Dr. Roseanne Gichuru and Dr. Monique Gary joined us to discuss the topic of body image challenges during and after cancer treatment. These are their answers to your follow-up questions:

“Do doctors still shy away from estrogen based creams for the dryness? My understanding is that the estrogen is not systemically absorbed. So we should be able to use these.”

From a generalist position, vaginal estrogen is ok for patients on tamoxifen. For women on AI, the decision to use is based on a discussion between the patient and care team  oncology/breast surgeon etc. Breast data shows it may be used as a last resort.


“I have a lot of concerns about loss of feeling and sensation with mastectomy. Can you comment on this?”

Loss of sensation is quite common post mastectomy. Studies show numbness or loss of sensation is more likely to decrease the further out from surgery one is and as nerve tissue regenerates. However, it may not fully return to pre surgery levels.


“Is breast reconstruction not recommended for someone that has Stage 4 Breast Cancer? If not, what do you recommend for breast that is sagging and shrinking in bra size?”

There is mixed data on reconstruction for stage 4. This maybe determined on a patient  by patient basis. Getting resized for bras is a good place to start. These services are offered at many department stores for free. Using cupped bras and or mastectomy bras may also be helpful.


“Advice for preparing for mastectomy mentally and emotionally? Preparing for loss of feeling, the big change, etc.”

Briefly – optimizing mental and emotional health, finding or aggregating a support team.  Physical exercise and PT will help.


“When on hormonal therapy (Tamoxifen & Lupron) that will eventually go to an AI, how do you get your libido and sexual desire back?”

Recognize that sexual wellness is multifaceted so managing mental, physical, nutrition, rest, hydration, etc then start to think about what used to turn you on and start a plan to get back to that. Sometimes low confidence interferes with libido too.

Engage the partner in the journey as well. Just as the woman is navigating this stage, so is the partner. It is a time of exploration and discovery for both parties.


“What if your surgeon and you don’t see eye to eye on where scars will be? I don’t feel like my doctors listen to me and what I want for my body and focus too much on the medical side only.”

A candid conversation with the surgical team regarding your concerns is a good place to start. Writing down your questions/concerns beforehand and taking a friend with you to the appointment is helpful. Discussing the anticipated consequences of your concerns is also  an important part of the conversation with the team. This conversation may need to happen over several appointments.


“I would like information on side effects or risks for having my implants removed?  I had a second surgery for capsular contraction but it came right back.  This is my second time with breast cancer so I had prior radiation. I am so uncomfortable all the time.”

Risks – bleeding, infection, risks associated with receiving anesthesia, seroma and hematoma formation, return to OR for additional surgery, pain, numbness, increased scarring, poor healing and cosmesis, and changes in cup size.


Watch the full video April Virtual Hangout: Navigating Body Image Challenge and Cancer at uniteforher.com/herlibrary