Tag: Breast Loss

Don’t Call It a Boob Job…

I remember telling people that I had breast cancer. Most tried to be as supportive as they could, some weren’t quite sure what to say. But regardless of how they reacted, there was a general expectation that breast cancer surgery meant that I had lost both breasts to the disease.

A few people went as far as trying to get me to “look on the bright side” that I had gotten a “nice rack” out of the deal. For the record, I had opted for a lumpectomy, otherwise known as breast-conserving surgery, which removes only the tumor and some surrounding healthy tissue to ensure that the entire diseased part is removed. There was no “nice pair” to be had.

So maybe this is a good place to clarify a few things.

A mastectomy is performed to remove all breast tissue, usually (but not always) along with nipples, areolae and lymph nodes, of one or both breasts. It’s done to treat breast cancer or, in the case of prophylactic mastectomy, prevent development of cancer in the breasts.

There are alternatives to reconstructive surgery that may be very meaningful to the breast cancer survivor, including creating something beautiful out of what she might otherwise consider an ugly experience.

Whether or not a woman chooses to have a mastectomy vs. a lumpectomy is a very personal decision and based on a number of physiological and even emotional considerations. No one should ever be judged for their decision regarding this.

Similarly, well-intentioned folks should not assume that breast cancer means a bouncing new set of perky breasts. Not everyone who gets a mastectomy will opt for reconstructive surgery. In fact, there are tattoo artists who specialize in using mastectomy scars and the newly-flat chest as a canvas to create meaningful and beautiful artwork.

It’s also important to note, total removal of the breast does not come without its downsides. Surgical complications are more likely with mastectomies, and because so much breast tissue and skin is removed, there may be loss of sensation in the chest area that in some cases is permanent.

A newly published study in JAMA Surgery (Dominici et al., 2021; note, the free PMC version of this article does not appear until Sept 2022) with a reader-friendly version appearing in the NCI blog Cancer Currents) compares quality-of-life scores between a variety of breast cancer surgery types, including lumpectomy, unilateral mastectomy (one breast) or bilateral mastectomy (both breasts). All subjects were young (under age 40 at time of diagnosis) cancer patients with early stage breast cancer who gave scores to their perceptions of items such as breast statisfaction following surgery and both psychosocial and sexual well-being. Having a bilateral mastectomy with radiation treatments resulted in the poorest quality-of-life scores out of all surgery options.

Important: while the sample size of this study was ample, with 560 subjects filling out the questionnaire, the women were predominantly white, married and financially stable. A more diverse subject pool might affect the scores and the study must be replicated with inclusivity in mind in order to extrapolate the findings to the general female population. It should also be noted that no surgical groups’ quality-of-life scores were particularly stellar – such is the way with cancer surgery – but those of bilateral mastectomy patients were worse.

All women, regardless of age, have the right to have their questions answered before making a decision about breast cancer surgery.

Given the notable difference between these scores, and the fact that all the different surgical options were open to these young women due to their early-stage tumor status, it stands to reason that women should be informed by their oncologists and surgeons of the possible outcomes of their decisions and second opinions should be encouraged.

That doesn’t mean that a bilateral mastectomy isn’t the right choice for a younger woman with early-stage breast cancer, only that she should be aware of the possibilities of complications and persistent quality of life issues. She should not be pressured in either direction because there is a lot to consider and it’s not an easy choice, nor does it come at an easy time in her life.

So please, don’t call it a free boob job.

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If you are contemplating a prophylactic mastectomy in the absence of a genetic predisposition (BRCA+) and have early-stage breast cancer, please read this article from breastcancer.org and discuss your options with your medical team.

Invisible Effects: Body Image, Part 1

This is going to take several posts to get through. Body image is a dicey subject for me.

First of all, let’s talk breasts. Mine are not very big to begin with. Okay, they’re teeny. That usually doesn’t bother me although there have been times that, standing 5’11”, I’d wished that I’d had a more sizable bustline. Most notably, this was when I was toying with the idea of competing in fitness-based figure competitions; ultimately, I decided to stay away from the extreme dieting and arbitrary body judgments that came along with these contests.

Regardless, breasts were an important part of giving figure competitors an attractive, balanced look. But at such low body fat levels, breasts were collateral damage. So what the dieting took away, silicone gave back. I found this odd because no matter how hard these women worked to achieve the “perfect” physique, according to the judges (and society) they couldn’t pull it off without something artificial. We have a powerfully ingrained notion that breasts = femininity.

I hadn’t realized how much I bought into the notion that I needed breasts to define myself as “female”.

When I learned that I had breast cancer, one of my first thoughts, right after, “Am I gonna die?” was, “Will I lose my breast?” The diagnosis left me empty, but thoughts of disfigurement drained me even more. There were different possibilities for surgery, different conditions under which I’d lose more or less breast tissue. And they were all stressful. I mean, I had little breasts, but they’d nursed two children into toddlerhood and I was remarkably attached to them.

And if I needed an entire breast removed, would I opt for reconstruction? Is there even such a thing as an AA cup implant? Or would a larger implant push me into getting the other side done too, for the sake of symmetry? As you can see, I was wading into excessive-surgery territory.

Finally, if I didn’t get reconstruction, would I get freaked out by a flat ribcage where my tiny-but-now-incredibly-important breast had been? Furthermore, would my husband, accepting and loving as he was, be turned off by a missing breast?

True to form, I had died a thousand deaths before finding out that I could get by with a lumpectomy. And because of the small size of the lump and where it was situated, close to my armpit, it hardly changed my breast at all (as noted in my post about breast changes). So all the worry was for naught.

But many women have not been so lucky. Emotional aspects of breast loss, reconstruction, lack of sensation and societal pressures are not discussed nearly enough but can have a powerful impact on the psyche of cancer survivors. And this drives home the point that cancer is complicated far beyond the cold, clinical elements of treatment choices and survival rates. Breast cancer gets at who we have been taught that we are as women. Re-evaluating that, and possibly re-examining it as a society, will take a lot of work.