A reconstrução mamária visa melhorar a qualidade de vida e auto-estima da mulher após câncer de mama. Atualmente, existe uma baixa procura pela cirurgia, e poucos estudos apontam os fatores relacionados à não-realização do procedimento. Objetivo: Descrever os fatores relacionados à não-realização da reconstrução mamária e investigar a qualidade de vida e auto-estima de mulheres submetidas à cirurgia por câncer de mama. Métodos: A amostra constituiu de 53 mulheres submetidas à cirurgia por neoplasia mamária, freqüentando um núcleo de reabilitação durante o período de agosto a dezembro de 2006, e que responderam a um formulário acerca da doença, do tratamento e dos fatores relacionados à não-realização de reconstrução. Foi aplicado o instrumento The Medical Outcomes Study 36-item Short Form Health Survey - MOS-SF36 - e a Escala de Auto-estima de Rosemberg. Resultados: A maioria das mulheres tinha idade superior a 50 anos, era casada, raça branca, baixa escolaridade e baixa classe econômica. Houve predomínio da cirurgia de mastectomia, com tempo médio decorrido após a cirurgia de 5,8 anos. A maioria das mulheres realizou radioterapia e quimioterapia e algumas evoluíram com limitação na amplitude de movimento e nas tarefas domésticas, linfedema, dor, entre outras complicações. Em relação à cirurgia reconstrutiva, todas as mulheres já tinham ouvido falar, mas nem todas foram orientadas pela equipe médica sobre essa possibilidade no momento da retirada do tumor. Os profissionais de saúde representaram a fonte de informação mais relatada pelas mulheres a respeito da cirurgia reconstrutiva, e foram também os sujeitos com os quais elas menos discutiram sobre o assunto. A maioria das mulheres conhecia o seu direito de realizar reconstrução pelo Sistema Único de Saúde e relatou que a cirurgia é de longa duração, envolve muitas etapas e pode ocorrer rejeição da prótese. A maior parte das entrevistadas relatou medo em realizar a cirurgia, por sofrimento e complicações após a técnica, e acrescentou que não faria a reconstrução, apesar de achar que estava na idade ideal e usar prótese externa. Houve predomínio de mulheres sem vida sexual ativa e satisfeitas com a auto-imagem. A maioria afirmou ter liberdade em usar qualquer tipo de roupa e relatou que se sente bem ao estar com roupa, com biquíni/maiô e sem roupa. Sobre a rede de suporte, houve mudanças positivas no relacionamento familiar e com o companheiro após a cirurgia por câncer de mama. A avaliação da qualidade de vida através do MOS-SF36 revelou menor escore para o domínio \"dor\", \"aspectos físicos\", \"vitalidade\", \"saúde mental\" e \"capacidade funcional\". O questionário de Auto-estima de Rosemberg obteve valor médio de 34,4 pontos. Conclusão: Os dados apontam adaptação das mulheres em face das conseqüências do tratamento de câncer de mama, não priorizando a realização de reconstrução mamária. / The goal of breast reconstruction is to improve woman\'s quality of life and self-esteem after breast cancer. Nowadays, there are fewer women that underwent this surgery, and few studies had investigated the reason why woman do not choose this procedure. Objective: Describe the factors involved to not having breast reconstruction and to investigate the woman\'s quality of life and self-esteem after breast cancer surgery. Methods: A sample of 53 women that underwent breast cancer surgery, taking part of a rehabilitation center during the period of august until december 2006, answered a questionnaire that included information about the disease, treatment and questions about why they did not have breast reconstruction. The Medical Outcomes Study 36-item Sort Form Health Survey - MOS-SF36 - and Rosemberg Self-Esteem Scale was administered. Results: The majority of the women was 50 years or older, married, white, low educational level and low economic status. Most woman underwent mastectomy and the average time since surgery was 5.8 years. The majority of the women received radiotherapy and chemotherapy and some of them had limitation of the movements and home activities, lymphedema, pain and others complications. About breast reconstruction surgery, all women had heard about it, but not all of them received information from their physicians about this possibility before breast surgery. Health professionals were related to be the more main source of information by woman and this was also the group that they had less discussion with. Most women knew about their right of having breast reconstruction by the public health care system, but claimed that the surgery is long, that multiple surgeries are needed and that the prosthesis can be rejected by their bodies. The majority of the women revealed fear of complications associated with the reconstruction and said that they would have not done the surgery, although they feel they are in a correct age and use external prosthesis. Most women did not have active sexual life and were satisfied with their body image. Most of them expressed freedom to wear any clothing and feel comfortable when fully dressed, with swim cloths or naked. About support groups, there were positive changes in the relationship with family and partner after breast cancer surgery. The MOS-SF36 showed lowest score to \"bodily pain\", \"role-physical\", \"vitality\", \"mental health\" and \"physical functioning\". Rosemberg Self-Esteem Scale received 34.4 average score. Conclusions: This study suggests woman\'s adaptation to the consequences of breast cancer treatment, not giving importance to breast reconstruction.

