.7% of the women, daily frequency, and constantly, interfering with sleep and mood of the women interviewed. Movements related to increased pain were reaching, pushing, pulling and supporting. Most of the women reported the practice of massage for pain relief .. The pain after treatment for breast cancer was characterized as pulsatile, which radiates, boring, annoying, that sticks and leaves tense. Emotional changes in women increased (43.3%) the pain, resting / relaxing decreased the pain to half and most of them said they can bear pain. The place mostly chosen by women to identify the pain were the chest and upper arm between the elbow and line height in axillary front view of the image. Conclusion: Data suggest that pain is an important symptom in women after treatment for breast cancer, and it should be valued by health professionals who accompany them, are necessary further studies that may clarify issues as factors osteomioarticulares and development of the symptom the pre and post operatively.

Made available in DSpace on 2016-04-28T20:37:55Z (GMT). No. of bitstreams: 1 Rafaella Brito e Silva.pdf: 1626008 bytes, checksum: ca0cab06932ad47b9b99abbec0434255 (MD5) Previous issue date: 2011-10-24 / This thesis, which is the result of a personal and professional experience with dance, as well as of an interest in studies and iniciatives in the field of Psycho-oncology, consisted of a survey based on the theoretical framework of Gestalt therapy and was aimed to understand how mastectomized women experience belly dancing and how it affects the relation to theri own bodies. The relevance of this study is related to the need for expansion of therapeutic strategies focused on health promotion during the breast cancer post-treatment of mastectomized women. It comprises a qualitative research during which 8 sessions took place, 2 times a week for 1 hour and a half each, making use of the movements of belly dance. After each session, the participating women were requested to answer in writing the following questions: How have you experienced belly dancing? How did you feel? . At the outcome of the 8 sessions, a group interview was conducted to the end of discussing and learning the meaning of each woman s experience. The analysis and discussion were developed based on the participants reports, employing the phenomenological method and using theorists in Psychology and Oncology as references, as well as authors working in the dialogue between both domains. It was possible to identify a plethora of contributions of belly dance for the care of mastectomized women: dancing as an instrument of pleasure; the demystification of female identity attached to the breast only; music and movement as a means to be in touch with femininity and sensuality; the development of a more accurate body perception; and belly dancing as a facilitator in the process of reframing and discovering new ways of being and existing, in order to obtain from the participants a more active stance with regard to the ongoing difficulties. It can be concluded that belly dancing is a possible therapeutic approach in the rehabilitation of mastectomized women / Esta dissertação, fruto de uma experiência pessoal e profissional com dança e do interesse por estudos e ações na área da Psico-Oncologia, consistiu em uma pesquisa baseada no referencial teórico da Gestalt-Terapia e teve como objetivo compreender como mulheres mastectomizadas vivenciam a dança do ventre e quais os efeitos dessa vivência na sua relação com o corpo. A importância desse estudo está relacionada à necessidade de ampliação de estratégias terapêuticas voltadas para a promoção da saúde no pós-tratamento do câncer de mama de mulheres que foram mastectomizadas. Tratase de uma pesquisa qualitativa na qual foi realizada uma vivência de 8 sessões, 2 vezes por semana durante 1 hora e meia, com movimentos da dança do ventre. Após cada sessão, solicitou-se, que as colaboradoras respondessem, por escrito, a seguinte pergunta: Como você vivenciou a dança do ventre? O que você sentiu? Ao término da vivência, foi realizada uma entrevista em grupo com a finalidade de discutir e apreender o significado da experiência vivida por cada mulher. A análise e discussão foram feitas com base no discurso das colaboradoras, pautada no método fenomenológico, tendo, como referência, teóricos no âmbito da Psicologia e Oncologia, bem como autores que atuam na interlocução desses dois domínios. Foi possível identificar uma variedade de contribuições da dança do ventre para o cuidado da mulher mastectomizada: a dança como instrumento de prazer; a desmistificação da identidade feminina ligada apenas ao seio; a música e o movimento como facilitadores do contato com a feminilidade e sensualidade; o desenvolvimento de uma percepção corporal mais apurada; e a dança do ventre como facilitadora no processo de ressignificação e descobertas de novas possibilidades de ser e existir, de modo a obter-se uma postura mais ativa diante das dificuldades enfrentadas. Pode-se concluir que a dança do ventre é um possível recurso terapêutico na reabilitação de mulheres mastectomizadas

