







































Education, Society and Human Studies 
ISSN 2690-3679 (Print) ISSN 2690-3687 (Online) 

Vol. 2, No. 4, 2021 
www.scholink.org/ojs/index.php/eshs 

1 

Original Paper 

Psychological Rehabilitation on a Patient with Breast and Arm 

Amputation: A Case Report 
Isabela Castelli1* 

1 Researcher of Universidade de Brasília; Psyhologist on Hospital de Base do Distrito Federal 

(IGESDF), Brasília, Brazil 
* Isabela Castelli, Researcher of Universidade de Brasília; Psyhologist on Hospital de Base do Distrito 

Federal (IGESDF), Brasília, Brazil 

 
Received: November 6, 2021   Accepted: November 12, 2021   Online Published: November 16, 2021 

doi:10.22158/eshs.v2n4p1                         URL: http://dx.doi.org/10.22158/eshs.v2n4p1 

 
Abstract 

We define amputation as a removal of totally or partial part of an organ. Amputations can be caused by 

chronic diseases as cancer, infection and diabetes, or by a traumatic accident. Where, we discuss the 

differences between the two types of amputation. This paper is a case report on an amputee patient, the 

consequences in short e long term. We suggest possible interventions for psychological professionals 

and multidisciplinary healthcare team. Also, we discuss the lack of academic production about 

traumatic amputations. 

Keywords 

traumatic amputation, healthcare team, psychological intervention 

 

1. Introduction 

1.1 Amputation: An Overview 

Amputee surgeries refer to the removal of totally or partial part of an organ. Currently, this type of 

surgery is considered reconstructive surgery because the final objective is to restore the organ (Gabarra, 

2010; Seren & Tilio, 2014). 

There are few illnesses that can lead to an amputation: cancer, diabetes, infections and traumas. About 

this last type of amputation, it’s necessary to highlight the sudden break with the “normal” life before 

the trauma and the need to quickly adapt to a completely new form of living (Paiva & Goellner, 2008). 

In other words, the patients usually distinct their lives on “before and after” the traumatic amputation 

(Paiva & Goellner, 2008). 

 



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We should stand out about the traumatic amputees’ patient’s profile: young, on working age and with 

no previously known disease (Perkins et al., 2012; Shankar et al., 2020).  

In the United States of America, are estimated 185.000 amputations per year which 45% are provoked 

for traumatic accidents (Kratz et al., 2010; McKechnie & John, 2014). It’s estimated that by the year of 

2050 the total number of amputees will reach about 3.6 million people (Ramos, 2012). That makes the 

attendance and follow-up of amputees a public health issue. 
1.2 Psychological Reaction in Amputation 

The experience of amputation brings physical and psychological changes (Melo et al., 2020). It’s 

important to highlight that these changes are called “adjustment reactions” and they are not considered 

pathological reactions. This adjustment reactions involve feelings like anger, fear of the future, sadness, 

self-esteem change and anxiety. Therefore, it’s important that the patient receive psychological 

treatment as soon as possible (Srivastava et al., 2011; Tenner et al., 2018; Melo et al., 2020). 

Despite the vast report of these symptoms the number of studies publications is still very low 

(Boccolini, 2000; Kratz et al., 2010; Shankar et al., 2020). 

It’s possible to didactically divide two moments post amputation: (a) acute phase, immediately after the 

surgery, when the principal mission of the patient is to survive with the necessary adaptations; (b) 

chronic phase, the moment when the patient must lead with the characteristic of its new physical 

limitation, the pain, the meaning of loss, quality of life and, eventually, the fitting on a prosthetic.  

In both phases—acute or chronic—the limitation imposed by the absence of a member result in serious 

daily life changes; impacting social, work and sexual life (Galván & Amiralian, 2009; Milioli et al., 

2012; Sahu et al., 2016). 

Psychological interventions are recommended in both phases in order to avoid aggravation os 

psychological changes (Gabarra & Crepaldi, 2009; Srivastava et al., 2011; Vicent et al., 2015; Melo et 

al., 2020). 

Authors defend that follow-up of psychological intervention in medium and long term (to six months to 

a year) it’s important to follow the evolution of the adaptation of the adjustment reaction (Kratz et al, 

2010; Perkins et al., 2012). According to these authors, the first year after an amputation brings 

emotional symptoms, being the most frequent depressive and anxiety symptoms’. 

This important to discuss that negative symptoms are not necessarily negative reactions—they can be 

the adjustment reaction. These reactions can lead the patient to treatment motivation. Some patients 

understand the amputation as a chance to “live a new, health life” (Melo et al., 2020, p. 326). 

Given the above, it is essential that an amputee patient be evaluated and monitored by a psychological 

professional (Boccolini, 2020). 

