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Changes in Your Breast Size

Both surgery and radiation therapy can affect the size of your breast. It's easy to see this physical change. However, it's the changes you can't see in your self-image and sexuality that may have a much greater impact on your sense of well-being.

Cause and effect

A mastectomy involves removal of all or a sizable part of the breast and sometimes other tissue. Obviously, this can dramatically change the appearance of the breast area. However, even a lumpectomy, which involves removal of just the breast tumor and a small amount of surrounding tissue, can visibly change breast size in some women. In particular, removing a large tumor from a large breast may not much alter its appearance, but removing even a small tumor from a small breast may lead to a more noticeable change.

Radiation therapy after a lumpectomy sometimes affects the size of the treated breast as well. The breast may become larger due to fluid buildup or smaller due to the development of scar tissue. Any such change usually begins within a year of completing therapy, although it may last longer than that. However, if you notice any new change in breast size, shape, appearance, or texture after a year, tell your doctor right away.

Self-image and sexuality

Movies, television shows and magazines often create an unrealistic standard for the ideal female body. Many women feel that their real-life bodies don't measure up. When breast cancer treatment leads to a change in breast size, or the loss of part or all of a breast, this insecurity can be magnified. It's common for breast cancer survivors to wonder whether they will ever feel attractive or confident about their bodies again.

Since our culture also equates beauty with sexiness, a change in breast appearance can lead to self-doubts about sexuality as well. These doubts can turn into self-fulfilling prophesies if they keep a woman from relaxing, getting undressed, and enjoying intimacy with her partner. The good news is that neither surgery nor radiation therapy physically decreases a woman's ability to feel desire, lubricate vaginally, or reach orgasm. While some self-consciousness is normal at first, once women have had time to adjust psychologically to changes in their appearance, most go on to have sexually and emotionally satisfying lives.

More than skin deep

If you still are concerned by changes in the size of your breast, though, it may help to remind yourself that you are more than the sum of your parts. Your breast may not look the same, but you as a person are just as beautiful and desirable as ever. When you have self-doubts, discuss them openly with your partner. And since your breast cancer and its aftermath have probably been difficult for both of you, be patient with each other as you become sexually reacquainted. If sexual problems persist, however, talk to your doctor, nurse, or counselor. Or, to find a certified sex therapist in your area, visit the American Association of Sex Educators Counselors and Therapists website.

Of course, sometimes it just helps to talk to another woman who really understands what you are going through and who may be able to offer practical hints for coping. Breast cancer support groups can be an invaluable resource. The American Cancer Society's Reach to Recovery is one peer support program that encourages women to talk frankly about self-image issues. To find a Reach to Recovery program in your area, visit the American Cancer Society website or call (800) ACS-2345.

Practical points

Finally, women whose clothes don’t fit right because one breast is smaller than the other may find that wearing a breast enhancer helps to add symmetry. This is an insert that can be worn inside one cup of a bra for a more balanced appearance and a better fit. They come in different shapes and sizes because women’s surgeries are all individual and the amount of breast tissue removed varies. Another option is wearing bras with fiberfill. The fiberfill helps to camouflage asymmetry from one breast to the other. Those with larger differences in breast size, more than one cup size, may opt to wear a full breast form or have breast reconstruction surgery. There are many options available for a full breast form: attachable, lightweight, climate-control, and others. Even after reconstruction, however, many women still wear a small breast shell or pad, since the new breast may differ somewhat from the natural one. Also, for some women who have had reconstruction, over time, the natural breast may change shape, increase in size due to weight gain or decrease in size due to weight loss.