Perception of the breast cancer patient with respect to aesthetic treatments and bioethics considerations​

Nuria Sáez. Enfermera

By: Núria Sáez Gómez

Registration n. 53119 (COIB)

Graduate of Nursing

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From the thesis completed for the University of Law in Barcelona, Master of Bioethics and Law, in 2012-2014, titled: “Perception of the person with breast cancer with  respect to body image acceptance and the response of the public health system to these needs” [bioethical dilemma when treating people without the resources or body image integration services].

Keywords of the thesis: nursing, aesthetic care, quality of life, body image, breast cancer, aesthetic treatments, Spanish public health system.

I am reminded that there is still a lot of work to be done by nurses in body image and dermal aesthetics management. Upon revisiting the thesis, I realize that a great deal of progress has taken place in the skill set associated to the profile of the nurse managing body image, since in 2012-2014 this profile had not yet been identified. Although we can see that, on a social level, people at that time already demanded change, wanting nurses to position themselves as providers of care in body image management and be with the patient from the start until the end of the process.

The main objective of the thesis was to give visibility to the subjective and objective perceptions of breast cancer nurses in terms of meeting patients’ needs, improving their physical appearance, integrating bodily changes into their lives, and stimulating their self-esteem and mood with positive repercussions on their recovery.

The bioethical implications must be highlighted, due to the close relationship between health and the perception of health created by a private or public image.

The thesis was developed in collaboration with the COIB (Official Association of Barcelona Nurses), with their department of Program Management, Training and Professional Responsibility Consulting, where I am an expert in body image management, independent practice, and complementary therapies applicable to nursing. I am grateful to the organization for their support and work.

Study objectives:

  • Observe the objective needs of users with breast cancer receiving aesthetic care.
  • Discover the subjective needs of users with breast cancer receiving aesthetic care.
  • Highlight what limits exist in healthcare in the aforementioned areas. Assess the bioethical aspects of treatment provided to women with breast cancer.
  • Highlight what aesthetic care services are provided by the health department to users suffering from breast cancer.

Services provided by the body image and dermal aesthetics nurse are not included in the common services of the National Health System. At the time of writing (2020), a national bulletin (BOE) application states the intention that nurses might perform micropigmentation in the reconstruction of the breast areola in public care units managed by nurses.

The ideal would be for nurses to manage the following:

  • Treatment of hair loss or alopecia and improvement of skin and nails conditions
  • Performance of micropigmentation as necessary to outline eyebrows and define the areola and nipple area
  • Erasing tattoos and minimizing scarring when the skin is fully recovered

Another issue is one of the most frequent side effects in patients treated with breast cancer: the onset of lymphedema. It is important that the management of this condition be carried out by physiotherapists who advise which will be the most appropriate treatment in each case: manual lymphatic drainage, pressure therapy, bandages, hydrotherapy, etc.

When cancer treatment ends, it is time to help patients improve their body image. Under the oncologist’s prescription and according to requirements and expectations in each case, some techniques for managing body image can be carried out by the nurse, such as restorative oncological micropigmentation, hydration and revitalization treatments with hyaluronic acid and vitamins, or radiofrequency to recover skin quality.

For the patient this is a time of many changes, both physical and emotional. We know that people who take care of themselves as well as their image while receiving treatment also improve their mood; it’s a known process: “I look good, I feel good.”

The body image management nurse for oncological aesthetic care offers comprehensive health treatment, at the biopsychosocial level, to all people who are undergoing oncological treatment. This counseling can be done before, during, and after illness in the following areas among others:

  • Self-care guidelines session
  • Personalized facial treatments
  • Body hydration treatment
  • Back and arm massage
  • Tired legs massage
  • Scalp massage and hydration
  • Relaxation massage
  • Hands and feet treatments
  • Reconstructive makeup
  • Hair solutions

Services provided by nurses with holistic and aesthetic knowledge

Nurses Marta Prats and Rosa Ródenas are among the nurses who have created their own company in recent years. Doubts as to whether a nurse can create a business are still widespread in the profession, explains Montserrat Bayego, head of the COIB’s Independent Practice area. Still, more and more professionals are creating avenues for providing care differently.

In 2010, according to a COIB study, 4,000 nurses worked in Barcelona on their own and independently, representing 13 percent of registered professionals.

Patients who have overcome breast cancer need their lives to return to normal. With this in mind they demand and require – before, during, and after treatment – all the information on how they are going to feel and where they can go for assistance, as well as adequate documentation to help them choose how to meet all of their needs. Aesthetics and self-image care are included among these needs as the way to feel feminine again and stop being anchored in a past that, according to the recommendation of all health professionals, must be left behind as soon as possible.


Women who overcome breast cancer need to improve their quality of life, which is linked to the feeling or perception of well-being.

The number of women affected is incalculable because body image related requests by women with breast cancer are recorded neither in public nor in private centers, and only some studies shed light on the matter. It is clear, however, that the female gender holds body image and femininity as a reference, intertwined with personal success, self-esteem and social acceptance, therefore it is normal that they will actively seek the support to improve said image according to their needs.

A positive outcome would be for women to find support during the transition from overcoming the disease to considering optional treatments such as breast prosthesis or reconstruction. This would include interest and follow-up of the emotional state of patients by clinical psychologists specializing in oncology.

When these patients seek more support in the improvement of body image they will try to see what is offered. This search will initially lead to the services provided by the Spanish public health system: prevention, surgery, and treatment but in some cases excluding prosthetics and reconstruction. It is at this crucial moment that the nurse plays an important role in providing advice on body image and on aspects involving bioethical considerations, as orientation addressing every need the person might have is key to their recovery.

Preliminary bibliography

  • Magaly Marión Luna Goza, M.D. “Bioethical considerations in the treatment of breast cancer”, published on 03/26/2012
  • Excerpts from author’s Master in Bioethics and Law of the University of Barcelona
  • Data from the Spanish Breast Cancer Research Group (GEICAM)
  • Reina Sofía University Hospital, Clinical Subcommittee on Breast Cancer, “Breast cancer protocol: Prevention, Diagnosis, Treatment and Tracing”, Córdoba 2009.
  • Tahamara Portela Fernández, B.S. “Nursing practice and the humanization of care in the operating room”, published on 08/29/2012