I had my first breast biopsy at age 39 for microcalcifications, which turned out to be benign. Eight years later, at age 47, I was diagnosed with my first breast cancer, at that same biopsy site. It was a Stage IIA invasive ductal cancer with micrometastases to two nodes. I had a lumpectomy, two re-excisions to get clean margins, chemo, radiation, and Tamoxifen. Five years later, I celebrated being cancer free, thinking the battle had been won. Three months after that, I was diagnosed with a Stage IIIC invasive lobular cancer in the opposite breast. In spite of five years of checkups every six months and annual mammograms, my 5.1 cm lobular tumor was not detected until it was finally palpable on physical exam. It was a new primary, not a recurrence, only this time very locally advanced.
Given my history, a bilateral mastectomy was the only option that made sense to me. My surgeon and oncologist agreed. At the age of 52, I had a modified radical mastectomy of the left breast and a simple mastectomy of the right. I also had a sentinel node biopsy on the left, which led to a complete axillary dissection of all three nodal levels — 23 nodes removed, all 23 positive for cancer.
I knew from the moment I decided on mastectomy that I did not want reconstruction. I felt that I had had enough surgery and I was not inclined to take the roll of the dice that reconstruction can often become. With my locally advanced Stage III diagnosis, I also felt that reconstruction might not be the best decision. In addition, I had developed lymphedema of my left arm two months after surgery, during chemotherapy. I was afraid further surgery would aggravate that condition. Had I been younger and single, my choice might have been different. But being 52 and married 34 years to a great guy, rebuilding my chest was just not a priority. My goal was to feel whole and healthy again.
Though I have never regretted my decision not to reconstruct, I still had to grapple with the loss of my breasts and what that would mean for my life and the perceptions I held of myself. As a pre-adolescent, I spent hours looking at the women's lingerie section in the Sears catalog, dreaming of the day I would actually wear a bra. Getting my first training bra was a huge event in my life. Like many women, I used to feel somehow lacking because I was a late bloomer and never did develop the ideal bosom that was constantly flaunted in advertisements and on TV.
Over the years, though, I came to like my body. I developed an appreciation for my breasts by taking comfort in the fact that they were not too large, not too small, and still kept their youthful lift, most likely due to my childless status. Basically, my breasts were a part of how I perceived my physical self and how I felt my physical image was presented to the rest of the world. But more than physical image, my breasts were also a symbol of my femininity and my sensuality. They were like a badge worn proudly that stated "I am Woman."
Prior to surgery, I tried to prepare myself for the coming change in my body image by looking at mastectomy photos. I even took photos of my naked body with breasts and then used Photoshop to alter the images as I imagined they would be post-mastectomy. The day after surgery, when the dressings were removed, I saw my scars for the first time. I intentionally closely examined my body, noting the changes in my chest, the scars, and the sensations, in an effort to bond with the new me. I still stand at the mirror often and examine my profile, noting my prominent lower ribcage with the rotund abdomen below it which now is so much more apparent than it was when I had breasts.
I believe my quality of life suffers only if I fail to alter my perceptions of what the loss of breasts signifies.
Am I sad to lose my breasts? Absolutely. Would I prefer a body image that was whole and traditionally female from outward appearance? Of course. Do I feel that not having breasts makes me less a woman or takes away from my appeal as a sensual being? Well that's a harder question. I think logically the answer is no, but on a deep emotional level it is still hard to separate from all the years of indoctrination regarding society's expectations for female attractiveness.
And yet, I truly believe that it is my heart, mind, and spirit that defines me as a feminine, sensual woman, not my physical appearance.
It has now been almost 28 months since I had breasts. I started out assuming I would wear prostheses and even got fitted for a pair prior to my radiation treatments. During my six weeks of radiation, however, my skin was too tender to wear a bra and I did not want to aggravate my lymphedema. What I discovered was a wonderful sense of freedom going flat-chested. It seemed so much simpler and more natural to me. It took some time for me to get over my initial embarrassment in public, feeling that everyone's eyes were burning through me. But I soon realized that most of us really are not that observant and that it was only my internal thought processes making me uncomfortable, not any actual responses I was getting from others.
There was another element to my decision to go flat — I wanted to be open and not hide the fact that breast cancer does dramatically change the way one looks and feels about oneself. One of the reasons I chose not to have reconstruction was that I don't believe breast cancer survivors should feel pressured to hide how their bodies have changed. I support a woman's choosing reconstruction or a prosthesis if that's what it takes to make her feel whole again, but I fear too many women make those choices based on the fear of "offending" society with the hard visual truth of their breast cancer aftermath. My purpose is not to shock society, nor am I someone who is driven to share every intimate detail of my life with strangers. Rather, going flat is a matter of honestly facing my life as the "new me," accepting my body as it is, and living my life without needing to present a more gender-specific stereotype.
I know there will still be days when I will mourn the loss of my breasts, but I expect those days to be few and far between. Of more concern to me is what impact breast cancer will have not only on the length of my life, but also on its quality. Breast cancer has caused me to reorder my priorities. I try not to stress out over the "little things," although I can't say I am completely successful at that yet. But I do try to find something every day that can bring a smile to my face or someone else's. And I know that I am grateful for every day that allows me to share with others and learn more about myself.