Embracing Body Image Amidst Breast Cancer
Written by Melissa Schenkman, MPH, MSJ
When you look in the mirror, how do you think and feel about your body?
It’s a question that women across the United States answer for themselves every day as they step out into the world, and often our answer and our feeling is not a positive one. For many of us, we focus on the things we would like to change about our bodies, rather than the positive qualities about our looks that we already possess.
Michelle Kang is no stranger to often criticizing her own body when she looked in the mirror. In her 20s while living and working in New York City, image was everything.
“I wasn't happy with what I saw and would focus on what I thought needed to change,” Kang recalled.
But when Kang was diagnosed with breast cancer at age 27, her perception of her reflection had to change, as it was no longer about identifying imperfections to improve upon, but instead, adjusting to and accepting major physical changes, some that would be a part of her the rest of her life.
Her insights and experience provide a guide for how women in the breast cancer community, the chronic disease community as a whole, and women in general who are living with an unhealthy body image, should think and view the reflection you see of yourself the next time you look in the mirror.
The Emotional Impact of a Breast Cancer
For most women who have received a breast cancer diagnosis, the news is often accompanied by total shock and fear. Kang was no exception.
As a very healthy 27-year-old, who worked out five times per week, ate a mainly plant-based diet, rarely drank alcohol, did not smoke, received regular doctor’s checkups for preventive care, and had no family history of breast cancer, Kang was totally shocked when she discovered a lump in her breast and when doctors confirmed it was cancer.
Of the many things she feared, including not surviving, she worried about how treatment would impact the very physical characteristics that defined who she was and her image–particularly her breasts and her hair.
Body image–how you think and feel about your body–can have a huge impact on your mental health.
According to the U.S. Office of Women’s Health, women who have a positive body image are more likely to have good mental health, while having a negative body image can put women at a higher risk for depression, eating disorders, and other mental and physical health problems.
But in breast cancer and cancer survivorship the stakes can be even higher.
A 2021 study made the point that for breast cancer patients and survivors, their bodies “are not only affected by the disease, but also by the secondary consequences of treatment, such as surgery and chemotherapy.”
So, it is not just a matter of patients and survivors having an appreciation for their changed features, but also being able to deal with a perception of her body image, in which she also now feels her body is “less whole, less feminine, and as a source of danger and betrayal.”
The Physical Changes
The most common treatments for breast cancer–mastectomy, lumpectomy, and reconstructive surgery–each come with its own set of unique physical changes. While every person’s body has the ability to respond differently to a procedure, here are some of the common physical changes that women experience that impact their feelings about body image:
Mastectomy - (removal of the entire breast)
Pain and Discomfort: This discomfort may persist for some time after the surgery.
Scarring: Scars will be present where the breast tissue was removed. The appearance of these scars can be influenced by the surgical technique used.
Nipple and Areola Changes: In some cases, the nipple and areola may be removed during mastectomy.
Limited Range of Motion: Some individuals may experience a temporary limitation in arm and shoulder movement on the side of the surgery.
Lymphedema: Removal of lymph nodes during mastectomy can disrupt the normal flow of lymphatic fluid, leading to swelling known as lymphedema. This can affect the arm on the side of the surgery.
Changes in Sensation: Numbness or changes in sensation around the chest and underarm are common after mastectomy.
Michelle after having her double mastectomy. During recovery she had to wear a special bra and Jackson-Pratt drains. The drains collect fluid from the surgical sites, promoting healing and recovery, and reducing the chances of infection.
Lumpectomy - (removal of the tumor and a small portion of surrounding tissue)
Pain and Discomfort: While lumpectomy involves removing a small amount of tissue, there can still be pain and discomfort post-surgery.
Changes in Breast Appearance: Lumpectomy may result in changes in the size and shape of the treated breast.
Scarring: There will be a scar at the site of the lumpectomy, and the appearance of the scar can vary. It may fade over time but will always be present to some degree.
Potential Radiation Effects: If radiation therapy is part of the treatment plan, the skin in the treated area may become red, sensitive, or discolored. These changes are usually temporary but can have an impact on the appearance of the breast.
Reconstructive surgery - (implants or autologous tissue, which involve additional surgical procedures)
Scarring: Reconstructive surgery involves incisions, resulting in scars. The extent and location of scars depend on the type of reconstruction chosen.
Restoration of Breast Shape: Reconstructive surgery aims to restore the shape of the breast. This can be achieved through the use of implants, autologous tissue (flap reconstruction), or a combination of both.
Changes in Sensation: Nerve damage during surgery can lead to changes in sensation in the reconstructed breast. Some women may experience numbness or altered feeling.
“Dealing with cancer made it even harder to face my reflection, especially after losing my hair, losing both breasts, and having scars across my chest. But there was a moment during the later stages of my treatment that shifted things for me. I will never forget the day I looked in the mirror and saw new hair starting to grow on my head. It felt like my very first victory after what felt like a constant stream of losses,” Kang said.
“This was a pivotal moment in my journey that changed my perspective, reminding me that despite the challenges, there were more positive moments to come. I walked away that day with one of the biggest lessons cancer taught me, which is self-love.”
Society's Influence on Body Image
An incredibly important lesson for Kang to hold onto and for each of us to learn from her, given what we face in society today.
