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class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Experiences of young mastectomised Colombian women: An ethnographic study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "113" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Celmira Laza-Vásquez, María Elena Rodríguez-Vélez, Jasleidy Lasso Conde, Alix Yaneth Perdomo-Romero, Roland Pastells-Peiró, Montserrat Gea-Sánchez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Celmira" "apellidos" => "Laza-Vásquez" "email" => array:1 [ 0 => "celmira.laza@usco.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Elena" "apellidos" => "Rodríguez-Vélez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jasleidy" "apellidos" => "Lasso Conde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alix Yaneth" "apellidos" => "Perdomo-Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Roland" "apellidos" => "Pastells-Peiró" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Montserrat" "apellidos" => "Gea-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Grupo de Investigación «Salud y Grupos Vulnerables», Programa de Enfermería, Universidad Surcolombiana, Neiva, Departamento del Huila, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Estudios Sociedad, Salud, Educación y Cultura (GESEC), Facultad de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencias de mujeres jóvenes colombianas mastectomizadas: un estudio etnográfico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Introduction</span><p id="par0030" class="elsevierStylePara elsevierViewall">Breast cancer (BC) is a serious health problem, in both developed and developing countries,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> being one of the most common cancers among women. Each year, 1.5 million women are diagnosed with BC (25% of all the women with cancer)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and there were a total of 2,088,849 new cases in 2018.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In Latin America, each year more than 462,000 new cases are diagnosed and there are almost 100,000 deaths from BC. In Colombia, this problem is no exception: it is the second cause of death in women, with an incidence of 42 per 100,000 in 2018.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">An important phenomenon is the diagnosis of the disease at 45 years of age or sooner, a group called “young women with BC” in scientific literature.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> According to Adams et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> for women a diagnosis at these ages implies feeling and being <span class="elsevierStyleItalic">«out of sync»</span> because their normal life cycles are interrupted by a condition that is socially perceived as one for older women. Likewise, BC becomes especially important due to the fact that it affects the breasts, which are essential in the social understanding of femininity, maternity and sexuality. Various authors have also described how the disease is connected with fear of reoccurrence, death at an early age and the potential impact on families, as well as the anguish stemming from an unexpected diagnosis at this stage of life.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Bearing in mind the implications of BC in young women, breast reconstruction becomes a socially-essential matter for continuing on with their lives. However, this social mandate has been very controversial from the viewpoint of critical feminisms. This is because they contain the idea of the absence of breasts as a deformity and a feminine disability<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and view breast reconstruction as a way of restoring the women’s corporality and femininity.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Given this context, it is important to approach the question of how these discursive practices affect the women’s determination to reconstruct their breasts. This objective of this study was to give voice to a group of young women suffering from BC to explore their experiences about reconstructing their breasts after mastectomy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Design</span><p id="par0055" class="elsevierStylePara elsevierViewall">This was a qualitative study based on focused ethnography. This type of ethnography centres on the small elements and activities in which people involve themselves. It is especially useful for obtaining information on a specific topic and when the object of the study target is limited to small social groups. It features focused research questions, short-term, field trips and intensive data gathering and analysis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We have placed the study within a feminist framework, taking the proposal of Campbell and Wasco<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> as reference. This approach makes it possible to focus on the women and their worries to capture their life experiences respectfully, and legitimates the women’s voices as sources of knowledge. In consonance with feminist research, qualitative research was chosen.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study context was the League Against Cancer-Huila Section (Spanish: Liga Contra el Cáncer-Seccional Huila) in Colombia. This is a regional institution that offers various health services and pursues an important social and political agenda in the fight against cancer and the defence of the rights of individuals suffering from it. Using a criteria-based random sample,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> 8 young women (diagnosed at the age of 45 years or before) with BC (reconstructed or not after mastectomy) were interviewed until discursive saturation was achieved.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the participant profile.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0070" class="elsevierStylePara elsevierViewall">Data was collected by the main researcher (CLV) between August and November 2017, backed by the other nurses on the Colombian team (MRV, CRP and APR), in which APR was the field coordinator.