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.
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    • "In curative care, however, patients with cancer commonly report an expectation or desire to 'get back to normal' following treatment (Little & Sayers 2004; Denford et al. 2011). Moreover, psychological intervention research in curative settings has concentrated on the restoration of mood and function (Costanzo et al. 2007) and helping patients towards an 'ordinary life' through resisting the effects of cancer (Naaman et al. 2009b; Moorey & Greer 2012). "
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    ABSTRACT: Existential concerns about cancer have been studied extensively in palliative care but less so in curative settings. The present report aims to describe ways in which patients viewed the continuity or discontinuity of their identity in the face of the mortal threat of cancer. Twenty-eight patients with breast, prostate or lung cancer attending pre-treatment, treatment or follow-up appointments were interviewed about their emotional experiences following diagnosis. Qualitative analysis followed an inductive, constant comparative approach. Patients spoke of ‘getting back to normal’, but presented two distinct accounts of ‘normality’. Some, particularly those only recently diagnosed, maintained continuity to past identity by upholding previous routines, emphasising resilience and minimising the impact of cancer. Others talked of a new ‘normality’ discontinuous with their past. Most accounts, however, evidenced elements of continuity and discontinuity, often in ostensibly contradictory ways. We suggest that holding contradictory perspectives simultaneously characterises an intermediate stage of adjustment for some patients: between reliance on continuity with the past in the aftermath of diagnosis and, later, a sense of being a new person, changed by cancer. Practitioners should appreciate that patients' wishes for ‘normality’ can signify very different responses to cancer, and that holding such contradictory orientations is functional, not aberrant.
    No preview · Article · Jan 2015 · European Journal of Cancer Care
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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.
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