Acute psychological care by the operating surgeon.

The diagnosis of breast cancer causes severe psychological conflicts. This is because of the sudden need for a mutilating breast operation and because of the threatening confrontation with a potentially lethal disease. The consequence can be a spectrum of physical and mental sequelae, access to which the physician may find difficult. Here, the interpersonal relationship between the patient and the operating surgeon is of particular relevance, not only for the hospital phase but also in the time to follow. These effects therefore fall into the sector of psychosocial care. Within this framework, an improvement of the postoperative quality of life may be the result, probably via emotional processes. Various recent studies have confirmed the empirical finding that this care may result in an extension of the survival time. The acute psychological care by the operator involves: diagnostic, response to diagnosis, decision making of the patient, informed consent, the perioperative phase, postoperative information and the further "decision making" because of the operative findings, and discussion at the time of discharge. In connection with the informed consent there are several points of a heavy psychological load; namely, the likelihood of the diagnosis, the problem of the intraoperative histology and their consequences, procedure modalities, the possibility of a one-stage- or two-stage-operation, the meaning of the type of incision, the consequences and need for a lymph node excision, information about possible complications, discussion about postoperative treatment modalities, the prognosis and finally of psychological points of view. The influence of the surgeon is in this regard is of great importance. Especially as concerns the alternatives of tumorectomy with radiation and mastectomy (without radiation) and possible reconstruction. Other problems are connected to possible adjuvant chemotherapy or hormone therapy and perhaps bone marrow transplantation. Alternative conservative therapeutic modalities are, also of special interest.