Body image and breast cancer

Body image is one part of self-esteem. Self-esteem is how you feel about yourself as a whole, which includes your skills and talents as well as your limits and flaws. People with healthy self-esteem generally feel good about themselves and believe they deserve respect from others.

Being diagnosed with, and treated for, breast cancer is one of many experiences that can affect your body image and self-esteem. How you feel about your body image during and after treatment depends on a number of things. For example, your self-esteem and body image can be related to the type of treatment you’ve had (and how your body may have changed as a result), your personal history, and how you felt about yourself physically and emotionally before cancer.

There is no doubt: breast cancer treatment can cause trauma that affects your body, your mind, and your emotions. Surgery, chemotherapy, radiation therapy, and other treatments can have side effects that impact how you look and feel; and treatment, in general, can make you feel tired and scared. It’s not unusual to experience depression or anxiety at some point before, during or after treatment.

No two people share the same feelings about their body image, and no two people experience their diagnosis or treatment the same way either. How you react to and cope with your body image after treatment is unique to you and your life. Your body image can change depending on your emotions and your mental health at any given time. For example, if you’re feeling sad, depressed, or anxious, you may have a negative body image. In contrast, if you’re happy with what you’re doing, how your life is going, and how you feel you managed during treatment, you may not think so much about how others see you, and you’ll likely have a more positive body image.

Body image also affects how you interact with others. It can have a big effect on your intimate and sexual relationships, because those areas of your life are closely linked with how you feel about your physical self.

Everyone responds differently to the physical changes of breast cancer. Some factors that could impact your response are:

• Your age
• Your gender identity, how you express gender through your appearance and communication style, and your sexual orientation
• What breasts, hair, and other physical features mean to your identity
• How you felt about your body before diagnosis
• A personal history of sexual abuse
• A personal history of eating disorders
• A personal history of serious illness
• Whether you have a disability
• Media messages (from TV, ads, or social media)

Your past experiences and relationships, personality, and your support system also play a role.

Managing self-esteem

Some people may have lower self-confidence or self-esteem after treatment. If you’ve been diagnosed and treated for breast cancer, it’s normal to worry that people may see you differently, feel bad for you, or think you can’t do things you used to do. Sometimes, people say things about treatment-caused physical changes that can be upsetting, even if they don’t mean to.

Low self-esteem can be connected to negative body image and poor quality of life. If diagnosis and treatment have affected your self-esteem, let your care team know how you’re feeling, and ask about options. You may also choose to see a licensed mental health professional or join a support group. Your nurse navigator or hospital social worker can also connect you with support.

Remember that your body is just one part of you — and that there are things you can do to help you feel better about yourself. For example:

• Acknowledge that you faced something that was hard to go through. Be kind to yourself.
• Allow time to adjust to your body’s changes.
• Remind yourself that messages in the media and our culture often show idealized female bodies, not the bodies of real women who have had real life experiences.
• Spend time with people who love and support you.
• Embrace humor when possible. Laughter is good for the mind and the body.
• Do something thoughtful for a loved one to take the focus away from your own thoughts and worries.
• Become a volunteer to support other people who are in treatment for breast cancer. Your experience could benefit someone else during a challenging time. Volunteering can also build a sense of confidence, leadership, and connection.
• Exercise and take care of your physical health.
• Buy new clothes, skin care products, or accessories if that makes you feel good.
• Enjoy a bath, a nap, or being outdoors.

Learn more about managing the emotional side effects of a breast cancer diagnosis.

Coping with side effects that impact body image

There are many things you can do to manage the most common side effects of breast cancer treatment that affect your physical appearance. Keep in mind that what works for someone else may not work for you; different people may find a sense of empowerment in different ways. Do what makes you comfortable. You may choose to:

• Use a wig, hat, or scarf to cover hair loss
• Embrace baldness — or other visual side effects (scars, skin changes) of having cancer — as a symbol of what you have gone through
• Have reconstructive surgery to rebuild the breast(s) if mastectomy (breast removal) is part of your treatment
• Go flat (choose not to have reconstructive breast surgery) after mastectomy
• Get a tattoo to make any scars into something meaningful for you

Treatment-related weight gain can also affect body image. If you’ve gained weight after chemotherapy or other treatments and are having a hard time losing weight, talk with your health care team. A registered dietician can help, too.

Eating well, being active, and getting enough rest are also good for your overall health and sense of well-being.

Using complementary therapies can also help if you are struggling with body image issues after treatment. These practices can reduce stress and improve the quality of your life. Examples include:

• Guided imagery
• Art therapy
• Expressive writing
• Mindfulness-based stress reduction

Sex after breast cancer

Breast cancer treatments can cause fatigue, discomfort, pain, and other changes to your body. These changes may lower your sex drive or make sex painful. Stress can have the same effect.

For women whose breasts were part of arousal or for whom breast play was enjoyable or a trigger for orgasm, the loss of one or both breasts can have a major impact on your sexual response and satisfaction.

Some women with a breast cancer history report lower sexual desire, lower ability to reach orgasm, more sex-related pain, and less frequent sex than women who have not had breast cancer. But there are ways that you can improve your sex life and manage these side effects. For example, if you have gone through premature menopause as a result of treatment, you may have vaginal or vulvar dryness, which can make sex hurt. Talk with your oncologist or gynecologist about lubricants and moisturizers that can help. Your care team is there to support and advise you, too. It can also help to connect with other women who’ve been treated for breast cancer about how they manage sexual side effects.

If you are in a sexual relationship, even if the desire is there, you might feel uneasy about the changes to your body. It’s normal to worry about a partner’s response to how your body has changed. Be open and honest about what you’re feeling, and encourage your partner to do the same. Seeking advice from a couples counselor or sex therapist may also help.

Keep in mind that sex and intimacy are different things. Holding hands, kissing, touching, and just spending time with a partner can maintain intimacy, even if you aren’t having sex or as much sex as you had in the past.

If you are not in a sexual relationship, it can be nerve-wracking to tell potential new partners about your breast cancer history. Take new relationships slowly. If you’re nervous about telling a date about your diagnosis, you can practice what you’re going to say in a mirror or with a trusted friend first. Don’t be shy about ending the relationship if the person can’t handle it. Read more about sex and intimacy after a diagnosis.

Whether or not you are sexually active with a partner, masturbation is a way to explore how your body has changed and responds to touch, and to feel physical pleasure and orgasm. Watch the Sex, intimacy, and breast cancer video series presented by our Young Women's Initiative to hear personal stories from young women diagnosed with breast cancer.

Finding support

Body image issues after breast cancer treatment can lead to a variety of strong emotions. Any and all of these emotions are normal, and there are many ways to find support and connection to help you cope and move forward. Support may be available from:

• Doctors or other members of your health care team, including hospital social workers
• Support groups for people who have been treated for cancer
• Trusted friends and family members

Visit these pages to learn more about supportive resources:

• Community
• Breast cancer support groups
• Emotional health

You can also call or visit the LBBC Breast Cancer Helpline to be matched with a trained volunteer who has been treated for breast cancer. Our volunteers are here for you — with emotional support, guidance, and hope.