# A 52-year-old woman with newly diagnosed stage II breast cancer is scheduled for a modified radical mastectomy followed by adjuvant chemotherapy. During preoperative teaching, she expresses anxiety about body image changes and asks about reconstruction options. What is the most appropriate nursing intervention at this time?

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> subject: Adult Health

## 문제

A 52-year-old woman with newly diagnosed stage II breast cancer is scheduled for a modified radical mastectomy followed by adjuvant chemotherapy. During preoperative teaching, she expresses anxiety about body image changes and asks about reconstruction options. What is the most appropriate nursing intervention at this time?

## 보기

1. Reassure the patient that her husband will love her regardless of physical changes and that she should focus on recovery.
2. Provide detailed information about all reconstruction options and recommend immediate reconstruction
3. Suggest she focus on survival rather than appearance since the cancer treatment is the priority
4. Acknowledge her concerns, provide basic information about reconstruction timing options, and arrange a plastic surgery consultation. **✔ 정답**

**정답: 4**

## 해설

The nurse should validate the patient's concerns and provide appropriate resources for informed decision-making about reconstruction options.

This question addresses the nurse's important role in dealing with the complex psychosocial issues related to a patient's concerns about body image changes and reconstruction decisions before breast cancer surgery. Acknowledging the patient's concerns about body image changes after mastectomy is the correct approach. This is a normal psychological reaction to life-altering surgery.

Breast reconstruction is a personal decision that requires careful consideration of multiple factors, including cancer stage, treatment plan, patient preferences, and medical indications. The timing of reconstruction is divided into immediate reconstruction (at the same time as mastectomy) or delayed reconstruction (months to years later), each with its own advantages and considerations. Immediate reconstruction can preserve the breast skin and offer psychological benefits, while delayed reconstruction allows cancer treatment to be completed first.

The most appropriate nursing intervention combines emotional support with practical resource coordination. By acknowledging the patient's concerns, the nurse validates the patient's feelings and establishes therapeutic communication. Providing basic information about reconstruction timing helps the patient understand options without being overwhelmed by excessive details. Most importantly, arranging a plastic surgery consultation ensures the patient receives professional guidance tailored to their specific situation.

This approach respects the patient's autonomy in decision-making while ensuring access to appropriate resources. The plastic surgeon can discuss surgical options, timing considerations, risks, benefits, and realistic expectations based on the patient's individual circumstances and cancer treatment plan.

## 심화 해설

Understanding the Patient's Concern

The patient is expressing anxiety about body image changes and inquiring about reconstruction options. This is a critical moment in preoperative care. Research demonstrates that body image disturbance and social avoidance are significant adverse reactions following modified radical mastectomy, directly impacting psychological well-being [4]. The nursing priority is not to dismiss this concern or to push a specific clinical pathway, but to validate the patient's feelings and facilitate informed, shared decision-making.

Analysis of Incorrect Options

- Option 1: Reassuring the patient that her husband will love her is dismissive. It invalidates her personal experience of body image as a component of her own identity and sexuality, not just a factor in her relationship. A systematic review confirms that breast reconstruction significantly impacts sexual function and body image for the survivor herself, making this a deeply personal concern [1].

- Option 2: Providing detailed information on all options and recommending immediate reconstruction is premature and directive. A mixed-methods study highlights that women's goals for reconstruction are highly complex and vary based on individual values, not clinical assumptions [2]. The nurse's role is to support autonomy, not to steer the patient toward a specific surgical decision.

- Option 3: Suggesting she focus on survival over appearance creates a false hierarchy of needs. As survival rates improve, clinical focus has shifted toward quality of life and psychosexual survivorship [1]. Addressing body image is not a cosmetic luxury; it is integral to holistic cancer recovery.

Why Option 4 is Correct

Acknowledging her concerns validates the patient's emotional state, which is a foundational therapeutic communication technique. Providing basic information about reconstruction timing options (immediate vs. delayed) addresses her expressed knowledge deficit without overwhelming her or overstepping nursing scope. Crucially, arranging a plastic surgery consultation is the most appropriate action because it connects the patient with the expert who can engage in detailed shared decision-making. Research on decisional support tools shows that structured preoperative information, such as that provided by a specialist, significantly improves decisional confidence and reduces decisional conflict . This intervention respects the patient's autonomy, ensures she receives accurate and tailored information from the correct source, and addresses the core nursing goal of managing expectations to improve long-term satisfaction [2].References (research sources)

- [1]Impact of breast reconstruction on sexual function and body image in breast cancer survivors: A systematic review.Meta-analysis/systematic reviewTriantafyllou M, Michalopoulos N. (2026) · DOI: 10.1016/j.jpra.2026.05.056

- [2]Are Expectations in Breast Reconstruction Manageable? A Mixed-Methods GoBreast II Study on Women's Goals of Breast Reconstruction After Mastectomy.Research articlePaganini A, Karlsson SA, Westesson LM, Larsson C, Uusimäki A, Svensson K, Sparding T, Hansson E. (2026) · DOI: 10.1016/j.clbc.2026.02.009

- [4]Effects of digital exercise therapy and cognitive behavioral therapy on body image and social distance of postoperative patients with breast cancer: study protocol for a randomized controlled trial.RCT/clinical trialPeng M, Wu X, Chen X, Yao B, Ke Q, Sun Y, Wu X, Liu S. (2026) · DOI: 10.1186/s13063-026-09754-9

## 임상 시나리오

Preoperative Body Image Support in Breast CancerValidating concerns and facilitating informed choices
When a patient expresses anxiety about body image before a modified radical mastectomy, the priority is to acknowledge and validate her feelings. Do not dismiss concerns by redirecting focus to relationships or survival.

The most appropriate intervention is to provide basic information about reconstruction timing (immediate vs. delayed) and arrange a plastic surgery consultation. This supports shared decision-making without being directive.

CautionAvoid recommending a specific surgical option. The goal is to empower the patient with information and access to specialists, respecting that individual values and goals for reconstruction vary significantly.

## 핵심 개념

- **Modified Radical Mastectomy** — Surgical removal of the entire breast, including the nipple-areolar complex, and axillary lymph node dissection, while preserving the pectoralis major muscle.
- **Adjuvant Chemotherapy** — Systemic drug treatment given after primary surgery to eliminate micrometastases and reduce the risk of cancer recurrence.
- **Shared Decision-Making** — A collaborative process where clinicians and patients make health decisions together, integrating clinical evidence with patient values and preferences.
- **Body Image Disturbance** — A subjective negative perception of one's physical appearance, a common psychological sequela following mastectomy that can impair quality of life.
- **Plastic Surgery Consultation** — A preoperative referral to a reconstructive surgeon to discuss options like implant-based or autologous tissue reconstruction, timing, and expected outcomes.

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