(224) Women's Expectations and Representations of Breast Surgery Impact on their Sexual and Reproductive Life
Authors: Kaabia O , Wadday A 
Published: March 2024

Abstract

Introduction
Breast surgery is a difficult experience, whether for benign or malignant diseases. It concerns all women, regardless of their ethnic origin or socio-demographic condition. Due to the life-altering nature of this experience, patients' expectations before surgery can sometimes become unrealistic regarding their body image, sexuality, quality of life, and even fertility and reproduction. The diversity of these expectations is influenced by clinical, socio-demographic, and psychological factors.

Objective
The main objective of this study is to assess the factors responsible for the variability of female patients' expectations before breast surgery. The secondary objectives of this survey are to evaluate the representations of female patients of the potential impact of breast surgery on their body image, reproduction, and their sexuality.

Methods
We conducted a one-year cross-sectional study (2022). We included all female patients over the age of 18, with a breast disease, scheduled for elective breast surgery at our department, except those with a history of previous breast surgery. The data collection was by filling in a pre-established 9-item form including the validated translated versions of the standardized following scales: the Female Sexual Function Index (FSI), the Hospital Anxiety and Depression Scale (HADS), and the Body-Esteem Scale for Adolescents and Adults (BESAA). Patients' expectations were divided into 4 sub-categories: • Expectation on body image: 3 Items, concerning patients' perceived ideas regarding their femininity, their partner's reaction to them, and their body. • Expectations about sexuality: 9 items concerning patients' perceived ideas regarding their sex life, desire, partner's desire, excitement, lubrication, orgasm, sexual satisfaction, frequency of sexual intercourse, and dyspareunia. • Expectations on quality of life: 4 items, concerning the patients' perceived ideas regarding their daily, professional, family, and marital life. • Expectations on fertility and menopause: 8 items concerning the patients' perceived ideas regarding their fertility, menstrual cycle, contraception, early menopause, menopausal symptoms, and hormone therapy. Patients' expectations are defined as unrealistic if the expectations of two of the 4 subcategories are unrealistic.

Results
We included 103 participants. Patients' general expectations were unrealistic in 30.1% of cases (n=31) focusing on sexuality (unrealistic in 30.1% of cases) and body image (unrealistic in 28.2% of cases). The risk factors for developing unrealistic expectations with regard to body image were a surgery delay greater than 2 months (p=0,004; OR=8,143), a radical breast surgery (mastectomy)(p=0,006; OR=11,972), good anatomical knowledge (p=0,012; OR=9,615), and pathological HADS-A levels (p=0,032; OR=8,693). A breast surgery delay that exceeds two months was an independent risk factor for unrealistic expectations regarding sexuality (p=0,019; OR=4,273). Concerning the independent risk factors related to general unrealistic expectations, work at the time of the surgery (p=0,049; OR=4,081), a radical breast surgery (p=0,045; OR=4,757), good anatomical knowledge (p=0,037; OR=5,12), and a pathological HADS-A level (p=0,04; OR=6,698) were statistically significant. No independent risk factors were associated with quality of life and reproduction.

Conclusions
Our results emphasize the importance of a good knowledge of the risk factors that can promote unrealistic sexual and body image expectations prior to breast surgery. It allows for targeting high-risk patients and implementing the necessary preventive interventions.

Disclosure
No.