Edward A. Rose, M.D.
Coping strategies used by women with breast cancer are vital for adjustment to their disease. Coping ability can be impacted by factors such as support mechanisms, ethnicity, and age. In addition, some subpopulations of women are more sensitive to the loss of a breast than others, certainly influenced by cultural norms. These women (and men) need options for breast reconstruction available to them at the time of treatment planning.
There is an excellent study by Lake and colleagues1 that examined how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. They measured the ability to cope using a tool called the Brief Cope Scale. Study subjects included all women who had immediate breast reconstruction and mastectomy in their center over an 11-year span for ductal carcinoma in situ or node-negative invasive breast cancer. They matched patients based on year of diagnosis, adjuvant therapy, and age to one woman who had mastectomy alone. Out of 234 questionnaires sent, about 58% responded. Compared to the mastectomy-alone cohort, significantly more patients from the reconstruction cohort coped by active coping, defined as solving problems, seeking information, seeking social support, seeking professional help, changing environments, planning activities, and reframing the meanings of problems.2 In contrast, significantly more patients in the mastectomy alone cohort dealt with their stress by actively venting than in the reconstruction cohort.
So having breast reconstruction appears to impact on how patients deal with the cancer diagnosis and experience. The group with reconstruction were more actively involved in problem solving as a means of dealing with stress. Those who did not have reconstruction were more likely to resort to passive-aggressive venting. It is possible that women who sought reconstruction saw the reconstruction as the first step towards active problem-solving and coping. Coping is a complex, multifaceted process the defines how a person deals with an adverse event such as the diagnosis of cancer. Coping skills vary from person to person and are culturally-influenced. The ability to adequately and appropriately cope with a cancer diagnosis likely predicts depression and post-surgical outcomes. There are certainly adaptive and more maladaptive coping mechanisms. Members of the health care team should identify early how each woman deals with her breast cancer and help her through the process by giving emotional support and solutions.
This paper does not go so far as to propose cause and effect or to make recommendations. But it is interesting to hypothesize that reconstruction after mastectomy may promote a healthier coping process.
1Lake B, Fuller HR, Rastall S, Usman T. Breast reconstruction affects coping mechanisms in breast cancer survivors. Indian Journal of Surgery. 2019 Feb 5;81(1):43-50.
2Li MH, Nishikawa T. The relationship between active coping and trait resilience across US and Taiwanese college student samples. Journal of College Counseling. 2012 Jul;15(2):157-71.