Made available in DSpace on 2016-04-04T18:27:16Z (GMT). No. of bitstreams: 1 ana claudia.pdf: 454849 bytes, checksum: 2ec7642700236761ec5d3bf8ff3aebc8 (MD5) Previous issue date: 2006-02-08 / Pontif?cia Universidade Cat?lica de Campinas / Cancer is a disease characterized by the loss of the control of the cellular division and by the capacity of these disorganized cells to invade others organic structures. In Brazilian women, the breast cancer is the type of cancer that causes more deaths, but if it is detected early, there are large chances of cure. Many times it is discovered late which leads to mutilation treatment to the woman, as surgical removal of one or both breasts, partially or completely (mastectomy) followed by chemotherapy and/or radiotherapy. Undergoing a mastectomy because of a chronic disease has a very complex connotation to the women because their symbol of femininity, seduction and maternity has been removed. The changes in these women lives are in the personal, familiar and professional field. Therefore, it is extremely important that researches are made, seeking to know about the behaviors that contribute to the promotion of the psychological well-being of these women. This research had for objective to accomplish a functional analysis of the women's behaviors after the mastectomy surgery. Were interviewed four women that went by the mastectomy, with ages varying among 34 and 49 years old, leaded by a mastologist. The interviews were recorded and completely transcribed. The women also maintained a written registration, during fifteen days, in which they specified the context, the actions, feelings and thoughts corresponding to the situation, as well as their consequences of the existences related to the cancer. Categories of behaviors were identified and analyzed in their functions. The categories more mentioned by that sample were: believes (faith and faith in God and behaviors optimists), received social and family support and reflections regarding the own life. For each category of behavior, a functional analysis was accomplished as well as some were given examples of the participants verbalizations that demonstrate the antecedents, the behaviors and the consequences of these. It was verified that having faith and believing in God were behaviors that evoke positive consequences that can contribute to face the cancer. Optimistic behaviors increase the occurrence probability of the adhesion behaviors to the treatment (as taking medications, to going to the doctor, for instance). In the participants verbalization, we can observe that the social and familiar support is considered extremely important to the women. The context which women with breast cancer are involved also provides reflections about their own lives, contributing to self-knowledge. The diagnosis of the cancer, its treatment and its consequences are considered antecedent stimulus that evoke the behaviors included by the mentioned categories. Those behaviors generate diversified consequences, as positive and negative reinforcement. With this procedure it was possible to know some variables that act in the post-mastectomy atmosphere, which contributes to the elaboration of analyticalbehavior intervention programs that could benefit women with breast cancer. / O c?ncer ? uma doen?a que se caracteriza pela perda do controle da divis?o celular e pela capacidade destas c?lulas desorganizadas invadirem outras estruturas org?nicas. Nas mulheres brasileiras, o c?ncer de mama ? o tipo de neoplasia que mais causa mortes, por?m se detectado precocemente, h? alta chances de cura. Muitas vezes, ele ? descoberto tardiamente, gerando tratamento mutilantes ? mulher, como a retirada parcial ou total da mama e a realiza??o da quimioterapia e/ou radioterapia. Extirpar a mama em decorr?ncia de uma enfermidade cr?nica possui uma conota??o extremamente complexa para a mulher, pois o s?mbolo de feminilidade, sedu??o e maternidade foi amputado. As mudan?as na vida desta mulher englobam as esferas pessoal, profissional e familiar. Assim, ? de extrema import?ncia que pesquisas sejam feitas, visando conhecer os comportamentos que contribuem com a promo??o do bem-estar psicol?gico. Para