Beyond Simply "Living" - New Approaches to Reclaiming Mental and Physical Health After Mastectomy

A systematic review scheduled to be presented at the American College of Surgeons (ACS) Clinical Congress 2025 (10/4–7) reported that mastectomy (unilateral/bilateral breast removal) for breast cancer patients may lead to disadvantages in psychosocial outcomes such as sexual health and body image post-surgery. The integration of 20 studies extracted from approximately 3,000 papers revealed that psychosocial outcomes significantly worsened in at least one domain in 15 studies. The evaluation metrics (PROMs) were 38 types and varied, highlighting the issue of lack of standardization. The research team suggests the development of a screening tool to visualize the mental and physical preparedness of patients before mastectomy. It is important to note that this report is a conference abstract and not yet a peer-reviewed paper. News-Medical

What's new

While mastectomy is a life-saving option, the possibility that there is insufficient attention to long-term QOL was suggested, despite advancements in perioperative efficiency such as shorter hospital stays. The main evaluation areas were body image (assessed in 55% of studies), sexual function/sexual health (50%), pain/physical function (45%), and QOL (40%), but **psychological health (35%) and satisfaction (25%)** were not adequately measured. ACS

Consistency with previous research

Previous literature has reported that mastectomy (especially with radiation) may lower QOL compared to breast-conserving surgery. The U.S. National Cancer Institute (NCI) commentary, citing data from JAMA Surgery, summarizes that self-reported QOL tends to be lower in the mastectomy group. In young breast cancer cohorts, the relationship between the type of surgery and psychosocial outcomes has also been pointed out. Cancer Information Service

Furthermore, the 2025 study supplements that there are many complaints of decreased functions such as libido, arousal, and orgasm after mastectomy, and mental symptoms may co-occur. The latest review also organizes the point that hormone therapy (± ovarian function suppression) affects sexual health, showing that surgical factors and the impact of endocrine treatment are intricately intertwined. BioMed Central

Reactions on social media (voices of those affected)

On social media, the following "raw voices" stand out.

• Sexual pain, dryness, decreased libido: Posts indicating that continuous management is necessary for vaginal dryness that cannot be cured with lubricants alone.Reddit

• Loss of sensation and sense of loss: Testimonials that sensation loss may remain even with nipple preservation.Reddit

• Body image and self-esteem: Complaints that there are times when it is difficult to look in the mirror, regardless of reconstruction or choosing to go "flat" (opting not to reconstruct).Reddit+1

• Partnership: Voices advocating for couple counseling due to relationship friction accompanying changes in sexual function.Reddit

These are individual experiences, and "do not apply to everyone". Nevertheless, the point that the trends indicated by the conference presentation resonate with the narratives of those affected cannot be overlooked. ACS

To avoid misunderstandings

• Trade-off between life prognosis and QOL: Mastectomy saves lives when necessary. The current findings do not condemn "mastectomy as bad," but rather highlight the lack of information and support before decision-making. News-Medical

• Maturity of evidence: It is at the conference abstract stage, and future peer-reviewed publication and standardization of metrics are essential. ACS

For future practice: Checklist for patients and healthcare providers

For patients

1. Identify sexual health consultation services (gynecology, sexual function clinics, counseling) before surgery.

2. Ask specific questions about expected sensory changes (nipple preservation feasibility, scars, numbness).

3. Share information in advance about the impact of hormone therapy (vaginal dryness, libido) and coping strategies (moisturizers, pelvic floor physiotherapy, psychological support). Annals of Palliative Medicine

For healthcare providers

• Introduce standardized and simple screening of PROMs (repeated measurements pre- and post-surgery).

• Routinize partner-inclusive counseling and collaboration with specialists under ethical considerations.

• Design "post-operative life" with a multidisciplinary team including surgery, oncology, radiation therapy, gynecology, psycho-oncology, and rehabilitation. ACS

Implications for media/policy

What this review emphasized is the chaos of evaluation metrics. If each facility proliferates its own metrics, patients' concerns will continue to be "invisible." At the national level, it is necessary to advance the adoption of standard PROMs and **implementation support (insurance points and ICT development)**. ACS

Summary

• The systematic review suggests deterioration in sexual health, body image, and psychological aspects after mastectomy (15/20 studies). However, it is a conference presentation before peer review, and further refinement is needed. News-Medical

• It broadly aligns with previous research and voices from patient communities. The choice of surgical method is highly individualized, and comprehensive counseling before decision-making is key. Cancer Information Service
  
  

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