Importance of plastic surgery for women with mastectomies and the role of Brazilian Unified Health System: integrative review

BRANDãO, BRENDA LOPES; SILVA, ARIEL CARíSSIMO BARBOSA; FRANCISQUINI, ÍTALO NACIF; GOUVêA, MARIANA MACHADO; LOBãO, LúCIA MEIRELLES

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Revista Brasileira de Cirurgia Plástica

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Review Article • Rev. Bras. Cir. Plást. 36 (04) • 2021 • https://doi.org/10.5935/2177-1235.2021RBCP0132 copy

Importance of plastic surgery for women with mastectomies and the role of Brazilian Unified Health System: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

■ ABSTRACT

Introduction:

The benefits of performing breast reconstruction in mastectomized patients go far beyond aesthetics, contributing to a woman’s emotional health, self-esteem and sex life. Thus, this study aimed to address the relevance of performing plastic surgery in women with mastectomies in Brazil and highlight women’s rights within the Brazilian Unified Health System during the process.

Methods:

For this, an integrative qualitative review was carried out through data collection on the SciELO, PubMed and LILACS platforms, in addition to a complementary search on Google Scholar. The articles included in the study were analyzed using the content method.

Results:

In total, 21 articles were included, in which it was observed that women with mastectomies reported feelings of fear, shame, suffering, reduced sexuality and dissatisfaction. It was also observed that these feelings decreased after performing the cosmetic procedure.

Conclusion:

Because the breasts represent a symbol of sensuality and female pride, it is extremely important that the Brazilian Unified Health System, as well as health professionals, are trained to welcome and resolve the patients’ doubts, ensuring that there is no negligence in the care and providing a decent treatment.