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The women were invited to participate by telephone and, after giving their consent, individual semi-structured interviews<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> were carried out at the South Colombia University (Spanish: <span class="elsevierStyleItalic">Universidad Surcolombiana</span>) to ensure maximum participant anonymity.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The fundamental themes on which the interview script were based were defined considering literature review on the study problem, an expert group later reaching a consensus on content. The interview topics were as follows: 1) the experience of living with BC being a young woman; 2) what they experienced when they were told about the diagnosis of the disease; and 3) interest in reconstructing their breasts after the mastectomy.</p><p id="par0080" class="elsevierStylePara elsevierViewall">An open dialogue based on these themes was produced with the participants, lasting approximately an hour. During the interviews, field notes were kept to ensure that the impressions, ideas and reflections were not lost during analysis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The data were analysed using thematic analysis, which is described as «a method to identify, analyse and report patterns (themes) within data».<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This process features regular discussion and reflection by the researchers to establish the final categories, their main attributes and the connections among them. The programme ATLAS.ti 8 was used as support for the data analysis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Collecting and analysing the information were performed in tandem, and all the interviews were audio recorded and transcribed by the research group after anonymisation. The results were presented to the participants once they were prepared, and the information the women then offered was fed back into the results.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical considerations</span><p id="par0095" class="elsevierStylePara elsevierViewall">We took into consideration all the ethical aspects indicated in Colombian Resolution 8430 (1993)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and in the Council of International Organisation of Medical Sciences<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> for research involving human beings. The study was approved by the Ethics Research Committee of the Faculty of Health at the South Colombia University. Data confidentiality and participant anonymity were ensured and all the participants signed an informed consent.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Characteristics of the participants</span><p id="par0100" class="elsevierStylePara elsevierViewall">The mean age of the 8 women was 39.6 years at the time of the study. They were diagnosed at ages ranging from 24 to 44 years. Five of the participants had a family history of cancer diagnosis, so their mastectomies and reconstructions were bilateral. Two women were not considered candidates for immediate reconstruction and decided not to have breast reconstruction later on; 1 of the women had had a unilateral mastectomy. The 6 women that had received reconstructions reported being displeased with the operation due to various breast problems (such as nipple absence, breast size differences, scars and pain) but, in spite of that, none of them agreed to undergo a further surgical intervention to correct the problems.</p><p id="par0105" class="elsevierStylePara elsevierViewall">All the participants were enrolled in the Contributive Regime of the General Social Security Health System (Spanish acronym: <span class="elsevierStyleItalic">SGSSS</span>). Just 1 woman had a special health insurance policy (private medicine) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Emerging themes</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">The social stigma of being a young woman with breast cancer</span><p id="par0110" class="elsevierStylePara elsevierViewall">For the participants, their experiences have been hindered by the stigma of BC. Being young women meant feeling like «victims» of «looks» of pain and pity, as BC is socially perceived as an affliction that women more than 50 years old suffer. Friends, health professionals and their family or co-workers compared them with young women in their families: a daughter, a niece, a sister. Their changed bodies were a source of constant «finger-pointing» as women suffering from cancer at such an early age; the «marks» from the condition and treatment betrayed them, leading to expressions of pity that they heard in the streets, in hospitals and in their work places:</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] and it’s hard because one thing is that people look at it… ``Oh, look: so young'' […] I once went to the supermarket and she said: And you, why did you cut your hair? Then I just stood there looking at her and I told her: Not me; I didn’t cut my hair. Then she said: your hair is very pretty. What did you do to yourself? What happened to you?»</span> (I5:43)</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«Almost always when one went by and the people who didn’t know looked at her with the turban and they would begin to murmur to each other. Everywhere, yes, you heard the whispers and they got that look of ''poor thing.''»</span> (I1:27)</p><p id="par0125" class="elsevierStylePara elsevierViewall">Because, socially, cancer is considered a deadly disease, the women perceived that people «signalled them out» as subjects that were going to die soon, in spite of their youth:</p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] I never let my baldness be seen because I was once in a doctor’s office and someone asked me: Are you going to die from cancer? I felt horrible […] It made me sad and I said: Is it true that I’m going to die from that?»