Neste Outubro Rosa falamos aqui na Fala Feminina com mulheres que estiveram ou estão sob o processo do câncer de mama. Quando se descobre uma doença dessas só se pensa na cura. Mas com o passar do tempo (e do choque inicial), outros fatores começam a ter importância.
Como fica o sexo? E o silicone? Tira toda a mama?
Nossa editora Fátima Torri conversou com a mastologista Betina Vollbrecht sobre estes e outros assuntos. Confira abaixo.
Betina: Qualquer câncer é difícil, mas quando tu envolve mama acaba sendo mais complicado ainda. Porque, a mama tem toda a questão de sexualidade, de órgão sexual externo feminino. Eu aprendi contigo, Fátima, que o homem tem o falo e a mulher a fala e a gente tem a mama, que de alguma maneira acaba sendo nosso órgão sexual externo e que de alguma maneira envolve toda essa coisa de sexualidade. E, de repente, além disso tudo tu tem um câncer na mama, naquele órgão.
Então, isso tudo é uma coisa muito complicada de se conversar e de se falar e eu vejo muito, que a gente médico acaba falando: “vamos tratar o câncer, a gente tem que resolver o problema, vamos lá”. Mas, assim, existe uma mulher ali, existe um homem, existe um parceiro sexual, enfim…. Eu realmente tenho estudado bastante isso e acho muito importante a gente discutir isso. Agora, há uns dois ou três meses, as estudantes de sexologia da PUC me convidaram para dar uma palestra sobre isso, sexualidade pós câncer de mama, tinham várias coisas e uma dessas seria isso, e elas ficaram impressionadas como as pessoas entraram para ver a live e muitas pacientes entraram e me disseram: “entrei, vi a senhora falando”. Porque, na verdade, ninguém fala sobre isso, é sempre: “vamos tratar do câncer, não pode voltar a doença…”
Obviamente que isso é uma brincadeira, mas se coloca muita prótese no Brasil, é a cirurgia plástica mais feita no Brasil. Então, tem toda uma questão de discussão, é mais difícil, essas pacientes vão envelhecer né? Às vezes, as mães trazem meninas com 18 anos no consultório e me dizem assim: “Diz pra ela, que ela não pode colocar prótese. Eu tive câncer de mama, a avó dela teve câncer e ela não pode por silicone”.
Não, isso não é verdade, nenhum estudo científico até hoje mostrou que prótese de silicone vai aumentar risco para câncer de mama ou até que vai causar câncer de mama. Então, é uma coisa muito perguntada. Hoje, a gente já está muito treinado. Eu brinco com essa frase das pacientes que têm prótese e as que vão colocar, porque tem muita paciente com prótese. Então, a gente acabou se especializando nisso, a gente já sabe operar quem tem prótese, já sabe fazer exames em quem tem próteses. É uma outra realidade.
Mas a questão da prótese é muito perguntada: “tem que trocar a prótese, não tem que trocar”, “se ficar com uma prótese por mais de 10 anos aumenta risco?”, tem dessas coisas. Tem um tipo de linfoma que é raríssimo, que dá em quem tem prótese de silicone, mas é muito raro e acabou caindo na mídia, tendo discussões disso. Mas essa é outra discussão.
O interessante é essa questão de sexo, como voltar a vida. A gente está diagnosticando câncer de mama mais cedo, com mais chances de cura e volta a vida normal, só que como estão ficando essas pacientes? Nós estamos deixando elas vivas, mas estamos deixando ela bem? Isso nós também temos que questionar.
FF: O que tu quer dizer com isso? “Deixar bem”…
Betina: Continuar a vida delas. Eu faço uma mastectomia em uma paciente, uma lesão pequena, diagnostiquei no início. Como fica a vida dela depois? Entendeu? Ela volta a ter uma vida sexual? Ela volta a ter uma vida boa?
FF: O SUS e os planos de saúde, eles pagam próteses?
Betina: Reconstrução sim. Toda paciente tem direito, mas uma reconstrução é uma reconstrução, como o nome diz né. Isso por que nem sempre fica 100%. É como quebrar um vaso e colar, pode ser que fique imperceptível, mas provavelmente alguma coisa vai aparecer. Porque ficam cicatrizes, ficam alterações de sensibilidade, às vezes fica sem sentir o mamilo.
FF: Mas isso por causa do câncer?
Betina: Eventualmente por causa do câncer, onde ele está, às vezes pelo tipo de cirurgia que a gente faz, pode ser mais agressivo ou menos agressivo. Depois que a Angelina Jolie disse que tirou a mama, todas pacientes quando fazem diagnóstico querem tirar toda a mama, mas tirar toda a mama tem suas consequências: os mamilos perdem sensibilidade, a prótese pode não ficar muito bem… Então, se a gente faz diagnóstico de uma lesão pequena, pode ser menos agressivo do ponto de vista cirúrgico e do ponto de vista de tratamento. Muito pensando em como vai ser a vida da paciente no futuro. Porque elas vão ficar vivas. Graças aos tratamentos as mulheres estão vivendo, vão ter o câncer, vão tratar e a vida vai continuar.
FF: O que muda no corpo da mulher depois do tratamento de câncer de mama que influencia na vida sexual?
Betina: Muda a lubrificação vaginal, muda desejo… Quase nenhuma mulher que passa pelo tratamento não tem reclamações da vida sexual. Sempre muda muito.
Sobre o câncer de mama em mulheres mais novas
Betina: Parece sim ter mais mulheres jovens com câncer de mama, estatisticamente isso ainda não mudou muito, mas parece e tem relação com hábitos de vida.
Teoricamente, quanto mais cedo se tem filho menor as chances de câncer de mama, quanto mais filhos se têm menor a chance, quanto mais tempo se amamenta menor a chance também.
Se a gente olha por populações, por exemplo, índias praticamente não têm câncer de mama. Se a gente compara, por exemplo, a população feminina da África com as mulheres dos EUA, tem muito mais câncer nos EUA. Se a gente compara RS com a Bahia, tem muito mais câncer de mama no RS do que na Bahia. Porque, epidemiologicamente é isso: a gente tem menos filhos, amamenta menos, a mama só chega ao desenvolvimento final quando a mulher amamenta. A gente acaba não tendo filhos ou tendo filhos mais tarde, é uma característica hoje da população feminina.
Eu não sei se nós somos o país que mais coloca próteses, mas dentre as cirurgias plásticas que ocorrem no país a que mais é feita é a colocação de próteses, mais do que abdômen, por exemplo.
Confira o papo completo na nossa live:
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