Date of Award


Document Type



Edith Cowan University

Degree Name

Bachelor of Nursing Honours


School of Nursing


Faculty of Computing, Health and Science

First Supervisor

Associate Professor Kathryn White


Breast cancer is the most common of all cancers in women (26%) in Australia (Australian Institute Health Welfare AIHW, 1996; National Breast Cancer Centre NBCC, 1999). It is estimated that the lifetime incidence of one in eleven women in Australia will be diagnosed with breast cancer by the age of seventy-four (National Health and Medical Research Council NHMRC, 2000). Surgical resection continues to be the mainstay of treatment for early breast cancer, with approximately 50% of women diagnosed with breast cancer undergoing mastectomy (NBCC, 1999). Both the diagnosis of breast cancer and subsequent mastectomy raises a number of psychosocial issues for women. In addition to the diagnosis of a potentially life threatening illness, these women contend with the psychological consequences that accompany the loss of a breast. During the height of development of breast reconstructive techniques in the 1980's, mastectomy became more commonly recognised as an important aspect of a woman's experience with breast cancer. Breast cancer not only causes pain, suffering and the possibility of death, but also threatens a woman's self-concept, self-esteem and feminine identity through its attack on her body (Derogatis, 1986). To reduce the psychological impact associated with removal of the breast, breast reconstruction is increasingly being offered. In the past five years there has been an increase in the number of women seeking breast reconstruction, with an increasing focus on quality of life issues and survivorship for women diagnosed with breast cancer (Wilkins et al., 1995). To date little is known about women's experiences of undergoing breast reconstruction. Using a qualitative, exploratory descriptive approach this study investigated the impact of the transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction, on self-esteem and perceived body image for women with breast cancer. In depth semi-structured interviews, using both individual and focus group methods, were undertaken with ten women who had undergone a TRAM flap breast reconstruction between January 1st 2001 and January 1st 2003. Data was analysed using the process of thematic analysis to determine key concepts and themes that described these women's experiences. Three main themes emerged from the findings of this study: "Loosing a breast matters", ''The process of adjusting to a changing body image", and "Redefining normality". These themes and their sub-themes describe the experience of breast cancer survival and TRAM flap breast reconstruction for the women who participated in this study. These findings will further the current knowledge base on this topic and therefore assist nurses in providing sound information and psychosocially appropriate support to TRAM flap breast reconstruction patients and their significant others. Furthermore, this study's findings will be a further resource for women considering breast reconstruction treatment options following mastectomy.