</span> (I6:49)</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«Sometimes they look at me more from pity, or they suddenly say: ''That girl has so much life to live in front of her, not like a woman of a certain age.'' […]»</span> (I1:27)</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Learning to live with a changed body</span><p id="par0140" class="elsevierStylePara elsevierViewall">The physical changes induced by the disease and treatment were common in the daily lives of these women, causing them worry. Losing their hair, eyebrows and eyelashes, and having their skin and nails change colour were the most significant to them because they were visible externally:</p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«It hit me hard (it affected me a lot), above all the loss of my hair, my eyebrows, the black nails […] a person without hair seems like they are naked […].»</span> (I2:38)</p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«It was falling out like crazy (a lot)! And I cried that day […] I told myself: My God, now I’m really going to go bald!»</span> (I3:35)</p><p id="par0155" class="elsevierStylePara elsevierViewall">An initial effect of these changes occurred in the relationships with family members. The women consequently tried to hid or disguise the alterations by wearing scarves or caps and using eyebrow makeup. Hiding the signs of the disease from their children was fundamental, given that they did not know how to explain a potentially deadly disease and the reason for the changes that they were going through to them. In addition, many of the women did not talk about their disease as a way of taking care of them and protecting them:</p><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] when I was with my son, he asked me: ¿Mummy, why do you have that cloth (scarf) on your head?… I used to tell him it was because I was bald, that I was going to change my hair, that new fuzz (hair) was going to grow […] that I had to wear that little scarfie (scarf) because me head was cold or something like that, that I invented for him […] my son was three years old already.»</span> (I3:35)</p><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] my children never saw me, I didn’t let them… when they operated on me and the initial recovery was when my mum… when they would go visit me at my mum’s house, I covered up; I didn’t want to shock them […].»</span> (I8:44)</p><p id="par0170" class="elsevierStylePara elsevierViewall">As for their chests, with reconstructed breasts or not, they felt that it affected their relationships with different relatives. However, the strongest effect was undoubtedly on the relationships (not only sexual, but in daily life) that they had with their permanent partner. The participants clearly showed the fear that they felt about how their partners would react, about being seen and rejected, because they believed that there had been significant changes for which their partners were not prepared:</p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] I let myself be seen but not as uncovered as before, now I feel that restraint… even if he [husband] sees me nude, but it’s not the nudity so you can enjoy my breasts because there aren't any breasts any more.»</span> (I7:50)</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«With my husband […] well, in that I let myself be seen but not a lot, it's not the same anymore. I let myself be seen but now not as uncovered […].»</span> (I3:35)</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«Me, for example if I’m getting dressed and he [husband] is there, well, I try to make it so he sees me from this side (her back). No, I don’t feel comfortable and I always turn my back to him when I’m going to change clothes.»</span> (I2:38)</p><p id="par0190" class="elsevierStylePara elsevierViewall">To overcome this aspect, they turned to different tactics such as using loose-fitting blouses, not sharing the shower, and having sexual relations with the lights off and wearing something that covered up their breasts. However, in spite of this, none of the women considered new interventions to reconstruct their breasts or improve the aesthetics: the absence of breasts or changes in their appearance were not described as priorities in their lives:</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«And I told him, Oh doctor, I’m happy with what I have! If it fell to me to lose a breast because of the disease, now I have my health. Well, it doesn’t matter, that’s the way I am and I feel good.»</span> (I5:43)</p><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«In this [breast] I’m wearing an external prosthesis. I make them [external prosthesis] myself… the thing is that those prostheses don’t stick well, they’re heavy. I only use them with certain clothing and that’s it. I feel comfortable. Yes, yes […] I've never felt bad about myself and that is what's important, I accept myself.»</span> (I6:49)</p><p id="par0205" class="elsevierStylePara elsevierViewall">In fact, the doctors that took care of the women often proposed the decision for reconstruction; it was not by their own initiative:</p><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] basically that idea [the reconstruction] was the mastologist’s […]. And she is a woman and so she knows that this is a feminine symbol, it symbolises oneself […]. But if the mastologist hadn’t offered it to me, I wouldn’t have done it […].»</span> (I1:27)</p><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] I told the doctor: I don’t want any more. Then he offered me the one for the stomach, and I told him no. Well, that is, I feel that so much suffering isn‘t worth it; in my opinion, just for having cleavage one day and show off something there.»</span> (I5:43)</p><p id="par0220" class="elsevierStylePara elsevierViewall">They learned to live with this, finding different ways to hide the signs of the treatment that changed their body geographies:</p><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] I never went back to wearing those blouses like before, with plunging necklines. I can’t wear them anymore, I always, at all times, wear a top […] I always wear a top underneath so it can’t be seen.»