tanto, esta pesquisa teve por objetivo realizar uma an?lise funcional dos comportamentos de mulheres ap?s a cirurgia de mastectomia. Foram entrevistadas quatro mulheres que passaram pela mastectomia, com idades variando de 34 a 49 anos, encaminhadas por um mastologista. As entrevistas foram gravadas e transcritas em sua ?ntegra. As mulheres mantiveram tamb?m um registro escrito, durante quinze dias, em que especificaram o contexto, as a??es, sentimentos e pensamentos correspondentes ? situa??o, bem como suas conseq??ncias, das viv?ncias relacionadas ao c?ncer. Categorias de comportamentos foram identificadas e analisadas em suas fun??es. As categorias mais citadas por essa amostra foram: cren?as (m?sticas e otimistas), receber apoio social e familiar e busca pelo auto-conheimento. Para cada categoria de comportamento foi realizada uma an?lise funcional bem como foram dados alguns exemplos de verbaliza??es das participantes que demonstram os antecedentes, os comportamentos e as conseq??ncias destes. Verificou-se que acreditar em um ser superior que possa trazer a cura s?o comportamentos que desencadeiam conseq??ncias positivas que podem contribuir para o enfrentamento da enfermidade. Os comportamentos otimistas aumentam a probabilidade de ocorr?ncia dos comportamentos de ades?o ao tratamento (como tomar medica??es, ir ao m?dico, por exemplo). Nas verbaliza??es das participantes observa-se que o apoio social e familiar recebido ? considerado de extrema import?ncia no contexto vivenciado. O contexto ao qual encontram-se as mulheres com c?ncer de mama tamb?m proporcionaram reflex?es ? respeito da pr?pria vida, contribuindo com o autoconhecimento. O diagn?stico do c?ncer, seu tratamento e suas conseq??ncias s?o considerados est?mulos antecedentes, que evocam os comportamentos englobados pelas categorias citadas. Esses comportamentos, por sua vez, geram conseq??ncias diversificadas, como refor?o positivo e negativo. Desta maneira, com esse procedimento foi poss?vel conhecer algumas vari?veis que atuam no ambiente p?s-mastectomia, o que contribui para elabora??o de programas de interven??o anal?tico-comportamentais que poderiam beneficiar as mulheres acometidas por c?ncer de mama

INTRODUÇÃO: As necroses de retalhos da mastectomia (RM) afetam até um terço das mulheres submetidas à reconstrução imediata de suas mamas e aumentam o risco de outras complicações e, por fim, de falha da reconstrução. A glicemia capilar (GC) tem sido usada para monitorização clínica de mudanças agudas na perfusão tecidual de retalhos livres. Nós avaliamos a acurácia diagnóstica da GC para predição de necrose de espessura total (NET) em RM após mastectomia com reconstrução imediata. MÉTODOS: Duzentos e trinta amostras de sangue para mensuração de GC foram coletadas ao longo da ferida operatória de 30 mulheres submetidas à ressecção total de suas mamas. Uma amostra de sangue periférico para mensuração da GC periférica foi colhida em cada paciente. Fotografias da mama foram capturadas no final da cirurgia e no pós-operatório (entre 7 e 14 dias). Estas fotos foram comparadas por um investigador cego aos valores das GCs para determinar a ocorrência de necrose e em que pontos de coleta ela ocorreu. A associação entre GC e a ocorrência de NET foi testada usando modelos de equações de estimação generalizadas. Nós analisamos a acurácia diagnóstica da GC como um teste intraoperatório de predição de NET usando curvas de Característica de Operação do Receptor e a estatística C (ou área sob a Curva). RESULTADOS: NET ocorreu em 21/230 (9.1%) pontos de coleta aleatória de 9/30 pacientes (30%). Cada decréscimo de 10mg/dL no valor absoluto da GC (GCA) foi associada a uma razão de chance (RC) de 1.71 (1.21-2.41; p=.002) para NET e C=.78 (.65-.92). Cada queda em 10% da razão entre a GC e a GC periférica (GCr) foi associada com uma RC=1.77 (1.23-2.55; p=.002) para NET e C=.75 (.47-.89). Para pontos de corte de GCA < 90 mg/dL ou GCR < 80%, a especificidade e sensibilidade para o teste como uma ferramenta de rastreamento para NET foi de 67% (14/21) e 86% (179/209), respectivamente. CONCLUSÕES: A performance da GC como uma ferramenta de rastreamento para NET foi sub ótima, com um poder discriminatório moderado. No entanto, sua mensuração pode ser informativa como uma ferramenta adicional para esta avaliação ainda altamente subjetiva. As associações observadas entre a GC e a ocorrência de NET pós-operatória suportam nossa hipótese de que os tecidos dos RM sob stress perfusional demonstram alterações metabólicas precoces / INTRODUCTION: Mastectomy skin flap (MSF) necrosis affects up to one-third of patients undergoing immediate breast reconstruction