Orientador: Luis Otavio Sarian / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:44:28Z (GMT). No. of bitstreams: 1 Oliveira_RizaRutede_M.pdf: 1469028 bytes, checksum: 069aeedc965f94a1834d29ea6f0baa77 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Determinar a associação entre reconstrução mamária imediata após mastectomia radical com a recuperação da amplitude de movimento (ADM) do ombro. Sujeitos e Métodos: Estudo prospectivo do qual participaram 89 mulheres submetidas à mastectomia radical modificada (MRM), 42 destas com reconstrução mamária imediata (MRM+RI). Foram realizadas avaliações pósoperatórias semanais da amplitude de movimento do ombro no transcurso da fisioterapia (4 semanas). Os resultados da amplitude de abdução e flexão do ombro, em graus, do membro superior ipsilateral à cirurgia foram comparados nos grupos em função das variáveis independentes e de controle. Foi aplicado modelo de regressão logística para comparação das características clínicas e epidemiológicas das mulheres nos dois grupos. Foram então calculados médias e desvios-padrão dos valores de flexão e abdução do ombro em função das características clínicas e epidemiológicas. As médias destes valores foram comparadas em modelo multivariado de análise de co-variância. Foram produzidos gráficos de interação levando em consideração o grupo (com ou sem reconstrução) e os valores médios da variação em graus de flexão e abdução nas quatro avaliações. Foi então realizada análise multivariada de variância para medidas repetidas para avaliação dos efeitos do grupo (com ou sem reconstrução) e do tempo na recuperação da ADM de abdução e flexão. Resultados: A maior parte (78%) das reconstruções foi realizada com a técnica de transposição do músculo grande dorsal com inserção de prótese siliconada. A realização de reconstrução mamária imediata não esteve relacionada com maior déficit de flexão ou abdução em qualquer dos momentos estudados. Tabagismo e presença um ou mais cordões linfáticos axilares apresentaram maiores déficits de flexão ao final da série de avaliações (p=0,01, p=0,03, respectivamente). Mulheres com um ou mais cordões linfáticos axilares apresentaram maior déficit de abdução no final da seqüência de avaliações (p=0,03). Houve relação significativamente positiva entre o tempo de pós-operatório e a recuperação da ADM de abdução (p<0,01) e flexão (p<0,01). Mulheres submetidas ou não à reconstrução imediata não diferiram em relação ao tempo e à recuperação da abdução (p=0,85) e flexão (p=0,74). Conclusões: A reconstrução mamária imediata não esteve relacionada com o tempo e com a recuperação da ADM de flexão ou abdução do ombro. Tabagismo e presença de um ou mais cordões linfáticos axilares estiveram negativamente relacionados com o processo de recuperação da flexão ou da abdução do ombro ipsilateral à cirurgia. / Abstract: Objective: To assess the implications of immediate breast reconstruction following radical mastectomy on shoulder range of motion (ROM). Subjects and methods: This was a prospective study on 89 women that underwent modified radical mastectomy (RM), 42 of whom with immediate breast reconstruction (RM+IBR). Postoperative weekly assessments of shoulder ROM were performed for 4 weeks. Flexion and abduction ranges of motion of the shoulder ipsilateral to the affected breast were compared between the study groups. A multivariate logistic regression model was fit to compare the clinical and epidemiological characteristics of the women between the study groups. A multivariate co-variance model was produced to evaluate whether the flexion and abduction capacities were related to the clinical and epidemiological characteristics of the women. Interaction graphics were produced in order to graphically assess whether the recovery of the flexion and abduction capacities was different between the study groups. Finally, a multivariate analysis of variance for repeated measurements was performed in order to assess the group (with or without IBR) and time effects on the recovery of shoulder ROM. Results: Most (78%) of the reconstructive procedures were performed according to the Latissimus Dorsi Flap technique with silicone-gel implant. IBR was not related to the deficit in flexion or abduction of the shoulder at any of the study weekly assessments. Smoking behavior and presence of painful axillary cords were related to a higher deficit in shoulder abduction and flexion (P<0.01). IBR was not related to the time and intensity of the recovery of shoulder abduction (p=0.85) and flexion (p=0.74). Conclusions: IBR was not related to the flexion or abduction capacity of the shoulder. Smoking and the presence of painful axillary cords were negatively associated with the recovery of shoulder ROM after mastectomy. / Mestrado / Mestre em Tocoginecologia

