Making the Breast Decision: Mastectomy & Reconstruction?
It’s been 4 months since a core biopsy revealed I have invasive breast cancer. Since then, my days have been chock-full of research and reflection, so I’ve had plenty of time to think about the upcoming July 24th surgery that will theoretically save my life.
In the past 4 months I’ve had 14 infusions of chemotherapy and 16 weeks to weigh the options: single mastectomy, double mastectomy, reconstruction, no reconstruction, nipple tattoo, artistic tattoo, no tattoo. I’ve grappled with whether the path of least resistance would be to peel myself back to the bone, bravely staying flat chested forever, or to move gracefully forward with the replication of what I am about to loose.
Each option has its pros and cons. Of course they are all preferable to have no options at all.
With all the decisions that needed to be made, I’ve researched all my available choices (there are many) and prepared myself for the various possible outcomes of resection (there are a few). I’ve asked everyone I knew who’s gone before me all the relevant (and delicate) questions: Are you happy with your choices? Would you do things differently? Do you like the way you look?
Some of my fellow breast cancer warriors elected to remove only the breast affected by cancer, and haven’t sought to reconstruct. Some of these women use an external prosthetic in their bras and bathing suits, some don’t.
Many women I’ve spoken to have removed both the diseased breast and the healthy one prophylactically, and have reconstructed both. Some of these women were candidates for nipple-sparing mastectomies, which left their original areola and nipples intact; some were not and could not.
For those for whom saving the nipple and surrounding skin isn’t an option artistic tattooing can be healing. These women are empowered by reclaiming this part of their body with stunning tattoos where nipples or whole breasts used to be. Each woman’s options are affected by her case, diagnosis and genetic background.
The possibilities are many. The choices can feel overwhelming…
I’ve taken a winding, sometimes bumpy road to arrive at my own decision.
In the beginning I researched various autologous reconstruction procedures, all of which create new breasts using some fat, muscle, skin and blood vessels harvested from another area of one’s own body. But I came to the conclusion that this option could leave me physically weakened in the donor area of my body, and might seriously interfere with my yoga practice.
Then I asked myself if I’d be okay using cadaver or bovine (yes, cow) tissue to hold a silicon or saline implant in place. As an aspiring vegan, this presented me with a bit of an ethical dilemma, and I wasn’t sure if I could introduce any kind of foreign body into my own; whether it came from a four-legged friend or a chemical manufacturer.
Down to the bone.
In May, I came to the momentary conclusion that I would choose mastectomy without reconstruction. I started compulsively feeling my ribcage, imagining a smooth hillside slope from my collarbones down to my bellybutton. I’d press my fingers into the divots between my ribs and try to picture myself with a full set of 12 impressions instead of the breast tissue that presently occludes the spaces between my fifth, sixth and seventh intercostal muscles.
For hours and hours I Googled images of women without reconstruction to see how I would feel when trying on a more Balanchine ballet dancer version of femininity: flat chested and boy-like. What I found were hundreds, maybe thousands of brave women who have documented their journey through breast cancer and proudly displayed photographed themselves or posed for others.
Coffee table books and websites, like The Scar Project, celebrate these women and beautifully illustrate the process of survival and recovery. The photographs I unearthed revealed incredible courage and strength, and touched places deep inside my feminine soul.
But after sitting with this decision for several weeks, I realized that something was off. My decision no longer felt personal. It felt political, forced and academic. I realized that the pressure of what I thought I was supposed to choose was strangling what I wanted to choose.
Through meditation and self-inquiry, I realized how reactionary my initial decision had been. I had judged myself harshly in April for wanting “fake breasts,” and I had labeled myself vain. I needed to get out of my head and listen to my heart.
When I finally did, I realized that choosing not to reconstruct out of fear of being judged for having implants is no more authentic than choosing reconstruction for fear of being flat chested. Either path is honorable and navigating breast cancer is brave, period. Other people’s opinions are none of our business.
Beauty takes many forms.
I have unending admiration for the women who have lost their breasts to cancer and have chosen not to reconstruct. I think they are just as beautiful as women who’ve never gone through cancer, or prophylactically opted for surgery. But after much debate with myself, I have chosen another path.
Tomorrow, June 24th, I am having a bilateral mastectomy. I have chosen to remove both my breast that has cancer and the one that does not. If single stage reconstruction is possible, it will happen shortly after my breast tissue and cancer is removed.
If my cancer is still too extensive to save the majority of my skin and nipple, my plastic surgeon will put in tissue expanders that will stretch my skin until it is able to hold a pair of implants. Either way, I am excited to have a new pair.
This decision has brought with it great freedom. I feel released now; released from the pressure I was putting on myself to practice the asceticism I had applauded as part of renouncing reconstruction.
With my mind settled on rebuilding what cancer has taken from me, I’ve been able to return my focus to my heart. Spending time in quiet meditation and holding myself with greater tenderness, I’ve been mourning the imminent loss of the breasts I used to feed my son, and pleasure my partner.
In honoring our time together I’ve been directing thoughts of loving kindness towards my breasts and letting go of any negative feelings I’ve had about them in the past. I’ve come to realize that for me saying good-bye to my breasts has also been about letting go of any shame, blame or animosity I’ve felt about them in the past.
I’ve forgiven their colossal and quite early development in my pre-teens, the shrinking they did when I lost weight in my 20s, the tear-jerking mastitis I had during the first few months of breast feeding, and their abrupt deflation after I weaned my son. I’ve reached back into my relationship memories and forgiven the right one for being smaller than the left (a physically perceptible fact that mortified and embarrassed me in my 20s) and I’ve reframed any disappointments I’ve had in my sense of self as they’ve related to my beautiful mammary glands. On the brink of momentous change, I think I’ve finally made peace and let go of all the old gripes and insecurities.
I’ve put my hands over my chest and thanked my breasts for all the amazing things they’ve brought into my world: a strapping, well-nourished toddler, a satisfied and engaged partner, and a deeply loving maternal sensibility within myself.
I’m ready now; ready to make space in my heart to welcome myself home again: perhaps a little modified, but healthy, cancer-free and just as much a woman as before.
“Think of all the beauty still left around you and be happy.” ~ Anne Frank
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