How do you deal with body changes post-breast cancer treatment?

Breast cancer is the number one cancer affecting Singaporean women. It’s also the leading cause of cancer deaths in women. One in 13 Singaporean women will develop breast cancer in their lifetime, according to data from the Singapore Cancer Society (SCS). 

While there are increasingly more conversations when it comes to raising awareness for the cause, the post-breast cancer journey is still one that’s hardly talked about. The day of your last radiation or chemotherapy treatment doesn't mark the end of your journey with breast cancer – you’d have to adjust to many changes in your life, including how your body looks and feels.  

Together with Dr See Hui Ti, a medical oncologist at Mount Elizabeth Hospitals and Gleneagles Hospital, as well as Mark Lin, SCS’s psychosocial support services head, we dissect how the body changes post-breast cancer, how to cope with such changes, and the types of support are out there for such patients and survivors. 

Self-image and breast cancer

Breast cancer treatments such as surgery, chemotherapy, radiation therapy, and other medicines, may cause one to have lower self-esteem. This is common amongst patients, says Mark. “Using mastectomy as an example, doctors tend to focus on providing educational information involving treatment processes, efficacy, outcome, and other clinical details in a typical clinical setting. Meanwhile, a breast cancer patient is also likely to worry about the impact of her treatment and how she deals with her new social reality as she leaves the clinic and returns to her family and community.”

He notes that “a female breast, beyond its biological function of being able to produce milk for child rearing purposes, is the probably the clearest symbol of femininity. It is visible, distinct and for many, makes a woman physically feel like a woman. In losing that to mastectomy, many breast cancer patients must readjust themselves emotionally to know that they are no ‘lesser’ than any other woman”. 

While cancer might be a different journey for everyone, typically, how does the body change during and after breast cancer treatment? 

According to Dr See, the most common physical changes aside from surgery are:

• Weight gain due to lowered metabolism 
• Dry sensitive skin
• Darkened skin and nails 
• Body aches and feeling lethargic 

“Fortunately, [these symptoms] are temporary,” stresses the doctor. “Especially if they listen to [their doctors and oncologists], participate in [recovery] activities, and eat a proper diet.” 

Losing a sense of trust in their body

For some, being diagnosed with cancer can cause them to lose confidence and trust in their bodies, for “the skin that was supposed to protect them has betrayed them on a cellular level”. “For a short while, some might [lose a sense of trust in their bodies],” says Dr See. “For those who feel like they know their bodies, it feels like the body has betrayed them. But with good medical and clinical assistance, this [sense of betrayal] can be transient.”  

Working through self-image and sexuality issues after a breast cancer diagnosis 

According to Mark, “every woman deals with mastectomy differently. What is similar is how everyone would embark on a journey in logical reasoning; creating a narrative of their physical loss and how they integrate into their new norm of living moving forward. ‘Actually, I’m ok. I didn’t have big breasts to begin with anyway’ – is a common response I hear from cancer survivors”. 

This sense of vulnerability can spill over to relationships, highlights Mark. “Breast cancer patients have to grapple with a significant difference in the way intimacy is expressed and enjoyed.”

To overcome this, he recommends congruent and authentic conversations between couples – it’s extremely important, although it is easier said than done. “To hold such precious conversations often entails one’s ability to be vulnerable and to express without the fear of rejection by our partners. Without psychological safety and trust, many couples may end up not talking about the elephant in the room and proceed to make assumptions about each other’s needs without necessarily finding a good way to successfully integrate intimacy meaningfully with cancer,” he explains. 

Lifestyle habits to stick to post-cancer treatment

Dr See’s tips include:  

• Good moderate nutrition
• A Mediterranean diet is the best for anticancer
• Being low in sugar intake is also extremely important
• Unfortunately, I tell my patients to stay away from fruits because of the high sugar content – there are no nutrients that fruits offer that vegetables cannot provide    

Tips on regaining body image and confidence for breast cancer patients

Dr See encourages one to be patient through the recovery process. “Know that Rome wasn’t built in one day, nor can the empire be wiped out in one day,” quotes the doctor. “I help my patients gain better body image and confidence in their body by encouraging them to take photos on a weekly basis to see through their transformation.” 

Mark agrees, emphasising the importance of building mental strength whilst you’re regaining your physical strength. “The thing about body image and confidence is that it is really about the psychological, as much as the physical. I hope that all breast cancer patients can learn to define their own personal beauty in their own terms and love themselves because they matter. For those with partners suffering from breast cancer, I hope they learn to embrace their imperfections, to empower them to rise above the illness and find the needed confidence to be themselves.”

Types of support are out there for such patients and survivors

Under the SCS Psychosocial Support Service (PSS), there are a wide variety of programmes to support cancer patients holistically.  

Mark explains: “I manage a team of social workers who provide counselling and emotional support for people facing psycho-emotional adjustments related to cancer. If there are sexual health related concerns, cancer patients (and their partners) can see our clinical sexologist to better address those issues.     

In addition, we run support groups and provide peer support through the SCS Patient Ambassador Programme, where we match cancer survivors to newly diagnosed cancer patients. In doing so, we hope cancer patients will not feel that they are battling this alone. There is a community of people living with cancer, who are willing to share their experience to encourage others through their cancer journey.” 

SCS also has a Look Good Feel Better programme open to all women with cancer who are undergoing chemotherapy, radiation, or other forms of treatment. In Singapore, SCS partners with industry-trained beauty professionals to teach cancer patients cosmetic techniques and hair alternatives to manage the physical changes brought about by cancer treatment.