Orientadores: Aarão Mendes Pinto Neto, Francesca de Lorenzi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T17:05:20Z (GMT). No. of bitstreams: 1 Brenelli_FabricioPalermo_D.pdf: 1363886 bytes, checksum: e8aa4780193d755f30345cbcea9c2b50 (MD5) Previous issue date: 2012 / Resumo: Introdução: O enxerto autólogo de gordura é uma importante técnica para corrigir as sequelas da cirúrgia conservadora (CCM) no câncer de mama. Apesar de este método estar ganhando popularidade, muito pouco se sabe sobre a interação entre o enxerto de gordura e o ambiente oncológico no qual é enxertado. Existem evidências sobre a segurança do método em pacientes com mamas saudáveis e em mamas reconstruídas pós-mastectomia radical. Entretanto, existe muito pouca informação sobre este procedimento em pacientes com antecedente de CCM, as quais estão sob um risco maior de recidiva local (RL) se comparado aos outros grupos estudados. Além disso, uma vez que a gordura é enxertada na mama, alterações radiológicas podem ocorrer no rastreamento destas pacientes, podendo provocar um aumento no número de biópsia desnecessárias ou até mesmo mascarar possíveis lesões, retardando o diagnóstico de uma possível RL Material e Métodos: Cinquenta e nove pacientes com antecedente de CCM foram submetidas a 75 procedimentos de enxerto autólogo de gordura, segundo a técnica de Coleman entre Outubro de 2005 e Julho de 2008. Todas pacientes assinaram um consentimento informado e foram tratadas na mesma instituição. Exame clínico e radiológico das mamas foi efetuado em todos os casos antes do procedimento e pelo menos uma vez após seis meses do procedimento. A análise de dados foi realizada através de médias e medianas e a curva de progressão livre de doença foi estimada pelo método Kaplan-Meyer com nível de significância de 5%. Resultados: A média de idade das pacientes foi de 50 anos (DP: 8.5) e o seguimento médio foi de 34.4 meses (DP: 15.3). O tempo médio entre a cirurgia oncológica e o enxerto autólogo de gordura foi de 76.6 meses (DP: 30.9). A maior parte das mulheres tinha estádios iniciais de câncer de mama: 0 (11,8%); I (33,8%) e IIA (23,7%). Complicação imediata foi observada em 3 casos e igualmente, em apenas 3 casos foram observadas RL. Achados radiológicos anormais na mama forma observados em 20% das mamografias pós enxertia (15 casos) e em 6 casos tais achados foram considerados suspeitos e biopsiados, resultando em 2 casos positivos. Conclusão: O enxerto autólogo de gordura parece ser uma ferramenta segura para corrigir sequelas da CCM em casos bem selecionados, e não está relacionado com aumento de RL além do esperado para o grupo de pacientes estudado. Apesar de estar relacionado com um aumento de achados mamográficos anormais, estes são de fácil caracterização entre benignos e suspeitos, não atrapalhando o seguimento destas pacientes / Abstract: Background: Autologous fat graft to the breast is a useful tool to correct defects after breast conservative treatment (BCT). Although this procedure gains popularity, little is known about the interaction between the fat graft and the prior oncological environment. Evidences of safety of this procedure in healthy breast and after postmastectomy reconstruction exist. However, there is paucity of data among patients who underwent BCT which are hypothetically under a higher risk of local recurrence (LR). Moreover, since fat is injected in the breast, this technique can potentially produce radiological features that could increase numbers of unnecessary biopsies or even mask suspicious hidden lesions. Material and Methods: Fifty nine patients, with prior BCT, underwent 75 autologous fat graft procedures using the Coleman's technique, between October 2005 and July 2008. All patients signed an informed consent and were treated at the same institution. Radiological and clinical examination was performed in all cases prior of the procedure. Follow up was made by clinical and radiological examination at least once, after 6 months of the procedure. Statistical analysis was performed by means and medians and progression free survival was estimated by the Kaplan-Meyer method with significance level of 5%. Results: Mean age was 50±8.5 years and mean follow up was 34.4 ±15.3 months. Mean time from oncological surgery to the first fat grafting procedure was 76.6± 30.9 months. Most of patients were at initial stage 0 (11,8%), I (33,8%) or IIA (23,7%). Immediate complication was observed in 3 cases and LR was observed in only 3 cases of true LR. Abnormal breast images were present in 20% of the post-operative mammograms (15 cases) and in six cases biopsy was warranted resulting positive for LR in two cases. Conclusion: Autologous fat graft seems to be a safe tool to correct defects after BCT without increasing the expected rates of LR, in low risk and selected cases. Although it increases the rate of abnormal mammographic findings, those are easily distinguished between benign and suspicious lesion by a trained radiologist and do not interfere with the patient's follow up / Doutorado / Oncologia Ginecológica e Mamária / Doutor em Tocoginecologia