</span> (I4:38)</p><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«Tight clothes, like blouses clinging, I didn’t put them on because I already knew that that was always the same question over and over again, then I didn’t wear that. Then I learned to wear baggy (loose).»</span> (I7:50)</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Surviving, that is what matters</span><p id="par0235" class="elsevierStylePara elsevierViewall">Restoring the body was superimposed by the desire to survive, without the body changes (especially, those of the breasts) mattering. In the participants’ statements, a mixture of contradictory feelings were perceived: feelings of body acceptance/surrender, but with special emphasis on the importance of having survived a deadly disease, for which they felt privileged:</p><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«[…] you feel terrible because you look in the mirror […] [Silence] But at the same time, well, you sort of begin to assimilate it and you say: Well, it was my turn to go through this […] what’s important is to come out of this […].»</span> (I5:43)</p><p id="par0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«No, because at the same time they are your breasts […] God made them for you with two and now you have to get by with one. But at the same time, in all this process, it hasn’t seemed so important to me, because I say: Master, I’m still alive […] As a lady who has already passed away told me: The thing is that this disease is terrible and you are one of God’s miracles. You’re alive!»</span> (I4:38)</p><p id="par0250" class="elsevierStylePara elsevierViewall">The participants valued survival as a priority, but within this, surviving to take care of their children was the most important consideration. Making religious promises and doing religious activities to achieve their objective was a common characteristic. Definitely, surviving became the goal, not for themselves, but the take care of others:</p><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«No, well […] (Silence) What is always important is being well and being able to raise my daughters […] it’s the most important thing that I’ve got as a motive […].»</span> (I8:44)</p><p id="par0260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«My beloved god is very great, and I’ve said, I would often cling to him, to the Virgin. I would tell them: for my children, I need to see them grow up […] that way they have their grandparents, because the mum is mummy […].»</span> (I2:38)</p><p id="par0265" class="elsevierStylePara elsevierViewall">Because of this, they did not think about other operations for a late reconstruction or for correcting the initial reconstruction. Just considering the postoperative period or putting their lives at risk from the anaesthesia or other surgery-derived complications, they dismissed the idea:</p><p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«Even once when I saw the general practitioner, he told me: And why didn't you have that whore (breast) [NT: Spanish: pucha] fixed? And I replied: Oh, doctor, believe me that right then what mattered least to me was what that boob was going to look like. What’s more, I didn’t even think if I’d still have a single piece left or not. I was thinking about my son […].»</span> (I5:43)</p><p id="par0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">«The thing is that the first time [reconstructive surgery] it was very difficult, it was very painful, I didn’t want to continue anymore. I said: No, doctor; leave me like this.»</span> (I6:49)</p></span></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0280" class="elsevierStylePara elsevierViewall">Breast reconstruction after a mastectomy for BC has been fertile ground for discussion. The biomedical viewpoint sees it as a feminine necessity in the course of the disease that allows women to recover the emotional and physical wellbeing lost through mastectomy; in that way, they can get back to a «normal» body. These statements are reinforced by the mandates of the patriarchy prevailing in current societies, which imposes women’s subordination in both public and private spheres, identified as the ideological foundation of gender inequality. It controls women’s bodies with strong implications in society’s behaviour and the way it understands women’s health-related problems.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">The causes of the social stigma of BC arise from such discourse. The scientific literature suggest that women experience it constantly in their social and family relationships, because it is linked to a negative social reaction to body changes, to breasts and to the shame of not being a «whole» woman; and as a disease marked by «death».<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21–23</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">In contrast to what the study participants stated, some authors (such as Manne et al.,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Higgins et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and Fu et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>) found that young women are the most interested in reconstructing their breasts following a mastectomy. The last group of researchers attributed this to their desire to feel complete, «normal» and sexually desirable, besides other practical matters such as not having to wear external prostheses and being able to choose garment styles.</p><p id="par0295" class="elsevierStylePara elsevierViewall">However, another position is that proposed by the critical or third-wave feminisms: the proposal rejects patriarchal discourse, arguing the reconstructive surgery becomes a discursive practice so that women deny and hide the disease. Women’s trauma from the loss of their breasts is built upon how they become visually deformed, repugnant to see; and they should protect others, and themselves, from the look of disgust when facing the deformity.