Understanding normality: A qualitative analysis of breast cancer patients concepts of normality after mastectomy and reconstructive surgery

Peninsula Medical School, Exeter, UK.
Psycho-Oncology (Impact Factor: 2.44). 05/2011; 20(5):553-8. DOI: 10.1002/pon.1762
Source: PubMed


As survival rates increase, many people have to adjust to life after cancer. This includes adjusting to life after surgery. While previous research suggests that patients commonly strive to be 'normal' after mastectomy and reconstructive surgery, research surrounding individual perceptions of normality is lacking.
The aim of this study was to explore concepts of normality within a sample of breast cancer patients eligible for reconstructive surgery following mastectomy.
A total of 35 semi structured interviews, with women who had undergone or were about to undergo breast reconstructive surgery following breast cancer, were analysed using thematic analysis.
Four main themes emerged from the data. Women referred to looking normal (appearance); being able to fulfil everyday activities (behaviour); adapting to a new normal (reconstructing normality); and not being ill (health). The importance placed on each area of normality differed between patients. Additionally, patients used different standards to anchor concepts of normality. These included individual standards, social standards and clinical standards.
The results indicate that although there are commonalities between patients' concepts of normality, it is important for health care professionals to recognise potential individual differences. This may usefully aid communication and help to manage expectations among patients considering surgical options.

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    • "Indeed, Duggal and colleagues also reported that body image appeared to be more motiving than sexuality or femininity for many women who decided to undergo reconstruction. However, regaining a sense of normalcy may also be an important motivator for BC patients who have undergone or who will undergo breast reconstruction and who have defined normalcy as including " looking normal " (Denford, Rubin, & Pusic, 2011). Other researchers have constructed a grounded theory model of the role of breast reconstruction in women's self-image following BC (McKean, Newman, & Adair, 2013), supporting the notion that breast reconstruction might largely be about reconstructing one's sense of normal. "
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    ABSTRACT: Sexual minority women are at a significantly greater risk for developing breast cancer (BC) than heterosexual women. Little is known about the unique BC experiences of lesbian women. The present thesis describes the findings of an inductive thematic analysis of messages posted to a large lesbian-specific discussion forum found on Fifteen themes were identified, including privileging sensation over appearance, experiencing heterosexism in medical contexts, believing others perceive a lack of distress over breast loss because of patient’s lesbian sexual orientation, feeling pressure from surgeons to get reconstructive surgery, and viewing the BC journey as a sexual-identity disclosure crisis. In addition, gender expression appeared to moderate the lesbian patients’ experiencese of BC. For instance, a theme identified among butch-or gender variant patients was enjoying or accepting that others were confused about their gender post-surgery. Femme-lesbian patients, in contrast, reported being frustrated about gender misidentification resulting from breast and hair loss.
    04/2015, Degree: MS, Supervisor: Katie E. Mosack, PhD.
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    • "Recent research has indicated a relationship between breast reconstruction surgery and sense of normality. Denford et al. (2011) explored the concept of normality within women who were awaiting or had already undergone breast reconstruction surgery. The women considered surgery to relate to normality in: their physical appearance, ability to perform daily behaviours, 'adapting to a new normal' and health status. "
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    ABSTRACT: The present study aimed to develop a theoretical understanding of the role of breast reconstruction in women's self-image. Semi-structured interviews were conducted with 10 women from breast cancer support groups who had undergone breast reconstruction surgery. A grounded theory methodology was used to explore their experiences. The study generated a model of 'breast cancer, breast reconstruction and self-image', with a core category entitled 'feeling like me again' and two principal categories of 'normal appearance' and 'normal life'. A further two main categories, 'moving on' and 'image of sick person' were generated. The results indicated a role of breast reconstruction in several aspects of self-image including the restoration of pre-surgery persona, which further promoted adjustment.
    European Journal of Cancer Care 06/2013; 22(4). DOI:10.1111/ecc.12055 · 1.56 Impact Factor
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    • "As a result, cancer becomes more than a biological and physical state—it becomes a social experience [15], and for those affected, managing illness necessitates additional tasks including learning to access needed information, re-negotiating identities and relationships, and coping across the illness’ effects [16,17]. These efforts help patients adjust to life after diagnosis and define a “new normal” as they move through the illness journey [18]. "
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    ABSTRACT: BACKGROUND: Health and psychosocial outcomes for young adults affected by cancer have improved only minimally in decades, partially due to a lack of relevant support and information. Given significant unmet needs involving nutrition and exercise, it is important to understand how this audience handles information about food and fitness in managing their cancer experiences. OBJECTIVE: Using the theory of illness trajectories as a framework, we explored how four lines of work associated with living with a chronic illness such as cancer (illness, everyday life, biographical, and the recently explicated construct of communication work) impacts and is impacted by nutrition and exercise concerns. METHODS: Following a search to extract all nutrition- and exercise-related content from the prior 3 years (January 2008 to February 2011), a sample of more than 1000 posts from an online support community for young adults affected by cancer were qualitatively analyzed employing iterative, constant comparison techniques. Sensitized by illness trajectory research and related concepts, 3 coders worked over 4 months to examine the English-language, de-identified text files of content. RESULTS: An analysis of discussion board threads in an online community for young adults dealing with cancer shows that nutrition and exercise needs affect the young adults' illness trajectories, including their management of illness, everyday life, biographical, and communication work. Furthermore, this paper helps validate development of the "communication work" variable, explores the "mass personal" interplay of mediated and interpersonal communication channels, and expands illness trajectory work to a younger demographic than investigated in prior research. CONCLUSIONS: Applying the valuable concepts of illness, everyday life, biographical, and communication work provides a more nuanced understanding of how young adults affected by cancer handle exercise and nutrition needs. This knowledge can help provide support and interventional guidance for the well-documented psychosocial challenges particular to this demographic as they manage the adversities inherent in a young adult cancer diagnosis. The research also helps explain how these young adults meet communication needs in a "mass personal" way that employs multiple communication channels to meet goals and thus might be more effectively reached in a digital world.
    Journal of Medical Internet Research 05/2013; 15(5):e102. DOI:10.2196/jmir.2594 · 3.43 Impact Factor
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