Keywords:
Quality of life; Breast; Mammoplasty; Mastectomy; Sexuality

Author	Date	Title	Magazine	Type	Subject
Loyal et al.¹²12 Leal VCLV, Catrib AMF, Amorim RF, Montagner MA . O corpo, a cirurgia estética e a Saúde Coletiva: um estudo de caso. Ciência & Saúde Coletiva. 2010; 15 (1): 77-86.	2010	The body, cosmetic surgery and collective health: a case study.	Journal of Science and Public Health	Case study	Relationship of cosmetic surgery with collective health and health promotion.
Moura et al.¹³13 Moura FMJSP, Silva MG, Oliveira SC, Moura LJSP. Os sentimentos das mulheres pós-mastectomizadas. Esc Anna Nery. 2010; 14(3): 477-84.	2010	The feelings of post-mastectomized women.	Anna Nery School of Nursing Magazine	Descriptive Qualitative Study	How women feel after mastectomy.
Cesnik and Santos¹⁴14 Cesnik VM, Santos MA. Mastectomia e sexualidade: uma revisão integrativa. Psicologia: Reflexões e Crítica. 2012; 25(2): 339-49.	2012	Mastectomy and sexuality: an integrative review.	Psychology Journal: Reflection and Criticism	Integrative review	Impact of cancer and mastectomy on women's sexuality.
Majewski et al.¹⁵15 Majewski JM, Lopes ADF, Davoglio T, Leite JCDC. Qualidade de vida em mulheres submetidas à mastectomia comparada com aquelas que se submeteram à cirurgia conservadora: uma revisão de literatura. Ciência & Saúde Coletiva. 2012; 17(3): 707-16.	2012	Quality of life in women who underwent mastectomy compared to those who underwent conservative surgery: a literature review.	Journal of Science and Public Health	Literature review	Comparison between women who underwent a mastectomy and those who underwent conservative treatment.
Cosac et al.¹⁶16 Cosac OM, Filho JPPC, Barros APGSH, Borgatto MS, Esteves BP, Curado DMC, et al. Reconstruções mamárias: estudo retrospectivo de 10 anos. Rev Bras Cir Plást. 2013;28(1):59-64.	2013	Breast reconstructions: a 10-year retrospective study.	Revista Brasileira de Cirurgia Plástica	Case study	Analysis of post-mastectomy breast reconstruction cases for breast cancer.
Colombo¹⁷17 Colombo FG. Avaliação do grau de satisfação de pacientes submetidas a reconstrução mamária. Rev Bras Cir Plast. 2013; 28(3): 355-60.	2013	Assessment of the degree of satisfaction of patients undergoing breast reconstruction.	Revista Brasileira de Cirurgia Plástica	Retrospective study	Patient satisfaction after breast reconstruction.
Furlan et al.⁴4 Furlan VLA, Neto MS, Abla LEF, Oliveira CJR, Lima AC, Ruiz BFO, et al. Qualidade de vida e autoestima de pacientes mastectomizadas submetidas ou não a reconstrução de mama. Rev Bras Cir Plást. 2013 Jun;28(2): 264-9.	2013	Quality of life and self-esteem of mastectomized patients undergoing or not breast reconstruction.	Revista Brasileira de Cirurgia Plástica	exploratory qualitative study	Quality of life of mastectomized patients undergoing or not breast reconstruction.
Gomes and Silva¹⁸18 Gomes NS, Silva SR. Avaliação da autoestima de mulheres submetidas à cirurgia oncológica mamária. Texto Contexto Enferm. 2013; 22(2): 509-16.	2013	Self-esteem assessment of women undergoing breast cancer surgery.	Text and Context Nursing	Cross-sectional observational study	Self-esteem of women after cancer surgery.
Guimarães et al.¹⁹19 Guimarães PAMP, Neto MS, Abla LEF, Veiga DF, Lage FC, Ferreira LM. Sexualidade após mamoplastia de aumento. Rev Bras Cir Plast. 2015; 30(4): 552-559.	2015	Sexuality after augmentation mammoplasty.	Revista Brasileira de Cirurgia Plástica	Case study	Assess sexuality after augmentation mammoplasty.
Braga et al.⁹9 Braga AKG, Santos TLC, Magalhães MAV. Processo de reconstrução mamária em mulheres mastectomizadas. Rev Interd. 2016;9(1):216-23.	2016	Breast reconstruction process in mastectomized women.	Interdisciplinary Magazine	Literature review	Process involved from mastectomy to breast reconstruction.
Thais Rodrigues Guedes²⁰20 Guedes TSR. Imagem Corporal de Mulheres Submetidas Ao Tratamento Do Câncer De Mama. Natal. Tese [Mestrado em Saúde Coletiva] - Universidade Federal do Rio Grande do Norte; 2016	2016	Body image of women undergoing treatment for breast cancer.		Masters dissertation	Self-esteem of cancer patients
Alves, VL et al.²¹21 Alves VL, Sabino Neto M, Abla LEF, Oliveira CJR, Ferreira LM. Avaliação precoce da qualidade de vida e autoestima de pacientes mastectomizadas submetidas ou não à reconstrução mamária. Revista Brasileira de Cirurgia Plástica. 2017;32(2):208-17	2017	Early assessment of the quality of life and self-esteem of mastectomized patients undergoing or not breast reconstruction.	Revista Brasileira de Cirurgia Plástica	Cross-sectional, comparative and analytical observational study	Make a comparison about the self-esteem of mastectomized patients undergoing reconstruction and those who did not undergo plastic surgery.
Martins, et al.²²22 Martins TNDO, Santos LFD, Petter GDN, Ethur JNDS, Braz MM, Pivetta HMF. Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade. Fisioter. Pesqui. 2017; 24(4): 412-19.	2017	Immediate breast reconstruction versus no post-mastectomy reconstruction: a study on quality of life, pain and functionality.	Physiotherapy and Research Journal	Cross-sectional descriptive study	Comparison between immediate breast reconstruction versus no post-mastectomy reconstruction.
Villar et al.²³23 Villar RR, Fernandez SP, Garea CC, Pillado MTS, Barreiro VB, Martin CG. Qualidade de vida e ansiedade em mulheres com câncer de mama antes e depois do tratamento. Rev Latino-Am Emfermagem. 2017; 25: e2958.	2017	Quality of life and anxiety in women with breast cancer before and after treatment.	Latin American Journal of Nursing	Prospective observational study	Before x after women being treated for breast cancer.
Casassola et al.²⁴24 Casassola GM, Stallbaum JH, Pivetta HMF. Satisfação com cirurgia oncológica da mama: Comparação entre pacientes mastectomizadas com e sem reconstrução mamária. SIEPE [Internet]. 14º de fevereiro de 2020 [citado 20º de novembro de 2020];10(3). Disponível em: https://periodicos.unipampa.edu.br/index.php/SIEPE/article/view/87256 https://periodicos.unipampa.edu.br/index...	2018	Satisfaction with breast cancer surgery: Comparison between mastectomized patients with and without breast reconstruction.	International Exhibition of Teaching, Research and Extension	Qualitative study	Comparison between women with mastectomies who underwent plastic surgery and those who did not.
Archangel et al.²⁵25 Archangelo SDCV, Neto MS, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics. 2019; 74:e883.	2019	Sexuality, depression and body image after breast reconstruction.	Clinics	Case study	Quality of life after breast reconstruction.
Cammarota et al.¹⁰10 Cammarota MC, Campos AC, Faria CADC, Santos GC, Barcelos LDP, Dias RCS, et al. Qualidade de vida e resultado estético após mastectomia e reconstrução mamária. Rev Bras Cir Plást. 2019;34(1):45-57.	2019	Quality of life and aesthetic result after mastectomy and breast reconstruction.	Revista Brasileira de Cirurgia Plástica	Case study	Quality of life of women undergoing breast reconstruction after cancer treatment.
Cosac et al.²⁶26 Cosac OM, Campos AC, Dias RCS, Costa RSC, Da-Silva SV, Damasio AA, et al. Reconstrução mamária: estudo retrospectivo de 16 anos. Rev Bras Cir Plast. 2019; 34(2): 210-7.	2019	Breast reconstructions: a 16-year retrospective study.	Revista Brasileira de Cirurgia Plástica	Case study	Analysis of post-mastectomy breast reconstruction cases for breast cancer.
Volkmer et al.²⁷27 Volkmer C, Santos EKA, Erdmann AL Sperandio FR, Backes MTS, Honório GTS. Reconstrução mamária sob a ótica de mulheres submetidas à mastectomia: uma metaetnografia. Texto & Contexto Enfermagem. 2019; 28: e20160442.	2019	Breast reconstruction from the perspective of women undergoing mastectomy: a meta-ethnography.	Text and Context Nursing	Literature review	What do women undergoing mastectomy think about breast reconstruction?
Carneiro et al.²⁸28 Carneiro MSF, Pinheiro CPO, Feitosa FVV, Soares MN, Rabelo IV, Lebre P, et al. Repercussões psicológicas da cirurgia plástica em mulheres mastectomizadas. Braz J of Develop. 2020; 6(7): 47743-51.	2020	Psychological repercussions of plastic surgery in mastectomized women.	Brazilian Journal of Development	Literature review	Quality of life of women who underwent mastectomies after plastic surgery.
Mollinar et al.¹¹11 Mollinar ABP, Pereira IPC, Araújo JSF, Smith JSR, Guerra MCA, Real Junior MMF, et al. Cirurgia oncoplástica e reconstrutiva da mama: análise acerca dos direitos do paciente no âmbito do SUS. Braz J Develop. 2020;6(8):54485-503.	2020	Oncoplastic and reconstructive surgery of the breast: analysis of the patient's rights within the scope of the SUS.	Brazilian Journal of Development	Literature review	Rights of SUS patients for mastectomy and breast reconstruction.

