Article Type: Original Articles
The Effects of Mastectomy and Post-Mastectomy Reconstructive Surgeries on Depression, Self-esteem, and Self-efficacy Belief Levels in Patients with Breast Cancer
Zehra Kanmaz, Osman Tolga Aricak
Objective: The aim of this present study is to examine the effects of mastectomy and post-mastectomy reconstructive operations on depression, self-esteem, and self-efficacy belief levels in patients with breast cancer compared with healthy controls.

Methods: A cross-sectional and correlational research design was implemented. Our study sample were composed of 240 women. Participants were 75 mastectomy patients, and 32 post-mastectomy reconstructive surgery patients, and 133 healthy women. In data collection, Personal Information Form, General Self-efficacy Scale, Coopersmith Self-esteem Inventory and Beck Depression Inventory have been used. Due to non-normal distribution of the variables; Mann-Whitney U, Kruskal-Wallis H and Spearman Rho correlation techniques were used to analyze the data.

Results: We found that mastectomy patients’ depression scores were higher than patients who had post-mastectomy reconstructive operation and control group. In addition; compared to patients with post-mastectomy reconstructive operations and control group, mastectomy patients had lower levels of self-esteem and self-efficacy beliefs.

Conclusions: It was then concluded that in terms of depression, self-esteem and self-efficacy levels, the best treatment might have been a combination of chemotherapy, hormonal therapy, and reconstructive surgery.


1.Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res 2017;50(1):33-56.

2.Denizgil T, Sonmez I. Comparison of self-esteem, body image, sexual satisfaction and sexual experiences between women who has mastectomy or breast conserving surgery for breast carcinoma. [Meme kanseri nedeni ile meme koruyucu cerrahi geçirmiş kadınlarla mastektomi operasyonu geçirmiş kadınlar arasında benlik saygısı, beden algısı, cinsel doyum ve cinsel yaşantıların karşılaştırılması]. Yeni Symposium 2015;53(3):17-25. [Turkish]

3.Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin 2019;69(1):7-34.

4.World Health Organization (2018, September 12). International agency for research on cancer. Latest global cancer data (Press release no 263). Retrieved from content/uploads/2018/09/pr263_E.pdf

5.Lundqvist A, Andersson E, Ahlberg I, Nilbert M, Gerdtham U. Socioeconomic inequalities in breast cancer incidence and mortality in Europe-a systematic review and meta-analysis. Eur J Public Health 2016;26(5):804-13.

6.Carroll AJ, Baron SR, Carroll RA. Couple-based treatment for sexual problems following breast cancer: A review and synthesis of the literature. Support Care Cancer 2016;24(8):3651-9.

7.Male DA, Fergus KD, Cullen K. Sexual identity after breast cancer: sexuality, body image, and relationship repercussions. Curr Opin Support Palliat Care 2016;10(1):66-74.

8.Recio-Saucedo A, Gerty S, Foster C, Eccles D, Cutress RI. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. The Breast 2016;25:1-13.

9.Fang SY, Shu BC, Chang YJ. The effect of breast reconstruction surgery on body image among women after mastectomy: A meta-analysis. Breast Cancer Res Treat 2013;137(1):13-21.

10.Lee GK, Sheckter CC. Breast reconstruction following breast cancer treatment-2018. JAMA 2018;320(12):1277-8.

11.Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 2000;36(15):1938-43.

12.Ha EH, Cho YK. The mediating effects of self-esteem and optimism on the relationship between quality of life and depressive symptoms of breast cancer patients. Psychiatry Investig 2014;11(4):437-45.

13.Han J, Grothuesmann D, Neises M, Hille U, Hillemanns P. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet 2010;282(1):75-82.

14.Sun Y, Kim SW, Heo CY, Kim D, Hwang Y, Yom CK, Kang E. Comparison of quality of life based on surgical technique in patients with breast cancer. JPN J Clin Oncol 2014;44(1):22-7.

15.Bandura A. Self-Efficacy: the exercise of control. New York: Freeman, 1997, p.31.

16.Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, et al. Cancer survivors’ self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv 2015;9(1):11-9.

17.Porter LS, Keefe FJ, Garst J, McBride CM, Baucom D. Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress. Pain 2008;137(2):306-15.

18.Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The Self-effıcacy Scale: construction and validation. Psychol Rep 1982;51(2):663-71.

19.Yildirim F, Ilhan IO. The validity and reliability of the general self-efficacy scale-Turkish form [Genel Öz Yeterlik Ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması]. Turkish J Psychiatry 2010;21(4):301-8. [Turkish]

20.Magaletta PR, Oliver JM. The hope construct, will, and ways: Their relations with self-efficacy, optimism, and general well-being. J Clin Psychol 1999;55(5):539-51.

