The Contemporary Psychoanalysis Group

Contemporary Psychoanalysis in Action

Making The Best Decision For Your Breast Cancer Surgery

The importance of exploring thoughts, feelings and associations

Posted Oct 26, 2014

By Katherine Noordsij, LCSW, PhD (Lit.)

This post is in recognition of National Breast Cancer Awareness Month—October 1 though 31st.

Breast cancer is a disease of the body.  For the patient’s doctor, questions like these must be answered: where is the cancer, what kind of breast cancer is it, what stage is it, what is the prognosis and how should it be treated.  But what does having breast cancer mean to the woman?  Exploring thoughts, feelings and associations can help a woman navigate her experience.

Meaning is evoked with different questions: how do you feel, what do you fear, what do you regret, what do you want. Breast cancer attacks a life-giving symbol of female fertility and sexuality, starkly silhouetting it against mortality.  Making meaning of this battle is difficult, but it will help a woman make more informed treatment decisions, and resume her life with a deeper understanding of herself and her relationships.

The Diagnosis

I stared through the windshield at the chain-link fence in front of my car.  I had pulled into the CVS parking lot, two blocks from the breast center.  The radiologist had told me to come back for a second mammogram in an hour. I might have breast cancer.  I couldn’t think.  I couldn’t move.  Just hearing that a mammogram is suspicious is terrifying.

The Decisions

Before treatment starts, the newly diagnosed breast cancer patient must make decisions that can stir powerful emotions. These decisions may include whether or not to spare the breast, and whether or not to have reconstruction.

Our breasts are a source of sexual pleasure and sexual attractiveness. From birth onward, breasts play a role in the dance of life.  To face a change in the breast or its loss has a profound impact. And there are fears of death, leaving children motherless, cutting short loving relationships, all of which can make a woman reel. 

Studies have shown that a lumpectomy with radiation has a better outcome in many cases than a mastectomy.  Women who are given the choice sometimes still prefer to have a mastectomy—their fear of death drives them to conclude that the only safe solution is to remove the entire breast. Some even wish to remove the healthy breast as well.  Off with them both, they decide, never to face the diagnosis of breast cancer again.

The treatment may include decisions about reconstruction.  One choice is to do nothing, leaving the chest wall flat. Alternately, a woman can have an implant in her body.  A silicone breast-shaped balloon is inserted under the muscle wall of the chest after many months of slowly stretching the skin with saline injections into a temporary balloon.

The “gold-standard” is to use muscles and fat tissue from one’s own body, snaked up from the belly or the back to shape new breasts.  Here is an opportunity to trump nature.  What breasts do you wish you had?  Size C, D?  Why not have augmentation surgery, and then make yourself over by adding a tummy tuck?

Facts and Feelings About Reconstruction:

Whether or not to have reconstruction, and then what type, are decisions much affected by how we feel about our bodies, our breasts.

  1. Losing a breast is an amputation, an assault to body integrity.  What will it feel like to look down at the front of your chest after the surgery and see flatness or perhaps a concavity?
  2. How did you feel when you were a young adolescent and your breasts did or didn’t begin to develop? 
  3. How do you feel in your own body as you move about your life?
  4. How much do you love your perky or voluptuous breasts and how they affect the people who look at you?
  5.  How much do you treasure or hate your fallen or pancake breasts, reflecting your age, life experiences, gravity?  

Issues to Consider Post-Surgery

Life after surgery will be different.  Chemotherapy in the form of a daily pill can continue for as long as 10 years.  Reconstruction can take months and cause issues long after the surgery.  The yearly mammogram, threatening to every woman, triggers frightening memories.

Sex with an existing partner may be affected although perhaps only for a short time. If a woman is single and looking for intimacy, she may expect her feelings about her changed body will impact how she and her partner negotiate physical intimacy.  Troubling feelings, such as fear, guilt, and shame, may interfere with the desire for intimacy and reduce a person’s ability to experience many of life’s joys.


There are many sources of help for a woman to explore what breast cancer means to her. Family and friends can help her hold the anxiety and discuss decisions.  Some breast cancer centers provide comprehensive care.  Many women find solace and assistance in groups of fellow-patients.  Survivors and doctors have written books on the process of treating and recovering from breast cancer.  Others find that a psychotherapist is a useful companion.

A psychotherapist is uniquely qualified to help the patient discover what it means to her to have breast cancer and to discover feelings hiding in the unconscious. If a feeling is too frightening to acknowledge, the mind may protect a person from this feeling, but it doesn't go away. Sometimes what remains is a “protective” reaction such as anger or denial. These unrecognized feelings can contribute to depression or derail treatment.  

In a safe therapeutic relationship, where a person is encouraged to say whatever comes into her mind, these feelings may emerge. I found that such a relationship helped me explore what my encounter with breast cancer meant to me and helped me to make better decisions, become more fully aware of myself and more present with others.

By Katherine Noordsij, LCSW, PhD (Lit.), is a graduate of the William Alanson White Organization Program and the Psychoanalytic Program.  She is in private practice and has offices near Columbus Circle in New York City and in Summit, New Jersey.  Visit her website,  Contact her at