Variables	Observed profile
Age group	More than 60% of women aged 41-60 years.
Color	It depends on the study's region, but it has a greater predominance in white women.
Education	More than 60% of women have education (in years) from 1 to 9 years, corresponding to complete primary education.
Family income	Family income is around 1 to 3 minimum wages.
Religion	It follows the regional pattern, tending to follow the national average, with more than half Catholic.

Feelings	% of articles
Anxiety	42.1
Fear	31.5
Depression	21.0
Sadness	15.7
Fault	10.5
Anguish	10.5
Insecurity	10.5
Conformism	5.2
Defensive posture	5.2
Shame	5.2
Worry	5.2
Inferiority	5.2
Feeling of worthlessness	5.2

Main changes after breast lift
Sexuality	Sexuality increased significantly, in addition to the improvement in sexual satisfaction, showing no significant difference between patients who were or were not in a stable relationship.
Self-esteem	The improvement in self-esteem appears to be directly related to the patient's age, and the younger she is, the greater the result in her emotional function.
Psychosocial well-being	Patients are more self-confident, more accepting of their own bodies, strengthened in social environments and emotionally healthy.
Physical well-being	Few or almost no complaints of unbearable pain in the area of the breasts after surgery were observed, with only the increased sensitivity in the area standing out.

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

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[1] Conflicts of interest: none.