Breast cancer treatment often walks a fine line between life-saving surgery and long-term quality of life. A recently published systematic review, to be presented at the American College of Surgeons' Clinical Congress 2025, has now thrown fresh light on one such trade-off. Mastectomy's potential impact on sexual health, body image and psychological well-being. While mastectomy, the surgical removal of one or both breasts, remains a cornerstone therapy for many women with breast cancer, its physical and emotional consequences are profound. The review analysed 20 eligible studies from nearly 3,000 initially screened, focusing on women with Stage 1 to 3 breast cancer (excluding stage 4 and prophylactic mastectomy cases) to understand post-surgery psychosocial outcomes.
The results draw attention to a gap often overlooked in surgical planning. Nearly 75 % of the studies reported poorer outcomes in at least one psychosocial domain (body image, sexual health, emotional adjustment). For many women, the physical act of surgery may save their lives, but the hidden cost in self-esteem, intimacy, and mental health may go unspoken or under-addressed. Let's unpack what the review found, what is known from prior research on breast cancer treatments, and how patients and providers can navigate these difficult trade-offs.
What Did The New Review Find?
Of the 20 studies included, 15 reported worse psychosocial outcomes in at least one domain, like emotional health, social adjustment, self-image, sexual function. The most commonly measured outcomes across studies were body image (55% of studies), sexual health/function (50%), pain or physical function (45%), and general quality of life (40%).
The review authors emphasise the need for standardized pre-surgical screening, where women are counselled about not just surgical risks but long-term psychosocial and sexual health implications. Because of heterogeneity and methodological limitations (study design, differing follow-ups, self-report bias), the findings cannot definitively quantify the extent of decline. The review is in conference stage, pending full peer-review publication.
Why Might Mastectomy Impact Sexual And Psychosocial Health?
To understand the connection, we need to consider how cancer therapy affects multiple domains, not just the surgery itself:
Loss of breast tissue and altered body image
The breast is not only a physical organ but is closely tied to identity, femininity and sexual embodiment. Removal (partial or total) changes symmetry, contour, sensation, and tactile feedback. Several earlier studies and reviews show that women who undergo breast-conserving surgery (lumpectomy) tend to report better sexual adjustment and fewer disturbances in desire, arousal, and orgasm, compared to those who undergo mastectomy.
Nipple-sparing mastectomy (when oncologically safe) often shows better psychosocial and sexual outcomes than skin-sparing or full mastectomy because it preserves the nipple-areolar complex, a sensitive area contributing to sexual arousal.
Loss of sensation or nerve injury
Surgical removal involves severing nerve pathways. Loss of nipple or breast sensation can dampen sexual experience. Some patients may develop neuropathic pain or hypersensitivity as well (post-mastectomy pain syndrome).
Adjuvant treatments and hormonal changes
Many patients receive chemotherapy, endocrine therapy (e.g. tamoxifen, aromatase inhibitors), or radiation. These can lead to premature menopause, vaginal dryness, loss of lubrication, low libido, pain with intercourse, and general fatigue, all of which influence sexual function.
Psychological effects
A breast cancer diagnosis and the trauma of surgery can lead to anxiety, depression, body shame, altered self-esteem, relationship stress and partner adjustment issues. Sexual intimacy may become secondary to survival and coping.
Interaction of physical and emotional dynamics
Sexual health is not just biological; it is relational. Partners' responses, intimacy dynamics, emotional closeness, support, and communication matter. If one partner is distressed or struggling, it compounds difficulties.
Because these factors overlap, isolation of the contribution from mastectomy per se is challenging, which is why the review calls for better, standardized measurement and integrated care.
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The Way Forward For Breast Cancer Patients
Here's what the findings of the review imply for women, clinicians and policy around breast cancer treatments and mastectomy:
Pre-surgical counselling should be holistic
Women should be informed not only about recurrence risk, surgical complications and recovery, but also about potential long-term changes in body image, sensation, sexual health, and psychological wellbeing.
Use validated PROMs or screening tools
To guide discussions, clinicians should adopt standard questionnaires (e.g. Female Sexual Function Index, BREAST-Q, body image scales) and assess baseline and follow-up changes. This helps track who may benefit from interventions.
Multidisciplinary support
Care teams should include psycho-oncology, sexual medicine, physiotherapy (especially pelvic floor), rehabilitation, and partner counselling. When sexual problems are detected early, interventions (lubricants, vaginal moisturizers, local hormonal therapy when safe, counselling, therapies) can help.
Risk-stratified surgical planning
Where oncologically safe, procedures that preserve the nipple or minimize disfigurement (e.g. nipple-sparing mastectomy) may be preferred. Reconstruction (with or without nipple reconstruction) can help restore appearance and confidence, though it does not fully restore sensation.
Further rigorous research needed
Given the methodological limits of existing studies, researchers must strive for larger prospective cohorts, standardized instruments, longer follow-ups, and cultural sensitivity (sexual health is deeply influenced by cultural values).
Cultural, social and Indian context matters
In India, conversations about sexuality remain taboo in many settings; women may not raise sexual concerns with oncologists unless prompted. Clinicians must create safe, nonjudgmental spaces. Also, resource constraints in many hospitals may limit availability of sexual health specialists or psycho-oncology support.
The systematic review suggesting that mastectomy may contribute to worse sexual health, body image and psychosocial outcomes is a sobering reminder: survival alone is never enough. As breast cancer care improves, quality of life must receive equal weight. The findings underscore urgency for comprehensive counselling, use of validated screening, multidisciplinary care teams, and more rigorous research, especially in contexts like India where sexual health remains under-prioritized.
For women facing mastectomy, the message is not to fear or avoid a lifesaving surgery, but to be informed and empowered. Ask your surgeon about nerve preservation, nipple-sparing options, ask whether reconstructive options are feasible, seek referral to psycho-oncology/sexual medicine, and keep the conversation going with your partner and care team. In the evolving era of cancer survivorship, the goal should be not just living, but living well with dignity, intimacy, and psychological resilience.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