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a> All this is strongly backed by the communication media.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,30</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">This discourse of the «normal» body has permeated both the current societies and women. However, our female participants gave priority to surviving the disease over breast reconstruction and the obligation to return to «normality»; that is, surviving without caring about their changed bodies and being victims of social stigma from the marks that the disease has left them. The foregoing reaffirms the standpoint advocated by Navarro<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> with respect to women’s capacity to demand an active role in their health.</p><p id="par0305" class="elsevierStylePara elsevierViewall">This fact is not frequently backed in the scientific literature, but there are indeed studies that reaffirm it. Holland et al.,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> in a study carried out in young women with BC in the USA, drew attention to the women’s choice to survive the disease, in spite of the medical offer of reconstruction. This choice was not evaluated positively because the women’s worries were more linked to being healthy to take care of their children.</p><p id="par0310" class="elsevierStylePara elsevierViewall">Findings from other studies have added the fact that some women have stated that they feel comfortable with a «non-standard» body that does not comply to gender patterns.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> They felt no need to have their breasts reconstructed.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">As Blanco Sánchez explains that, for many women, when you manage to preserve life, many other needs appear for which breast reconstruction is not essential; this decision is consequently often excluded.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Seeing their children grow up and accompanying them along their journey towards being adults becomes the final goal. This is their response to the roles socially imposed on women, without the conditions of the body in which they survive mattering to them.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">However, the way that patriarchal mandates also place women at a crossroads, by causing them a strong contradiction in feminine roles, must not be ignored. This has been pointed out by Pérez<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> in a paradox that is established between women’s breasts and the feminine roles imposed by these precepts: breasts are the symbol of femininity and its underlying values. Contradictorily, they juxtapose sexuality and maternity: breasts are a sexual marker but they also signal their maternal function.</p><p id="par0325" class="elsevierStylePara elsevierViewall">Patriarchal canons give account of a fractured, incomplete understanding of the experiences of the women that go through this disease. Davis<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> calls for reconceptualising women’s experiences about their bodies. The renewed concept has to be validated as an important source of knowledge, without assuming it to be authentic or absolute, or in juxtaposition with other knowledge sources such as physicians and socio-cultural concepts.</p><p id="par0330" class="elsevierStylePara elsevierViewall">There are a few limitations to the study. First of all, only women from a region in Colombia were considered. In addition, other factors such as ethnicity or purchasing power that made our study participants a heterogeneous group were not taken into consideration.</p><p id="par0335" class="elsevierStylePara elsevierViewall">In short, for women that are mastectomised for a breast cancer, their main interest is not always returning to normality through breast reconstruction, in spite of social stigma and the severe physical changes that they experience in their bodies. Above this priority prevails the desire to survive the disease to take care of their children and loved ones, responding to socially-imposed gender roles.</p><p id="par0340" class="elsevierStylePara elsevierViewall">Consequently, healthcare for women with BC that undergo a mastectomy has to consider their experiences and expectations, as well as their emotional needs. This is necessary for designing individualised nursing intervention strategies from a culture and gender perspective.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0345" class="elsevierStylePara elsevierViewall">This study was funded through the Institutional Call to set up a bank of projects of medium-sized financial support for research, development and innovation (2016–2017), aimed at the research groups at the South Colombia University. Code MI-INV-FO-10.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0350" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1481869" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1349312" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1481868" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst6030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1349313" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Participants" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data analysis" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Characteristics of the participants" ] 1 => array:3 [ "identificador" => "sec0050" "titulo" => "Emerging themes" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "The social stigma of being a young woman with breast cancer" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Learning to live with a changed body" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Surviving, that is what matters" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack519944" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-13" "fechaAceptado" => "2019-09-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1349312" "palabras" => array:4 [ 0 => "Breast neoplasms" 1 => "Mammaplasty" 2 => "Qualitative research" 3 => "Nursing" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1349313" "palabras" => array:4 [ 0 => "Neoplasias de la mama" 1 => "Mamoplastia" 2 => "Investigación cualitativa" 3 => "Enfermería" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Focused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Three issues emerged in the women's discourses: 1) The social stigma of being a young woman with breast cancer; 2) Learning to live with a body transformed by disease and treatment; and 3) Surviving, which is the most important thing.