M.A. / Many women who live with body disfigurement as a consequence of illness, continue to suffer from body perceptual disturbances many years following their recovery. Problematic however, is the tendency of disease-specific studies investigating body perceptual disturbances to focus on illness associated body changes. Consequently, this silences the experiences of many women who live with body disfigurement in the absence of illness and more specifically, in instances where body disfigurement is the result of having suffered a common ailment (Francis, 2002; Newell, 2000). Impeding the concerns raised are inferences of earlier studies such as that by Patterson and Craig (1963) who reason that, by virtue of the body's integrity being dependent upon external appearances, hysterectomy, as something internal to the body, fails to feature as a psychological difficulty experienced in women who have this. Recent studies by Newell (2000) and Francis (2002) identify a need for research on body disfigurement following a common ailment and in the absence of illness. In an attempt to address some of the concerns raised, and in keeping with body disfigurement resulting from a common ailment (e.g. cancer, dysmenorrhoea and uterine fibroids, etc), this study compares levels of depression and self-concept in women who have undergone either mastectomy, hysterectomy or vulvectomy. Additionally, this study challenged the inferences by Patterson and Craig (1963) in that the onset of psychopathology in these women is here thought to develop irrespective of the levels of disfigurement visibility (whether disfigurement is internal to the body as in hysterectomy or external to the body as in mastectomy and vulvectomy). In terms of the three areas of participation, of the hysterectomy group (n = 16), of the mastectomy group (n = 8), and of the vulvectomy group (n = 4). Additionally, only participants who had not undergone reconstructive surgery were selected. To investigate for self-concept and body perceptual disturbances, data was collected using the Beck Depression Inventory II, the Self-Description Questionnaire III, the Six Factor Self-Concept Scale and also from open-ended questions posited in a Biographical Questionnaire. The Mann-Whitney, Kruskal-Wallis and Wilcoxon Signed Ranks tests were utilised as nonparametric statistics of choice in the data analyses. The results showed seven areas of significant group differences as this pertains to: levels of depression, physical appearance, spiritual/religious values, general esteem, opposite sex peer relations, parent relations and power. Most striking was the participant responses made in respect to the Importance versus Accuracy subsection of the SDQ-III. Of the 12 statements contained under this section, all were considered to be more important to the participants than the statement was thought accurate of them. Significant differences on this subsection were observed in terms of: parent relations, spiritual/religious values, emotional stability and physical appearance. Although investigating depression and self-concept in women with body disfigurement in South Africa proved to be a complex and difficult research undertaking, the results of this study clearly strengthen its implementation value and demonstrate the need for future research in this area. This pilot study enabled for invaluable insight to be gleaned in terms of the thoughts, feelings and struggles of these women. Similarly the study provided for a method of pre-testing and fine-tuning prior to Phase Two. Additionally, the results of this study contribute to the sparse volume of literature on body disfigurement in the absence of illness. This complex, yet emotionally charged and dynamic terrain is fraught with a magnitude of possibilities for future research and of which can take an infinite number of directions. Altered body appearance and function can invariably result in highly complex psychological and psychosocial disturbances. Francis (2002) echoes what this study commits to when she says: "… when the process of knowing is fractured in a sudden catastrophe, when knowing of the external surfaces of the familiar body is interrupted, the sense of being at home in ones body becomes problematic" (p. 108). As such, this study embraces the possibility that many women in South Africa, who live with body disfigurement in the absence of illness, continue to suffer disturbances in body perception years later and that this is so despite being illness free and irrespective of visibility levels. The study's demonstration of this in real-life intervention serves to highlight this. Similarly, in that 92.3% of participants felt the need to join group therapy or formulate support groups for disfigured individuals as a means by which to voice and better come to terms with past and current traumatic experiences encountered as a result of living with altered body appearance and function, the need for future research in body disfigurement in the absence of illness, is strengthened. It is hoped that, albeit in some small way, this study adds volume to the silenced experience of these women. Similarly, this study hopes to provide a foundation from which many silenced experiences can be voiced.

