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A holistic approach to care for women struggling after mastectomy: an interpretative phenomenological analysis

Silvestri, A. (2019). A holistic approach to care for women struggling after mastectomy: an interpretative phenomenological analysis. (Unpublished Doctoral thesis, City, University of London)


Background: Breast cancer is the most prevalent type of cancer among women worldwide today. Although the number of diagnosed cases continues to increase, the efficacy of treatment has also been improving, allowing survival rates to rise. Breast cancer treatment and surgery often involve a variety of changes in women’s appearance, altered sense of identity and relational challenges. A limited amount of research has been found in connection to the subjective embodied experience of women after mastectomy and during rehabilitation.

Purpose: The aim of the present study was to conduct an idiographic exploration of the participants’ perceptions of physical and psychological struggles after mastectomy relating to identity change, self-image and sexual intimacy and how these were embodied in the context of overall wellbeing after illness.

Method: This research sought to explore in depth participants’ subjective experiences of femininity and sexuality after mastectomy using Interpretative Phenomenological Analysis (IPA) through semi-structured individual interviews.

Results: Three major themes emerged from the data: (1) the ‘Ill Self’, (2) the ‘Vulnerable Self’ and (3) the ‘Coping Self’. Nine sub-themes emerged from the data: (1) ‘shock’, ‘pain’, ‘body-changes’, (2) ‘control’, ‘uncertainty’, ‘other’s gaze’, (3) ‘warrior’, ‘comparing losses’ and ‘recovering’. The themes illustrate a linear but complex experience of women losing their healthy status and functioning to becoming breast cancer patients, and through to recovery. The first major theme ‒ ‘Ill Self’ ‒ includes participants’ responses to physical and psychological experiences in the context of illness. Participants expressed the difficulties faced in this first stage of diagnosis and how that seemed to have shifted their position from being healthy to becoming a patient. This major theme reflects participants’ views on interactions with their bodies and how these are expressed through self-image as they lose/gain body parts (mastectomy and/or reconstruction). The second major theme ‒ ‘Vulnerable Self’ ‒ was identified through participants’ exposed vulnerability in relational dynamics but also vulnerability to the challenges presented by illness. Participants revealed conflicts with others and themselves in surrendering and taking power. The ‘Vulnerable Self’ also illustrates women’s concerns about the uncertainties regarding the recovery process and their feelings of exposure to the other’s gaze during rehabilitation. The third major theme - ‘Coping Self’ ‒ is the final identity recognised in the data. I identified the participants’ need to gather their remaining emotional resources following a phase of high vulnerability and to continue their journey into recovery and the reestablishment of wellbeing.

My findings explicitly show the need to create a strong professional network of support between counselling psychologists and other relevant healthcare professionals. This network of support relies on the close involvement of clients during assessment and formulation. Designing a holistic treatment plan which is based on individual client needs (identity, relationships, sexual recovery, body image, etc.) but which also accounts for the physical and psychological needs of service users is paramount for the recovery of quality of life after breast cancer.

Conclusion: The findings of this study add to the body of research regarding women’s struggles after mastectomy and the embodiment of illness. Participants reported their perceptions and reactions regarding identity change, self-image and sexual intimacy after mastectomy. The participants’ desire for a holistic approach to care from specialised services during treatment and recovery was noted. A shortcoming in terms of the provision of psychotherapeutic services to facilitate sensitive communication and follow up on the recovery of breast cancer patients was identified within medical teams, at times of extreme physical and psychological struggle for participants.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
School of Health & Psychological Sciences > Psychology
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