and increases the risk other complications rand, ultimately, reconstruction failure. Interstitial glucose level (IGL) has been used clinically to monitor acute changes in local tissue perfusion in free flaps. We evaluated the accuracy of IGL for prediction of full thickness necrosis (FTN) in MSF after mastectomy with immediate breast reconstruction. METHODS: Two hundred and thirty random blood samples for IGL measurement along the surgical wound edges of 30 women undergoing unilateral total breast resection with immediate reconstruction were collected. At the same time, a peripheral blood sample was also tested. Pictures of the breast were taken after skin closure with markings identifying the position where the samples were taken and 7 to 14 days post-operatively. These pictures were compared by an investigator blinded to IGL values to determine the occurrence of FTN and at which IGL sampling sites it occurred. The association between IGL and the occurrence of FTN was tested using generalized estimating equation models. We analyzed the diagnostic accuracy of IGL as an intraoperative test for FTN with the use of Receiver Operating Curves and their C-statistics (or Area Under the Curve). RESULTS: FTN occurred in 21/230 (9.1%) random sampling points from 9/30 patients (30%). Each 10mg/dL decrease in absolute IGL (IGLA) was associated with an OR=1.71 (1.21-2.41; p=.002) for FTN and C=.78 (.65-.92). Each 10% decrease in the ratio of IGL to peripheral glucose level (IGLR) was associated with an OR=1.77 (1.23-2.55; p=.002) for FTN, with C=.75 (.47-.89). For cut-offs of IGLA < 90 mg/dL or IGLR < 80%, the specificity and sensitivity of the test as a screening tool for FTN were 67% (14/21) and 86% (179/209), respectively. CONCLUSIONS: The performance of IGL as a screening tool for FTN was suboptimal, with a moderate discriminative power for FTN. However, it can be informative as an additional tool to the still highly subjective intraoperative evaluation of MSFs. The observed association between IGL measurements and post-operative FTN supports our hypothesis that tissues of the MSF under perfusion stress will show early metabolic alterations

Estudo de abordagem qualitativa que fundamentou-se em referenciais socioculturais, tomados da antropologia e apoiu-se no interacionismo simbólico, com o objetivo de identificar se a mastectomia realizada num grupo de mulheres mexicanas com câncer de mama interferiu na sua qualidade de vida. Foram entrevistadas vinte mulheres que são assiatidas no Centro Estatal de Atenção Oncologica da cidade de Morelia, Michoacán no México, para seu tratamento e controle da enfermidade. Os dados coletados das entrevistas foram submetidos à análise de conteúdo e foi utilizada a técnica de análise temática. Assim, foram identificadas unidades temáticas que convergiram na auto-imagem, auto-estima e relacionamento conjugal, antes e após a mastectomia, com características positivas, que fornecem, e com características negativas, que debilitam a qualidade de vida nestes aspectos. Assim, antes da mastectomia elas sentiam-se satisfeitas com o próprio corpo e felizes por cumprirem os seus papéis sociais. O aspecto que diminuiu a qualidade de vida antes da mastectomia, caracterizou-se por uma desvalorização de suas identidades. Após a mastectomia, observaram-se aspectos positivos como a atitude de superação, a adoção da estratégia do autocuidado e a importância que elas dão ao suporte social. Os aspectos que influenciaram de forma negativa na qualidade da auto-imagem e auto-estima são descritos por elas como um processo de luto pela perda da mama, o isolamento e estigma a que foram submetidas, a desesperança vivida por elas, em muitas ocasiões e a incerteza de estarem livres da enfermidade. O relacionamento conjugal também apresenta características que fortalecem ou diminuem a qualidade de vida. Antes da mastectomia, esteve caracterizado pela minoria como uma atitude de aproximação social e sexual dos cônjuges. A maioria apontou aspectos negativos como o distanciamento social, emocional e sexual. Após a mastectomia o aspecto positivo caracterizou-se pela proximidade conjugal e pelo suporte social que favoreceram nas mulheres a sensação de alivio e bem-estar. O aspecto negativo definido por uma parcela considerável delas, foi a distância sexual,geradora de estresse pessoal e de muito sofrimento e pesar. / Qualitative approach study it is based in a social-cultural referentials, used in anthropological studies and supported on the Symbolic Interactionism. The objetive was to identify if a group of Mexican women mastectomized with breast cancer, were affected in their quality of life. Twenty women