The objective of this study was to evaluate the cardiovascular effects and compare the analgesic efficacy intraoperative and postoperative provided by methadone administered via epidural (EP) or intramuscular (IM) in bitches submitted to total unilateral mastectomy surgery. For this it was used 12 female dogs anesthetized and randomly distributed into two groups of six animals each. In the first group the methadone was administered via epidural, after anesthetic stabilization (GEP) and another group, methadone was administered via intramuscular in the pre-anesthetic medication (GIM). In the first part of the study evaluated heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), carbon dioxide released at the end of expiration (ETCO 2) and arterial blood gas analysis. Both FC when FR and blood gas analysis did not show significant changes. The GIM had higher values in all pressure ratings (DAP, MAP and SAP), but within the parameters for the species. The GIM had higher values in all pressure ratings (DAP, MAP and SAP), but within the range for the species. Both routes of administration showed little change in the evaluated parameters, however the epidural demonstrated greater anesthetic and analgesic stability for this procedure. In the second part of the study, the postoperative analgesia was measured by pain scales at the University of Melbourn, Visual Analogue Scale (VAS) and Glasgow Simplified Composed Measure pain scale. It also evaluated serum concentration of cortisol, lactate and glucose. Difference was observed between the groups only in the T6 Melbourn scale and analgesic rescue at T2 to the animals of the GIM. Cortisol presented a significant enhancement in the first hour in both groups and the remaining analyzes did not demonstrate differences. The administration of methadone epidural provided higher postoperative analgesia period that intramuscular administration showing to be the best option for this procedure. For both steps, the mean scores were submitted to statistical analysis by Kruskal-Wallis test to the groups between the different moments and Wilcoxon to compare the groups within each time. The Scott-Knott post-test was used for comparison in pairs at 5% significance level. After observing of the study in its two steps can be concluded that both methadone administered via epidural as intramuscular are secure in the perioperative period because does not cause significant changes in the physiological parameters. However the epidural proved to have a more efficient analgesia during surgery and post-operative period, in which we observed a greater analgesia period which makes it a safe and the best route for satisfactory analgesia in the procedure and in the studied species. / O objetivo do presente estudo foi avaliar os efeitos cardiovasculares e comparar a eficácia analgésica transoperatória e pós-operatória proporcionada pela metadona administrada pela via epidural (EP) ou pela via intramuscular (IM) em cadelas submetidas à cirurgia de mastectomia unilateral total. Para tanto foram utilizadas 12 cadelas anestesiadas e distribuídas aleatoriamente em dois grupos compostos de seis animais cada. Em um grupo foi administrado metadona via epidural após estabilização anestésica (GEP) e em outro grupo a metadona foi administrada via intramuscular na medicação pré-anestésica (GIM). Na primeira parte do estudo foram avaliados frequência cardíaca (FC), frequência respiratória (f), pressão arterial sistólica (PAS), pressão arterial média (PAM), pressão arterial diastólica (PAD), tensão de dióxido de carbono ao final da expiração (ETCO2) e hemogasometria do sangue arterial. Tanto a FC, quanto f e hemogasometria não apresentaram alterações significativas. O GIM apresentou valores mais altos em todas as avaliações das pressões (PAD, PAM e PAS), porém dentro dos parâmetros para a espécie. As duas vias de administração demonstraram poucas alterações nos parâmetros avaliados, entretanto a via epidural demonstrou maior estabilidade anestésica e analgésica para esse procedimento. Na segunda parte do estudo, a analgesia pós-operatória foi avaliada pelas escalas de dor da Universidade de Melbourn, Escala Visual Analógica (EVA) e escala de dor de Medida Composta de Glasgow Simplificada. Avaliou-se também concentração sérica de cortisol, lactato sérico e glicemia. Foi observada diferença entre os grupos somente no T6 pela escala de Melbourn, e resgate analgésico no T2 para os animais do GIM. O Cortisol apresentou aumento significativo na primeira hora de avaliação em ambos os grupos e as demais análises não demonstraram diferenças. A administração de metadona via epidural proporcionou maior período de analgesia pós-operatória que a administração intramuscular sendo a melhor opção para esse procedimento. Para ambas as etapas as médias dos escores foram submetidas a análise estatística pelos testes Kruskall-Wallis para os grupos entre os diferentes momentos e Wilcoxon para comparar os grupos dentro de cada tempo. O pós-teste de Scott-Knott foi utilizado para comparação aos pares ao nível de 5% de significância. Após a observação do estudo em suas duas etapas pode-se concluir que tanto a metadona administrada pela via epidural quanto a via intramuscular são seguras no período transoperatório por não causar alterações significativas nos parâmetros fisiológicos estudados, entretanto a via epidural se mostrou mais eficiente em relação a analgesia tanto nesse período quanto no período pós-operatório, onde foi possível observar um maior período analgésico, tornando-a uma via segura para no procedimento e espécie estudados.

