乳がんを罹患し乳房切除となった女性の乳輪乳頭再建を行った体験の過程—乳輪乳頭再建によって再構成される乳がん女性のアイデンティティ

Areola and nipple reconstruction after mastectomy: the female experience: Areola and nipple reconstruction: reconstruction of female identity

要旨

　本研究の目的は，乳がんを罹患し，乳房切除となった女性が乳輪乳頭再建を行った体験の過程を明らかにすることである．乳輪乳頭再建を受けた7名に半構成的面接を行い，質的記述的に分析した．乳がんを罹患し乳房切除となった女性が乳輪乳頭再建を行った体験の過程について【乳輪乳頭再建によって再構成される乳がん女性のアイデンティティ】というコアカテゴリーが抽出された．乳輪乳頭再建を行った者は，乳がんを罹患し，《病期が初期にもかかわらず乳房切除となることに落胆》するが《再発，転移を防ぐために乳房全摘を決断》していた．しかし《あるものがない喪失感と違和感》があり，銭湯や趣味の場で《胸を見せられない》と〈今の自分ではやっていけない〉感覚となっていた．そして〈自己の模索と方向づけ〉を行っていた．乳輪乳頭再建を行った者は，《乳輪乳頭があっての胸》という価値観があり，《乳がん治療の身体的，精神的，経済的負担感の少なさによる後押し》もあり《習慣，社会生活の継続によって自己を維持する》ために，また《女としての自己を修復する》ために乳輪乳頭再建を行っていた．乳輪乳頭再建後は，《乳房全摘のきずあとが気にならず》，《遠目で見ると自然な胸》で，《日常生活行動に支障がなかった》．それにより《他人の目を意識しない》，《胸を失ったことを意識しない》，また《がんに罹患したことを意識しない》で日常生活を過ごすことができていた．

　This study aims to elucidate the process of women undergoing areola and nipple reconstruction after a mastectomy. Semi-structured interviews were conducted with seven subjects who underwent nipple-areola reconstruction, which were then analyzed qualitatively and descriptively. The core category of identity as women with breast cancer reconstituted by areola reconstruction was extracted from the experience of women who underwent mastectomies. First, they were "disappointed about having mastectomies at an early stage of the disease", but "decided to have a total mastectomy to prevent metastasis and recurrence." Further, they had a "feeling of loss and discomfort," and felt "they can't show their breasts" at public baths or during hobbies. They engaged in self-exploration and oriented themselves. Those who had undergone nipple and areola reconstruction have a sense of value in having breasts with nipples and areolas. "It gave them support after the physical, mental, and economic burden of breast cancer treatment." They underwent areola and papilla reconstruction to repair and maintain themself as a woman through habits and the continuation of their social life. After the areola and papilla reconstruction, "they didn't have to worry about the scars from the mastectomy," and "when viewed from a distance, their breasts looked natural." As a result, they could live their lives without a sense of awareness of what other people think or that they had lost their breast due to cancer.