who assist to the Oncologyc Attention Center of Morelia, Michoacán, México, for the treatment and control of their disease were interviewed. The data obtained at the interviews was submitted for analysis of content and thematic analysis method was employed. Thus, thematic units that converge were identified in self-image, self-esteem and the conjugal relationship before and after the mastectomy, being observed with positive characteristics that strengthened and negative which debilitated the quality of life in these aspects. It was observed that before the mastectomy, they felt satisfied with their body and happy to fulfil their social roles. The aspect that diminished the quality of life before the mastectomy was characterized by a devaluation of their identity. After the mastectomy, positive aspects were observed such as: the attitude of overcoming, the adoption of the strategy of self-care, and the importance given for them to the social support. The aspects that influenced negatively in the quality of the self-image and self-esteem, were described by them as a process of mourning for the loss of the breast, the isolation and stigma to which they were submitted, the hopelessness experence by them in many occasions and the uncertainty to remain free of the disease. The conjugal relationship also presented characteristics that strengthened or debilitated the quality of life. Before the mastectomy, a minority characterized it as an attitude of social and sexual approximation to the partners; the majority had a trendency towards the negative aspects such as the social, emotional and sexual distance. After the mastectomy, the positive aspect was characterized by the conjugal proximity and the social support that favored in the women the sensation of relief and wellbeing. And the negative aspect, defined by considerable number of them, as the sexual distance that acts as generator of personal stress and much suffering and sorrow.

Bakgrund: Bröstcancer är en vanlig cancersjukdom hos kvinnor. Kvinnorna genomgår olika behandlingar varav en är mastektomi. Borttagandet av hela bröstet/brösten medför flera omställningar som påverkar kvinnligheten, sexualiteten och kroppen samt hela kvinnornas livsvärld. Sjuksköterskan har en uppgift att stötta kvinnor med bröstcancer genom diagnos och behandling i samband med omvårdnaden. Syfte: Syftet med den här litteraturöversikten var att belysa kvinnors upplevelser vid en mastektomi. Metod: Litteraturöversikt baserad på tio stycken kvalitativa artiklar som blev analyserade. Resultat: Kvinnorna upplevde att mastektomin påverkade deras sätt att se på sig själva. Mastektomin ledde till ett undvikande beteende och de hade svårt att acceptera den nya kroppen. Den förändrade kroppen påverkar kvinnorna i de intima relationerna samt i de sociala relationerna vilket resulterade i ett lidande. Kvinnorna upplevde att kroppen hade svikit dem och de hade svårt att både se och röra vid sig själva. Kvinnligheten förändrades och kvinnorna fick läras sig att acceptera sin nya förändrade kropp. Slutsats: Mastektomin påverkade mer än bara kvinnans kropp fysiskt, det påverkade även kvinnan psykiskt. Känslan av att vara kvinna förminskades då de blev mastektomerade. Kvinnans hela livsvärld påverkades i samband med mastektomin och resulterade i ett livslidande. / Background: Breast cancer is a common cancer among women. Women undergo several different treatments and mastectomy is one of them. The removal of the entire breast/breasts causes several changes which affect womanhood, sexuality and the body as well and the women´s entire world of being. The nurse has a task too support women with breast cancer through the diagnosis and treatments in connection with nursing. Aim: The aim of this literature study was to illuminate women´s experiences around a mastectomy. Methods: Literature review based on ten qualitative articles that were analyzed. Results: Women felt that mastectomy affected their way of looking at themselves. Mastectomy led to avoided behavior and they had a hard time accepting the new body. The changed body affected women in the intimate relations and in social relations which resulted in a suffering. The women felt that the body had failed them, and they had difficulties to both see and touch themselves. Femininity was changed and women had to learn to accept their new changed body. Conclusion: Mastectomy affected more than just the woman’s body physically, it also affected the woman mentally. The feeling of being a woman was reduced when they undergo mastectomy. The woman´s entire world of being was affected in connection with the mastectomy an resulted in lifelong suffering.