Societal standards define beauty for women, as being proportionate with a slender waist, full bust, and long hair. Given the media’s frequent portrayal of women, upholding these standards puts tremendous pressure on women to uphold them in their own lives, so that they too, can be considered “beautiful” by society’s definition.
This affects our body image in that this is what we often compare ourselves to, and whichever part of that we fall short of, many of us either feel badly about ourselves for it or spend our time and money working to achieve that standard.
The ripple effect of these societal standards for beauty are felt even further because of the media's wide reach, especially with having social media 24-7.
In a 2016 systematic literature review–one studying combining and analyzing the results from 20 different studies on the topic of social media sites and their impact on body image–found that social networking sites, like Facebook and Instagram, were associated with negative effects on body image, including the development of eating disorders.
One thing that was found to be particularly problematic was when a person would post photos and then seek affirmation of those photos through status updates. Receiving negative feedback on the photos would lead that person to having negative feelings and thoughts about their body.
Another venue in which our body image is being impacted by society’s standards on beauty, is a place you may not have thought about: the video call. Ever since offices went remote during the start of the COVID-19 pandemic and began having to use digital conferencing platforms like Zoom, it’s led users to check their appearance far more and to look for and find flaws in their perceived virtual appearance.
So, the challenges we face to having a healthy body image of ourselves are everywhere, which makes the physical changes to the body from breast cancer treatment even more challenging and a greater need for developing self-acceptance to stay mentally strong.
Michelle having the remainder of her long hair cut after losing it throughout chemotherapy.
Self-Acceptance and Empowerment
As Kang has learned firsthand in her journey, self-acceptance and self-love in the face of breast cancer are extremely important. Not only do they make a difference in getting through the grueling treatment process, but also in the quality of life you live after treatment and in survivorship.
She found it helpful to connect with her body in ways that made her feel good, without focusing solely on its appearance. Shifting this focus can turn your perception of small physical milestones into big achievements and put a positive spin on how you feel about your body.
For her, just being able to take a walk during breast cancer treatment or when she did a push up for the first time during survivorship, reminded her to appreciate her body’s resilience.
“You might have thought to yourself that you should just be thankful to be alive and not worry about your looks, but it's important to understand that body image struggles are extremely valid, and you should never feel ashamed for having them after what your body has been through,” Kang said.
“While I may not have had a positive body image before or during cancer, I developed a new perspective and shifted my priorities after my breast cancer diagnosis and treatment. Because I fought so hard, I was motivated to become the best version of myself, and this included the act of redefining my relationship with my body and changing how I talked to it.”
Kang shares these strategies that she found helpful for self-empowerment and to maintaining emotional well-being:
Allow yourself to feel a multitude of emotions
“It’s so important to allow for the full spectrum of emotions, acknowledging that it’s entirely acceptable to experience a range of feelings simultaneously. It’s okay to grapple with both sadness and strength, to hold feelings of both anger and gratitude. I learned the hard way that forcing a constant state of positivity can have adverse effects on your emotional well-being. Grant yourself the space to authentically experience and process your emotions and extend self-compassion for whatever emotions resonate within your heart. Don’t ever forget that emotions can coexist.”
Try therapy
“A valuable lesson from my therapist resonates with me to this day. Therapy sessions don’t always have to yield profound epiphanies and aha-moments. They can also serve as a safe space for the release of emotions in the presence of a trained professional. At times, I refrained from sharing my emotions with friends and family, wary of burdening them and aware that certain nuances might be hard for them to fully grasp. Therapy provided me with a designated space on a recurring basis to freely express my feelings rather than bottle everything inside.”
Michelle about seven months into cancer survivorship.
Do things that bring you joy even when you feel sad
“My boyfriend, Paul, and I compiled a list of activities that brought me happiness, and we’d make plans throughout the week to have events and activities to look forward to. Even as I engaged in these activities, the thought of cancer and immense melancholy lingered in the corners of my mind. I learned that having the courage to continue on is one way you can take back your power from cancer. Amidst sorrow, it’s powerful to participate in activities that bring you joy, when possible. Equally important is extending self-kindness when you find yourself unable.”
Resources and Support
Learning how to have a healthy body image after a breast cancer diagnosis, treatment, and even during survivorship can be a monumental challenge. As Kang has shown us time, giving yourself grace, and seeking professional help in therapy, can make a world of difference in providing you with the tools you need to think about your body in a healthy way.
Here are some resources we recommend for supporting you in your journey:
Books:
The Body Image Workbook: An Eight-Step Program for Learning to Like Your Looks
Facing The Mirror With Cancer: A Guide To Using Makeup To Make A Difference
Organizations:
American Psychosocial Oncology Society (*They offer a national toll-free hotline as a resource to help people with cancer and their caregivers find counseling services in their own community. Call 1-866-7443.)
“Overcoming breast cancer in my twenties and dealing with the physical changes it brought—losing hair, losing breasts, bearing scars—showed me that loving yourself is so fundamental for finding joy and living a fulfilling life,” Kang said.
“It affects how you talk to yourself, how you present yourself, how you approach life, and how you treat others. Now, when I look in the mirror, I thank my body for what it’s endured, appreciate my battle wounds and what they represent, and focus on self-love.”
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