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Being a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Explorar las experiencias de un grupo de mujeres jóvenes en relación a la reconstrucción de sus senos posterior a la mastectomía.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Etnografía focalizada realizada en la Liga contra el Cáncer-Seccional Huila (Colombia). Mediante un muestreo casual orientado por criterio se realizaron entrevistas semiestructuradas a ocho mujeres jóvenes (diagnosticadas a los 45 años o antes) con cáncer de mama (reconstruidas o no después de la mastectomía) hasta conseguir saturación del discurso. La recogida de datos se efectuó entre agosto-noviembre de 2017, después de contar con aval del Comité de ética y el consentimiento de las participantes. Los datos se analizaron mediante la técnica del análisis temático posteriormente a ser anonimizados.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En los discursos de las mujeres emergieron tres temas: 1) El estigma social de ser una mujer joven con cáncer de mama; 2) Aprendiendo a vivir con un cuerpo transformado por la enfermedad y el tratamiento; y 3) Sobrevivir, eso es lo importante.</p></span> <span id="abst6030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect5045">Conclusiones</span><p id="spar6045" class="elsevierStyleSimplePara elsevierViewall">Ser una mujer joven y padecer cáncer de mama implica una diversidad de cambios que alteran de forma permanente las vidas de las mujeres y su corporalidad. Las mujeres priorizan sobrevivir para cuidar de los otros sobre la reconstrucción de los senos. A nivel sanitario, se debe incorporar la perspectiva cultural y de género para diseñar intervenciones enfermeras individualizadas que contribuyan a una mejor atención.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst6030" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Laza-Vásquez C, Rodríguez-Vélez ME, Lasso Conde J, Perdomo-Romero AY, Pastells-Peiró R, Gea-Sánchez M. Experiencias de mujeres jóvenes colombianas mastectomizadas: un estudio etnográfico. Enferm Clin. 2021;31:107–113.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">P: participant number.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age at diagnosis (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Health system regime \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Breast reconstruction \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Educational level \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Occupation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Civil status \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of children \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Civil engineer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physiotherapist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Self-employed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic service \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consensual union \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Housewife \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lawyer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prepaid medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lawyer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contributive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Technical school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Housewife \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2550177.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Profile of the participants.</p>" ] ] 1 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec9005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect5065">What is known?</span><p id="par0015" class="elsevierStylePara elsevierViewall">The number of young women diagnosed with breast cancer at the age of 45 years or less has recently increased. Due to the negative impact on body image, the women frequently choose breast reconstruction after a mastectomy.</p></span><span id="sec1010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect4070">What does this paper contribute?</span><p id="par0025" class="elsevierStylePara elsevierViewall">For many young women suffering from breast cancer, the priority is surviving the disease rather than the reconstruction of their breasts, in spite of the body changes caused by the condition and its treatment. This finding permits a better understanding of the women’s needs so that healthcare strategies can be designed from a gender perspective.</p></span></span>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World cancer report 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Stewart" 1 => "C. 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Thanks also goes to the League Against Cancer-Huila Section in Colombia for their support, and to the <span class="elsevierStyleGrantSponsor" id="gs0005">South Colombia University</span> and the <span class="elsevierStyleGrantSponsor" id="gs0010">University of Lleida</span> for funding the study.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24451479/0000003100000002/v1_202103180834/S2445147920300151/v1_202103180834/en/main.assets" "Apartado" => array:4 [ "identificador" => "63169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451479/0000003100000002/v1_202103180834/S2445147920300151/v1_202103180834/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147920300151?idApp=UINPBA00004N" ]
