The Existence of Non-Existent Phantom Breasts

Breasts, rectum and teeth - - these are body parts which, apart from our limbs, we can do without. Imagine you lost one of these parts (God forbid). The next concern, then, would be the implications of living without them. As highly adaptive creatures, would we easily adjust to this kind of situation? How do we expect our bodies to compensate for this “loss”? What aftereffects would physiological rearrangement (if any) have in our personality and well-being?

Perception researchers coined the term phantom phenomena to refer to the experiences individuals have when they feel pain and other sensations from their amputated body parts (Goldstein, 2007; Björkmana, Arnéra , Lundb, & Hydén, 2010). Amputees, for example, experience considerable suffering as they try to step off a bed using their phantom feet or legs or lift a cup with a phantom hand (Goldstein, 2007). I highly suggest that you watch the sixth season, fourth episode of House M.D. entitled “The Tyrant” to get a clearer grasp for this phenomena. This condition is believed to not only prevail in amputated limbs but in other parts as well (refer to the opening sentence). Whether we lose a loved one or limb, our brain has its way of reminding us that we’ve lost “it”. Signals from the brain are transmitted to the remaining limb which inflicts stump pain on amputees (Goldstein, 2007; Björkmana, Arnéra , Lundb, & Hydén, 2010).

My aunt once mentioned the dominance of breast cancer in our lineage - quite alarming how it hasn’t skipped a generation. So, as a future candidate of mastectomy (breast removal), it became of interest for me to investigate the relevance of phantom limbs with phantom breasts. Prior to this I’ve never heard about it. To everyone who is reading this (women most especially), I hope this enlightens you as well.

Phantom breast (PB) is the specific term used to describe the experience of the continued presence of the breast after mastectomy: feeling sensations of pain, experience of size, shape and weight of normal breast, itching and pinpricks (Dijkstra, Rietman, & Geertzen, 2007; Spyropoulou, Markopoulos, Zervas, Christodoulou & Papageorgiou 2009). Some studies have suggested decreasing PB sensations over time while others report experiencing it for the first time between their 6^th to 24^th month follow-up (Dijkstra, Rietman, & Geertzen, 2007). Based on the symptoms, it seems like PB and Phantom Limb are very similar. Does this also hold true with the level of pain experienced by individuals? Statistically, women who experience phantom breasts usually comprise less than half of the participants in studies; and, unlike the prevalence of phantom pain in limb amputees, breast amputees have reported to experience minimal pain (Dijkstra, Rietman, & Geertzen, 2007; Spyropoulou et al, 2009). Compared to phantom limb, life with phantom breast doesn’t seem to be distressing. With the way I see it, mastectomized women can move on with their lives unless vanity takes the best of them. Physiologically, this difference may be explained by the cortical representation of limbs and breast in the brain’s primary sensorimotor cortex – limb perception relies on more sensory modalities (proprioception and joint sensibility) as well as represented in a larger area than the breast (Dijkstra, Rietman, & Geertzen, 2007). This finding, combined with the technological advances (less extensive surgery) in mastectomy largely contribute to the indifference of individuals with PB.

Perception of pain can increase if one focuses on it and vice versa (Goldstein, 2007). Would you, for example, be more honest in reporting PB sensation and pain when given a questionnaire or verbally interviewed by a therapist? Assessment methods (questionnaires, cross-sectional studies) and period (assessed during psychological treatment or home visit) have been observed to cause variations between individuals’ perceptions on PB sensation and pain. Questionnaires and cross-sectional studies overestimated the prevalence of both PB sensation and pain than prospective studies (Dijkstra, Rietman, & Geertzen, 2007). Clearly there have been efforts to assess these PB individuals; however, with the unavailability of standardized methods and biases in reporting PB sensation and pain, validity and reliability are weak.

Lastly, I’d like to point out two more factors that have also been looked into: age and control. You’d probably agree with the fact that we like to have control over our lives. Some women agonize over the thought that there was something in their bodies that was out of control after losing their breasts (Björkmana, Arnéra, Lundb, & Hydén, 2010). They fear that this unending experience might overpower them and trigger recurrent pain. For the older age groups, most especially, the loss of a bodily function made them sad, dependent and more anxious about the future (Björkmana, Arnéra , Lundb, & Hydén, 2010; Dijkstra, Rietman, & Geertzen, 2007). This was when the scene in How I Met Your Mother (Marshall and Ted were discussing about losing something/someone) resurfaced in my memory:

“Marshall: Look, I understand that you guys had to break up eventually, but why today?

Ted: She’s leaving tomorrow.

Marshall: Yeah, but she’s still in town. So you spend one more amazing day together. Ted, think of it this way. If you knew that you were going to lose your leg tomorrow, would you sit on the couch and cry about it, or would you run and jump and do some awesome air kicks while you still could?”

How I Met Your Mother, Season 1 Episode 16

References:

Björkmana, B., Arnéra , S., Lundb, I. & Hydén, L. (2010). Adult limb and breast amputees’ experience and descriptions of phantom phenomena—A qualitative study. Scandinavian Journal of Pain, 1, 43–49. doi:10.1016/j.sjpain.2009.09.001

Dijkstra, P., Rietman , J. & Geertzen, J. (2007). Phantom breast sensations and phantom breast pain: A 2-year prospective study and a methodological analysis of literature. European Journal of Pain, 11, 99–108. doi:10.1016/j.ejpain.2006.01.002

Goldstein, E. B. (2007). Sensation and Perception (7th Eds.). Belmont, CA: Wadsworth

Spyropoulou, A., Markopoulos, C., Zervas, I., Christodoulou, G. & Papageorgiou, C. (2009). Phenomenological Study of Phantom Breast Syndrome. Maturitas, 63, S52.