The effect of counselling on physical disability and social recovery after mastectomy.

A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss. Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit. Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery, return to work, adaptation to breast loss and satisfaction with their breast prostheses. Eleven percent remained distressed by the mastectomy but most responded well to breast reconstruction. The nurse had little impact on physical disability. The morbidity found in the control group highlights the need to find ways of reducing it. While the appointment of a specialist nurse can achieve this the morbidity would probably also be much reduced if the breast was conserved when possible, reliable staging methods other than axillary clearance were developed and the adverse effects of cytotoxic drugs and radiotherapy were reduced.