Invisible Effects: Body Image, Part 3

In Part 1 of this series I wrote about breast loss (which I ended up not having to deal with) and how strongly I equated breasts with being female. In Part 2, it was about my fear of having no control over my body and being susceptible to weight gain as a cancer survivor.

In Part 3, I’m writing that my body reacted in a way completely opposite of what I feared, and I managed to regain some semblance of control.

As mentioned, many women with breast cancer, particularly those whose tumors are hormone receptor positive like mine, put on weight. On top of the “my-out-of-control-body-is-killing-me” feelings brought about by cancer, the threat of runaway weight gain added to my frustration.

Yes, this was another example of how, throughout my fact-finding research, I took to heart what I read and immediately assumed that if it happened to others, it was also going to happen to me. Except that it didn’t. Just as how statistically I shouldn’t have gotten breast cancer, I also shouldn’t have ended up almost 10 pounds below where I started pre-diagnosis.

My body is quite reactive. If you’ve read my posts about how I respond to anxiety, you know that I shed weight quickly. I am not an emotional eater; I am an emotional non-eater, and more often than not don’t have to fight cravings. I have to fight a lack of appetite

As weird as this may sound, the resulting weight loss was one of the strongest indicators that I wasn’t completely out of control, that my body hadn’t completely turned against me. And more than that, it was another reminder that my situation was not typical. So by maintaining a very doable 6 day/week workout schedule, I broke through the mentality that what others experienced was necessarily what I would.

Right side of my ribcage. I can see my serratus and external obliques, but have to focus on building strength, not losing weight.

In addition, and arguably more important is the fact that cancer recurrence and episodes of lymphedema have been associated with higher weight levels (see this Susan Koman web article addressing this issue, including journal references). According to a bioelectrical impedance analysis (BIA) body fat monitor, I’m sitting at about 20% body fat. The actual number doesn’t really matter, since these monitors are notorious for being inaccurate. What matters is that those numbers are stable and that I’m able to build muscle.

What also matters is that with my level of activity both pre- and post-diagnosis, recovery has been quite good. I feel strong. I feel lean and fit. My sense of self-efficacy is high. And I’m finally able to exhale after holding my breath about all the things that were happening to my body.

Piece by piece, I’m reclaiming my physical self again. At that same time, I’ve still got a lot to sort out in my head. I know that keeping my body fat in check doesn’t mean that I’m protected from cancer, despite what numerous news reports suggest. It makes me uncomfortable being bombarded with that message, though. According to the December 20, 2018 National Health Statistics Report (Fryer et al. (2018)), the average woman in the U.S. is obese. In the interest of public health, the “lose weight” message is trumpeted constantly. Every time I’m exposed to that, my perfectionism kicks in and I have to fight the urge to clamp down on my fitness and nutrition.

Being an outlier doesn’t gain me much sympathy, and it does comes with its own challenges. In the process of sorting out everything that’s happened to me, I’m working to keep an even keel going forward and not go to extremes. As with everything, moderation.

I Didn’t Expect THAT: Surgical Glue

This was one of the nicest surprises that I received throughout all of treatment.

Growing up, I always associated surgery with umpteen stitches that required removal. Then again, I also associated cancer with certain death. Luckily, neither one is a definite anymore. Since I’d never needed major surgery before, I had no idea that surgical glue is a thing. And what a thing it is! It would have probably been different if I’d had a mastectomy, but with a simple lumpectomy to remove a not-so-big tumor…all the stitches were dissolvable and internal.

Armpit_glue
A view of my armpit after my surgery. The top scar is lymph node excision, the bottom is lumpectomy. The shiny stuff is glue. Yay, no bandages needed and no stitches to remove!

On the outside, there was glue. It was plastic-y, kind of like if someone had taken nail polish and drawn a stripe across the incision, only it was more pliable. As my incisions healed, the glue flaked off. There were no dressings to change, no bandages necessary at all. Not having external stitches was a beautiful gift from my surgeon.

If you’ve read my other posts, you’ll know that psychologically I didn’t handle the concept of cancer well. It took me on an anxiety-fueled roller-coaster ride, as I went from a healthy, active woman to a cancer patient. I have a stubborn expectation of normality in my life, and over the years I’ve put a lot of work into maintaining it. Cancer blew that to shreds. And in a funny way, that littleĀ strip of glue brought a bit of “normal” back to me.

Sometimes, it’s the little things…

 

I Didn’t Expect THAT: Breast Changes

Or more accurately “Breast Changes, Lack Thereof.”

This one threw me for a loop. Prior to my lumpectomy, I scoured the internet for ideas of what partial breast removal looked like. In a word, disfigurement. Certainly, having half a breast was preferable to having no breast or dying from breast cancer, but I wondered how I would deal with losing a secondary sex characteristic that society uses as an indication of female-ness. My breasts had nursed two bouncing babies into toddlerhood and cancer was going to take one of them (breasts, not babies!). That kept me up at night.

Scars
Top scar: sentinel lymph node dissection; bottom scar: lumpectomy. Teeny!

After dying a thousand deaths, I found that my reality was not nearly as frightening. My lump was small and sitting at about 2 o’clock on my left breast. That put it dangerously close to my axillary (armpit) lymph nodes, which could enable the cancer to spread faster, but also in a place where tissue removal would be less noticeable. Three sentinel lymph nodes were removed from my armpit — they were found to be unaffected. My surgeon was able to get “clear margins” (no cancer cells were seen on the edge of the tissue that was removed) on the cancerous lump, and if not for the scars, there was little indication that I’d had surgery.

Scar_arm-down
View of my lumpectomy scar, arm down.

That blew my mind. With small breasts, I didn’t think I could spare the tissue. I was contemplating a prosthesis, and concerned that the size of the excision might tempt me to go with reconstructive surgery…but none of that was necessary. Even my surgeon was surprised. I told her it was because she was an excellent surgeon, but she wouldn’t accept the compliment. According to her, I was just very lucky.

After radiation treatment, that breast tightened up and even gained a bit of size. All at no extra cost.

So, whenever I do a gratitude meditation and count my blessings, I reflect upon this. There are so many things that could have been worse, and I had gotten lost in the terror of it all. But in the end, it was okay.

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Note: I wanted to show how similar both breasts looked, but then there’s all this potential for getting flagged as inappropriate, so you’ll need to be content with “side boob” photos and just take my word for it.