SAMMANFATTNING  Bakgrund: Bröstcancer är idag den vanligaste formen av cancer hos kvinnor och även den cancerform som är mest studerad. Att drabbas av bröstcancer genererar i ett lidande trots att sannolikheten för att överleva efter att ha diagnostiserats med bröstcancer har ökat. Kirurgi är den primära behandlingen vid bröstcancer vilket ökar behovet att vidare studera hur detta påverkar livskvaliteten samt hur det kan påverka kroppsuppfattningen. Förändringar av kroppsuppfattningen och livskvalitet i relation till sexualitet skapar lidande, därav behöver vård- och omsorgspersonal ha kunskap kring detta då lidandet är motivet till all vård. Syfte: Syftet med denna studie är att undersöka hur kvinnor med bröstcancer som genomgått en mastektomi upplever sin kroppsuppfattning och livskvalitet i relation till sexualitet. Metod: Deskriptiv litteraturstudie av vetenskapliga artiklar med kvalitativ ansats. Resultat: Mastektomi tenderar att ha inverkan på kvinnors kroppsuppfattning och livskvalitet i relation till sexualitet. De mest framträdande resultaten var att ärrbildningen och att samhällets normer hade en påverkan på kvinnors kroppsuppfattning samt att den feminina identiteten rubbades vid förlusten av bröstet. Vidare påvisar denna studie en negativ förändring av kvinnors livskvalitet i relation till sexualitet på grund av den förändrade kroppsuppfattningen.  Slutsats: Kroppsuppfattningen och livskvaliteten i relation till sexualitet påverkades negativt till följd av mastektomi. / ABSTRACT Background: Breast cancer is today the most common form of cancer in women and also the most studied form of cancer. Breast cancer generates in a suffering even though the probability of surviving after being diagnosed with breast cancer has increased. Surgery is the primary treatment for breast cancer, which increases the need to further study how this affects the quality of life and how it can affect body perception. Changes in body perception and quality of life in relation to sexuality create suffering, hence care and nursing staff need to have knowledge about this as suffering is the motive for all care. Aim: The purpose of this study is to investigate how women with breast cancer who have undergone a mastectomy experience their body perception and quality of life in relation to sexuality. Method: Descriptive literature study of scientific articles with a qualitative approach. Results: Mastectomy tends to have an impact on women's body image and quality of life in relation to sexuality. The most prominent results were that scarring and societal norms had an impact on women's body image and that the feminine identity was disturbed in the loss of the breast. Furthermore, this study shows a negative change in women's quality of life in relation to sexuality due to the changed body perception. Conclusion: Body perception and quality of life in relation to sexuality were negatively affected because of mastectomy.