21.Coopersmith S. The antecedents of self-esteem. San Francisco: WH Freeman and Company, 1967.

22.Turan N, Tufan B. Validity and reliability study of Cooopersmith self-esteem scale [Coopersmith Benlik Saygısı Envanteri’nin (SEI) geçerlik-güvenirlik çalışması] in 23. National Psychiatry and Neurological Sciences Congress Book (pp. 817-818), Istanbul, 1987. [Turkish]

23.Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.

24.Hisli N. A validity and reliability study of Beck depression inventory in a university student sample [Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği]. J Psychol 1989;7(23):3-13. [Turkish]

25.Eti Aslan F, Gurkan A. The risk of breast cancer at the women [Kadınlarda meme kanseri risk düzeyi]. J Breast Health [Meme Sağlığı Dergisi] 2007;3(2):63-8. [Turkish]

26.Sertoz Onen O, Elbi Mete H, Noyan A, Alper M, Kapkac M. Effects of surgery type on body image, sexuality, self-esteem, and marital adjustment in breast cancer: A controlled study [Meme kanserinde ameliyat tipinin beden algısı, cinsel işlevler, benlik saygısı ve eş uyumuna etkileri: kontrollü bir çalışma]. Turkish J Psychiatry 2004;15(4):264-75. [Turkish]

27.Lee CN, Deal AM, Huh R, Ubel PA, Liu YJ, Blizard L, et al. Quality of patient decisions about breast reconstruction after mastectomy. JAMA Surg 2017;152(8):E1-E8.

28.Mátrai Z, Kenessey I, Sávolt Á, Újhelyi M, Bartal A, Kásler M. Evaluation of patient knowledge, desire and psychosocial background regarding postmastectomy breast reconstruction in Hungary: A questionnaire study of 500 cases. Med Sci Monit 2014;20:2633-42.

29.Tsai HY, Kuo RNC, Chung K. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: a multicenter study in Taiwan. JPN J Clin Oncol 2017;47(10):909-18.

30.Hvilsom GB, Hölmich LR, Frederiksen K, Steding-Jessen M, Friis S, Dalton SO. Socioeconomic position and breast reconstruction in Danish women. Acta Oncol 2011; 50(2):265-73.

31.Kim MK, Kim T, Moon HG, Jin US, Kim K, Kim J, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol (EJSO) 2015;41(3):426-32.

32.Morrow M, Mujahid M, Lantz PM, Janz NK, Fagerlin A, Schwartz K, et al. Correlates of breast reconstruction. Cancer 2005;104(11):2340-6.

33.Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000;26(1):17-9.

34.Rubino C, Figus A, Lorettu L, Sechi G. Post-mastectomy reconstruction: A comparative analysis on psychosocial and psychopathological outcomes. J Plast Reconstr Aesthet Surg 2007;60(5):509-18.

35.Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: A prospective, multicenter study. Plast Reconstr Surg 2003;111(3):1060-8.

36.Adachi K, Ueno T, Fujioka T, Fujitomi Y, Ueo H. Psychosocial factors affecting the therapeutic decision-making and postoperative mood states in Japanese breast cancer patients who underwent various types of surgery: Body image and sexuality. JPN J Clin Oncol 2007;37(6):412-8.

37.Sun MQ, Meng AF, Huang XE, Wang MX. Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy. Asian Pac J Cancer Prev 2013;14(1):149-52.

38.Zhang C, Hu G, Biskup E, Qiu X, Zhang H, Zhang H. Depression induced by total mastectomy, breast conserving surgery and breast reconstruction: A systematic review and meta-analysis. World J Surg 2018;42(7):2076-85.

39.Akca M, Ata A, Nayir E, Erdogdu S, Arican A. Impact of surgery type on quality of life in breast cancer patients. J Breast Health 2014;10(4):222-8.

40.Topuz E, Uygun K, Aydiner A. Systemic treatment in breast cancer [Metastatik meme kanserinde sistemik tedavi] in Breast Cancer [Meme Kanseri] (1st Edition), pp.485-509, Istanbul: Nobel Tip Kitapevleri, 2003.

41.Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and chronic cutaneous reactions to ionizing radiation therapy. Dermatology Ther 2016;6(2):185-206.

42.Cathrine Lauridsen M, Overgaard M, Overgaard J, Hessov IB, Cristiansen P. Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncol 2008;47(4):569-75.

Key words: Cancer, depression, mastectomy, reconstructive surgery, self-esteem, self-efficacy.
Psychiatry and Behavioral Sciences 2019;9(3):119-127
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License