Abstract
ABSTRACT Objective: to analyze qualitative studies published in the national and international scientific literature on breast reconstruction after mastectomy for breast cancer, from the perspective of women. Method: systematic literature review using meta-ethnography, where the synthesis of knowledge is based on the induction and interpretation of the data found. Searches in the electronic databases identified 65 studies. 27 studides meet the inclusion and exclusion criteria. 13 studies compressed the analytical corpus of the review, according to the Critical Appraisal Skills Programme checklist. The data were synthesized by means of the meta-ethnographic approach. Results: the analyzed studies showed similarities regarding the women´s decision to perform breast reconstruction, the difficulty of choosing the type of surgery and to deal with the experience of the reconstruction, and that the women had difficulties in establishing relationships with certain health professionals, especially with doctors. They refer to the ambivalence of feelings regarding the expectations and results of breast reconstruction and complex process of "carrying on". Conclusion: this review synthesizes the scientific knowledge regarding women's perspective regarding the breast reconstruction process and highlights that health professionals must understand the perceptions of women undergoing mastectomy and breast reconstruction in order to improve the care provided.
Highlights
IntroductionIn Brazil, the incidence of mastectomies is still high, often due to the late diagnosis of cancer, other times due to the womans own choice, for fear of local recurrences or because they carry the BRCA1 and BRCA2 genes, with a possible indication of bilateral prophylactic mastectomy, or, in the case of young women, due to the fact that the cancer presents itself in a very aggressive way, situations that lead to the number of mutilating surgeries still performed in our country
The inclusion criteria for the selection of the studies were: articles published in journals referring to research using qualitative methodology in the study of breast reconstruction from the perspective of women submitted to mastectomy in the English, Portuguese and Spanish languages, with no initial limit to the date of publication, published no later than December, 31 2015
The diagnosis of breast cancer, the need for aggressive treatment, the removal of the breast and breast reconstruction arouse a series of negative feelings in women and causes them to enter into a movement called mourning, which abates any human being
Summary
In Brazil, the incidence of mastectomies is still high, often due to the late diagnosis of cancer, other times due to the womans own choice, for fear of local recurrences or because they carry the BRCA1 and BRCA2 genes, with a possible indication of bilateral prophylactic mastectomy, or, in the case of young women, due to the fact that the cancer presents itself in a very aggressive way, situations that lead to the number of mutilating surgeries still performed in our country. In cases where there is no indication of conservative surgery, surgeons aim to refine the radical surgical technique, improving the ability to reconstruct the breast, with the aim of maintaining the natural symmetry, considering sensation, the aesthetic aspect and seeking better quality of life for the women involved.[1,4,5,6,7]. With regard to the advances in the area of radical surgery, less aggressive mastectomies and breast reconstruction techniques must be mentioned, which combine techniques of oncological and plastic surgery in a surgical procedure (oncoplastic surgery),and aim to return the volume and contour of the breast to the woman submitted to partial, total or radical mastectomy, as a method of cancer treatment.[2,4,6,7]
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