Bakgrund: Den vanligaste behandlingen för bröstcancer är mastektomi som innebär kirurgiskt avlägsnande av bröstvävnad där hela eller delar av bröstet tas bort vilket kan ha en påverkan på kvinnans hälsa och välmående. Syfte: Syftet var att beskriva kvinnors upplevelser efter mastektomi i samband med bröstcancer. Metod: Utfördes som en allmän litteraturstudie med induktiv ansats. Nio artiklar med både kvalitativ och kvantitativ metod har använts i resultatet och granskats för att uppnå en hög vetenskaplig kvalité. Resultat: Resultatet utföll till fem huvudkategorier: kvinnlighet och kroppsförändring, överlevnaden segrar över förlusten, förändrade relationer, informationens betydelse och strategier. Resultatet visade att kvinnorna upplevde att skönheten och kvinnligheten påverkades efter mastektomin. Kvinnorna hade behov av information och stöd och försökte utveckla strategier för att hantera situationen. Kvinnorna upplevde även att relationen till partnern kunde påverkas. Konklusion: Kvinnornas fysiska och psykiska hälsa påverkas efter mastektomi. Genom stöd av närstående och vårdpersonal genererade det i en snabbare återhämtning. Information av vårdpersonal krävs för att kvinnorna ska kunna förbereda och hantera förlusten bättre. / Background: The most common treatment of breastcancer is mastectomy, which involves surgical removal of breast tissue where all or part of the breast is removed, which can have an inpact on women´s health. Aim: The aim was to describe women´s experiences after mastectomy in conjunction with breast cancer. Method: General literature review with inductive approach was used. Nine articles with both qualitative and quantitative approaches have been examined and analysed in the result and review a high scientific quality. Result: The results are presented in five maincategories: femininity and body change, survival triumphs over loss, changed relationships, the importance of information and strategies. The results showed that the women experienced that the beauty and femininity disappeared after the mastectomy. The women were in need of information and support and tried to develop strategies to deal with the situation. The women also experienced that the relationship with the partner could be affected. Conclusion: Women's physical and mental health are affected after mastectomy. Through the support of relatives and healthcare professionals generated that in a faster recovery. Information from healthcare professionals is required for women to be able to better prepare and manage the loss.

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor. I vissa fall måste kvinnan ta bort delar av, hela eller båda brösten, en så kallad mastektomi. Förlora bröstet är både psykiskt och fysiskt svårt och livskvaliteten påverkas. Kvinnan kan välja att genomgå en bröstrekonstruktion. Syfte: Syftet var att belysa kvinnors erfarenheter i samband med bröstrekonstruktion efter mastektomi. Metod: En allmän litteraturstudie genomfördes med nio vetenskapliga artiklar med kvalitativ ansats och sammanställdes med innehållsanalys. Resultat: För att belysa kvinnornas erfarenheter presenteras resultatet genom tre teman: erfarenheter att få information och stöd, förändrad kroppsuppfattning, förväntningar och fysisk återhämtning och slutligen livskvalitet och att bli hel igen. I resultatet framkom det hur viktigt det var för kvinnorna att få en relation till kontaktsjuksköterskan. Med denna kontakt kunde kvinnan känna trygghet och ta till sig information och göra sina val utan oro. Behovet av stödgrupp för kvinnorna under återhämtningsprocessen framkom. Kvinnors kroppsuppfattning förändrades. Slutsats: En bröstrekonstruktion gav kvinnor deras livslust tillbaka och kunde se ljust på framtiden med en hel kropp. Det är därför av stor vikt att sjuksköterskan förstår kvinnorna och deras erfarenheter av hur det är att genomgå en bröstrekonstruktion så att de kan erbjuda stöd och ge omvårdnad under hela processen. / Background: Breast cancer is the most common cancer that affects women. In some cases, woman must remove parts of or both breasts, a so-called mastectomy. Losing breasts is both mentally and physically difficult and quality of life is affected and may choose to undergo breast reconstruction. Aim: The aim was to illustrate women's experiences in connection with breast reconstruction after mastectomy. Method: A general literature study was conducted with nine scientific articles with qualitative approach and analyzed with content analysis. Result: To illustrate women's experiences, result is presented through three themes: experiences of gaining information and support, changing body image, expectations and physical recovery, and quality of life and becoming whole again. Results showed the importance to have a contact nurse. With this contact, she felt secure and absorbed information and made choices without worry. The need for a support group for women during the recovery process emerged, body perception changed. Conclusion: Breast reconstruction gave their life back and felt whole again. It is therefore of great importance that nurse´s understand their experiences of how it feels to undergo a breast reconstruction so that they can offer support and provide care throughout the process.

