Body image is a multidimensional, subjective and dynamic concept that encompasses a person's perceptions, thoughts, and feelings about his or her body. Body image is not limited to the aesthetic characteristics of the person, taking also into consideration his or her state of health, skills and sexuality (Neagu, 2015).
It is not uncommon that young, middle aged and elderly are found to have tumours in their breast or any part of the body that normally require a surgical procedure that might mean that part or whole are removed. Changing the image of a person's body might mean that she/he no longer feels whole.
Surgery on specific parts of the body also impacts on body image. Wounds resulting from surgery on the breast, uterus can have significant meaning for women, as it is connected to their reproductive functions, while surgery on the male genitalia links to reproduction and sexual prowess. Women may see the surgery as a loss of their feminity and a loss of ideal body, while men undergoing abdominal or prostatic surgery may fear impotence and loss of their manhood, also affecting their ideal body.
Body image perceptions adapt to the naturally changing events in life such as puberty, pregnancy and ageing. However, unpredictable or unavoidable changes to body image, such as those that can occur due to the trauma of surgery, sometimes precipitate long-term consequences. These may alter perceptions of body presentation and consequently self-image.
Certain operations can cause arouse specific fears in addition to the fear of pain and even the threat of life (e.g. mastectomy, formation of an ileostomy, colostomy or amputation) where fears of mutilation can be highly stressful. These fears can be related to the consequences of the change in daily life, and thus the perceived alteration of a concept of self (Atkinson, 2016).
According to Pudner (2016) changes that occur as a result of the surgical procedure, such as mastectomy or colostomy, may cause a disruption in body image, thus, a holistic approach to care should always consider the issue of altered body image as an impact of surgery, an integral part of a person's well being. Perceptions of damaged or altered body image, and thus the self-image, may significantly affect the patient's rehabilitation. This presupposes that health professionals are fully aware of the many meanings that changes in body image could have for the patient, the burdens that are carried by the individual and the factors that affect those burdens.
Breast surgery, either a lumpectomy or mastectomy, changes the shape of the breast and so effects body reality (Keeton and McAloon, 2002) and may impact on the woman's role in society. There may also be an associated feeling of shame and the woman may withdraw from an intimate relationship with her partner/husband (Smith, 1997).
If patients have a stoma formed, either temporary or permanent, it is a violation of body's integrity (Borwell, 1997) and can threaten the patient's self-esteem. It may alter their position in their social/cultural community and may lead to a life of isolation. Loss of body image causes a grief reaction which will release in the afflicted person feelings of insecurity, particularly if the person perceives the change as a crisis.
Fingeret (2014) conceptualizes body image concerns of patients with cancer on a continuum. For example, patients with mild to moderate difficulties adjusting to body image changes may engage in social situations even though they feel somewhat self-conscious. In contrast, those with extreme body image concerns avoid social situations nearly altogether and become isolated. It posits that many patients minimize body image difficulties due to shame, embarrassment, or guilt. Within this framework, a patient's body image concerns are not necessarily considered to be pathological in nature, but in most case a normative experience.
Body image is recognized as a critical psychosocial issue for patients with cancer. Body image is a complex construct that extends well beyond how one views his or her physical appearance. It has most consistently been defined as a multifaceted construct that involves perceptions, thoughts, feelings and behaviors related to the entire body and its functioning. According to the study of Fingeret, they point to a broad range of bodily changes a patient with cancer can undergo due to the disease and treatment that can affect body image. These include but not limited to appearance alterations (hair loss, scarring, swelling) sensory changes (pain, numbness) and functional impairment (dysphagia, dysarthria, impotence).
Cancer surgery may change the way one's body looks and feels. Any surgery that changes how the body looks and functions can affect one's body image. Body image can also be affected if a patient did not receive the outcome he or she expected after surgery. For example, during the surgery, the surgeon may find that a more extensive surgery is needed. Patients may have trouble coping with this change afterwards. Concerns about body image affect from 31% to 67% of the estimated 3.1 million survivors, according to Breast Cancer Survivorship Care Guideline from the American Cancer Society and the American Society of Clinical Oncology (ASCO). Hair loss, mastectomy (with or without reconstruction) and the poorer mental health are some of the most common self-image concerns.
The nurse identifies potential threats to the patient's body image and assesses the patients' ability to cope with the many assaults to body image he or she experiences throughout the course of disease or treatment. To accommodate treatments or because of the disease, many patients with cancer are forced to alter their lifestyles. Priorities and values change when body image is threatened. Disfiguring surgery, hair loss, cachexia, skin changes, altered communication patterns, and sexual dysfunction are some of the devastating results of cancer and its treatment that threaten the patient's self-esteem and body image (Smeltzer, 2011).
Therefore, the researcher chose to study this problem because, as practicing the nursing profession in the hospital setting. Many of the patients who were most of the time irritated and does not communicate well with the health care team. Understanding our patient's feelings are one of the most important factor in a nurse-patient relationship especially in an illness which has a long-term treatment plan. It can affect the nurse's way of caring the patient without understanding the root cause of the behavior the patient portrays.
The purpose of this study is to provide further understanding on the link between the patient's post-operative experience, the impact of surgery, the coping mechanism used and their adaptation to their disease, and consequently, give recommendations related to the enhancement and support of cancer patients in the community. Moreover, this work could help encourage patients and those nurses who takes care with such disease, to give particular emphasis and take considerations on the impact of surgery, coping mechanism enrichment and adaptation among patients. Nurses need to support their patients to reduce stress, prevent depression and improve quality of life.