Just to explain to the reader, a systematic literature review was carried out by this author to screen the 

number of studies that address psychological aspects of amputees. Descriptors used were “traumatic 

amputation” and “psychological trauma”. Were found a total of 143 articles. Of these, 14 were 



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duplicated. 30 articles did not approach amputation issues. Another three articles were excluded 

because approach only technical questions about amputation’s surgery (two of them discuss what the 

medication were to be used on the immediately post operatory and the other one discusses exclusively 

the surgical techniques for an amputation). Eight articles were excluded because treat about pediatric 

context (the reader can suppose that pediatric and adult context of amputation are different). 21 articles 

were excluded for treating revascularization surgeries (where, we can understand, that the patient was 

not amputated). 25 articles were excluded because they discuss penile amputations (which, for this 

review would bring low contribution). Seven articles were excluded for treat about complications of 

non-traumatic amputation. Three articles were excluded because they did not mention psychological 

aspects.  

On this survey, 110 articles were excluded; being considered only 31 articles. 

Based on the survey above descript, we can note that studies about traumatic amputation are rare. Just 

in front of that fact, we need to develop studies with traumatic amputees. 

 

2. Method 

2.1 The Case Report 

The patient, here named as P. for maintenance of confidentiality, was a 19-year-old girl with a normal 

life. At the time of the accident, P. worked on a restaurant, was engaged to her boyfriend, had a good 

circle of friends and no major conflict with her family.  

One night, on the end of her work shift, P. was sought by her fiancé to go home. On the highway, a 

drunk driver ran over P. and her fiancé who were on a motorcycle. After running over, the drunk driver 

dragged P. for 2.5 miles.  

During all this period, P. was conscient, trying to get loose from the car hood.  

Unfortunately, P. couldn’t get out from the car hood and this episode end with her left arm—that was 

stuck on the car hood—dropping for her body. Long story short: by this time, P. was amputee. 

P. was rescued by a team of firemen and was directed to a trauma reference hospital. Once in the 

hospital, P. stayed on very serious health condition. She remained on the ICU for more than a month. 

After the medical care and with the stabilization of the health chart of P., the psychologist started the 

sessions to work on post traumatic stress symptoms, self-image change and depressions/anxiety 

symptoms. 

The first sessions happened yet on the “acuate” phase, when P. was hospitalized in the ICU. At this 

moment, the main objective of the psychological intervention was to help the patient to elaborate the 

accident and to develop strategies to face the traumatic situation.  

After hospital discharge, P. remained accompanied by the psychology service of the hospital. When P. 

returned to home, the phase where we expect better adjustment reactions, P. had a lot of family 

disagreements, including jokes about her amputation. Adds to this fact, the engagement was over, 



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according to P. because the fiancé did not was interested in helping her on the health care treatment. P, 

lost her job and, until now, is not entered into the labor market. 

On more than one situation, P). though and tried suicide. On her words “because I could not support 

more of this situation”.  

It’s important to say that on the moment when I write this case, more than one year is passed over the 

accident and P. is still in psychological follow-up to handle the symptoms above describe. By now, the 

suicide thoughts are not present and our (mine and P.`s) goal is to adjust the social, work and affective 

life of P; even if it means resignification and great adjustment on her reaction in face of unfavorable 

events of life. 

Also, at this moment, the medical team is starting to work on the reconstruction of both breast with 

silicone implants. This treatment is costed by the Brazilian healthcare system—also known as Sistema 

Único de Saúde (SUS). However, the arm prothesis cost about U$ 28.000,00; this is not a treatment 

offer by the SUS and is way out of family conditions to acquire. 

Probably, P. should fit her new life without the arm. The absence of her arm is a very important 

thematic on the psychological sessions and it’s one of the most traumatic impacts that this accident 

brought to P. As psychological professional, is my duty to work on developing functional coping 

strategies. Also, interdisciplinary work is developed with a physiotherapist for possible physical 

adjustment for P. daily life.  

The communication with the multidisciplinary team is essential for the better health care for P.  

 
3. Discussion 

3.1 What Psychologist Could Do in those Situation  

The first conclusion this case report bring to discussion is the lack of studies and publication on the 

traumatic amputee area. This reinforces the importance of offering conditions for researchers to 

develop innovate studies. 

Another conclusion on this case report is the importance of psychological intervention on both phases: 

acute and chronic phases; therefore, which one has their specificities. More than “patients” the 

psychological professional should stare to the amputee as a person who need all the effort on the 

healthcare team. An amputee will need help to relearn the simplest things and activities in their live and, 

this, should motivate the healthcare team.  

In P. case, she will be accompanied as long as she need.  

 
 
 
 
 



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