Bakgrund:Bröstcancer är den vanligaste cancerformen hos kvinnor globalt. Ett behandlingsalternativ för bröstcancer är mastektomi, vilket innebär att delar alternativt hela det drabbade bröstet opereras bort. Behandlingen medför förändringar i kvinnornas liv. Författarna vill med denna litteraturöversikt skapa en ökad förståelse för denna patientgrupps upplevelser. Syfte: Syftet med litteraturöversikten var att beskriva kvinnors upplevelser efter mastektomi vid bröstcancer.  Metod: En litteraturöversikt gjordes med tio vetenskapliga artiklar hämtade från tre databaser: CINAHL Complete, MEDLINE och PsycINFO. Åtta artiklar var kvalitativa och två artiklar var kvantitativa. Det insamlade datamaterialet tematiserades enligt en beskrivning av Friberg. Ur analysen framträdde tre teman. Resultat: Resultatet presenteras i tre teman: En förändrad kroppsbild och identitet, sexualitet och relationer samt stöd. Resultatet visade att upplevelsen efter mastektomin var emotionellt påfrestande och att detta hade en varaktig påverkan på flera domäner i kvinnornas liv.  Diskussion: Författarna diskuterade kvinnornas upplevelser efter mastektomin och hur upplevelserna kan förstås utifrån Katie Erikssons teori om hälsa, vårdande och lidande. Författarna har använt sig av egna reflektioner samt aktuell forskning för att styrka fynden i resultatet. / Background: Breast cancer is the most commonly occurring cancer in women worldwide. A treatment alternative for breast cancer is mastectomy, which means surgical removal of one breast, partially or completely. The treatment entails both physical and mental changes in women's lives. With this literature review, the authors want to create an increased understanding of the experiences of this patient group. Aim: The purpose of the literature review was to describe women's experiences after mastectomy related to breast cancer. Method: A literature review was performed with ten scientific articles identified via three databases: CINAHL Complete, MEDLINE and PsycINFO. Eight of the articles were qualitative and two were quantitative. The collected data was thematized according to a description presented by Friberg. Three themes emerged from the analysis. Results: The results are presented in three themes: A changed body image and identity, sexuality and relationships and support. The result showed that the experience after the mastectomy was emotionally stressful and that this had a lasting impact on several domains in the women's lives. Discussion: The authors discussed the women's experiences after the mastectomy and how the experiences can be understood based on Katie Eriksson's theory of health, care and suffering. The authors have used their own reflections as well as current research to substantiate the findings in the results.

Orientador: Batista de Oliveira Júnior / Resumo: O presente estudo buscou avaliar e comparar o impacto emocional do diagnóstico de câncer de mama e da mastectomia em pacientes de diferentes faixas etárias. Participaram do estudo 58 pacientes, provenientes do Hospital Amaral Carvalho, com diagnóstico de câncer de mama e proposta de mastectomia (simples ou radical). Elas foram convidadas a participarem do estudo e, as que concordaram, responderam individualmente aos instrumentos: 1) Ficha de identificação e caracterização sóciodemográfica; 2) Entrevista semi-estruturada para identificação dos aspectos emocionais; 3) Escala de auto-estima de Rosemberg e; 4) Escala hospitalar de ansiedade e depressão. A amostra foi dividida em três grupos: grupo 1 – de 24 à 49 anos, grupo 2 - de 50 à 64 anos e grupo 3 – de 65 à 85 anos. Todas as discussões dos resultados analíticos foram realizadas no nível de 5% de significância. A análise dos dados demonstrou que não houve associação das respostas aos questionários com a idade e, no caso da ansiedade e depressão, houve predomínio do improvável nos três grupos. Concluiu-se que não houve diferenças significativas entre os três grupos etários, por isso, não foi possível provar que a idade é um fator que predispõe um melhor ou pior enfrentamento do adoecimento e da mastectomia. Entretanto, foi possível observar que as pacientes que apresentaram os menores níveis de aceitação da mastectomia, são as que atribuem às mamas o significado estético e ou sexual .As pacientes do grupo jovem foram as que s... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The present study aimed to evaluate and compare the emotional impact of the diagnosis of breast cancer and mastectomy in patients of different age groups. 58 patients from the Amaral Carvalho Hospital, with breast cancer diagnosis and a mastectomy proposal (simple or radical) participated in the study. They were invited to participate in the study and, those who agreed, answered individually to the instruments: 1) Identification card and sociodemographic characterization; 2) Semi-structured interview to identify the emotional aspects; 3) Rosenberg's self-esteem scale and; 4) Hospital anxiety and depression scale. The sample was divided into three groups: group 1 - from 24 to 49 years, group 2 - from 50 to 64 years and group 3 - from 65 to 85 years. All discussions of the analytical results were performed at the 5% level of significance. Data analysis showed that there was no association of the responses to the questionnaires with age and, in the case of anxiety and depression, there was a predominance of the unlikely in all three groups. It was concluded that there were no significant differences among the three age groups, so it was not possible to prove that age is a factor that predisposes a better or worse coping of the disease and mastectomy. However, it was possible to observe that the patients who presented the lowest levels of acceptance of the mastectomy, are the ones that attribute to the breasts the esthetic and / or sexual meaning. The patients in the young group ... (Complete abstract click electronic access below) / Mestre