When I was 43 years old, I was diagnosed with stage one breast cancer. After the tumor was removed, I had the minimal treatment of radiation. Because I was so young and because my mother had died of ovarian cancer, I was encouraged to do genetic testing. The testing revealed that I carried a mutation called BRCA1. It’s actually a lack of a tumor suppressor gene, and the mutation causes an increased risk of breast cancer and ovarian cancer.
At that point, prophylactic surgeries were suggested for me, a prophylactic oophorectomy or potentially a hysterectomy, and a prophylactic double mastectomy. At that point, I hesitated and then chose to have a prophylactic oophorectomy. When I had my ovaries removed, I asked my surgeon to take a picture of them. So she took a picture of them before she removed them. They were beautiful, soft, egg-like-looking structures against a pink background. I really mourned that surgery because I knew that by losing my ovaries, I was losing my potential to have children. I had three children that I loved and a new partner. We planned on having a child together, so going through with the surgery was a very difficult decision for me. Although, when I woke up in recovery, I was ecstatic and jubilant, making me realize what a weight the possibility of ovarian cancer had been.
It was recommended to me at that time to just have prophylaxis for the ovaries and Fallopian tubes and to keep my uterus, as studies indicated that women who did not have their uterus removed had a better quality of life. I went along with that recommendation, and then five years later, I started having uncontrollable bleeding from my uterus. I went immediately to my gynaecologist and it turns out that I had uterine cancer. My surgeon sent me to a gynecological oncologist and he immediately performed a hysterectomy and surgical staging.
When the pathology came back, my physicians were pretty much stunned because this 1-centimeter tumor was behaving in a very aggressive manner. It had behaved more like an ovarian tumor. The pathology revealed a micrometastasis to one pelvic lymph node. At that point, I had to have chemotherapy and also targeted radiation to my vagina. Losing my uterus was an enormous loss because I had borne three children who I dearly loved, and I was fond of my uterus. I thought of it in terms of my womb rather than a medical term. It was so sad to goodbye to this lovely friend.
At that point, my physicians pushed for me to do a double prophylactic mastectomy with reconstruction. That was extremely difficult for me to face as it is for, I think, many women. Besides being parts of my body my breasts were connected to the fact that I breastfed all my children. That was, for me, a really wonderful experience.
I was quite concerned the surgery itself and the aesthetic changes afterward. I put it off for about three years until a friend of mine had a similar surgery done. Her results were remarkably good. This gave me the courage to do it. Basically what was done was: incisions were made under my breasts, and the breast tissue was taken out and weighed. Then immediately, a surgeon put in implants. Around the implants, they put something called AlloDerm, which is a tissue that’s harvested from cadavers, and I believe also pigs with all of the donor’s DNA stripped. Within six weeks, my own DNA would take over.
The most common way of doing reconstruction with implants is to put in a spacer after the glandular tissue is removed that slowly stretches the muscle. Now, sometimes they’re putting implants above the muscle, but usually they went below the muscle which had to be stretched. It could take up to six months before you would get a final implant with the spacer method.
I went to a physician who would do direct-to-implant. The breast surgeon oncologist would take out the tissue, and the plastic surgeon would put in the implant and put the AlloDerm around it so that the stretching happened right there. I was also allowed to keep my nipples because I didn’t have my tumor near the nipple.
I came out of the surgery with breasts, fully lovely breasts.
Now, I wasn’t supposed to have any sensation, but I do have a tiny bit of sensation in them. I didn’t mourn my breasts. I didn’t miss my breasts. I still had breasts, as opposed to when I mourned my ovaries and my uterus, which were gone. I realized that medically, I don’t have breasts. Medically, I have flesh bags that are enclosing an implant and this AlloDerm, which has now grown into the rest of my physiology. But for me, I still have breasts.
I had to wear a certain kind of bra for a few weeks, but then when I went to change bras, I would go to the bra department in a store and I would say, “I’m looking at bras. I recently had a mastectomy and reconstruction.” The reaction was always, “Oh, I’m so sorry.” I would reply, “You don’t need to be sorry because I have breasts.” My friends would sympathize, ” What a terrible thing you’ve been through.” I’m not saying this to minimize anybody else’s experience. I’m just recounting what mine was. I Tod everyone, “No, it’s fine. It’s absolutely fine.”
The experience of mastectomy and immediate reconstruction has made me wonder over the years … what is a body part? It’s not just a scientific anatomical medical categorization that’s incredibly useful in treatment, but it also has a very strong narrative, personal normative component. For me, yes, I lost the ability to breastfeed, but I wasn’t going to be breastfeeding because I’d already lost my ovaries and uterus, and I already had grieved those things. But I feel very whole, even though I have had what was an extremely serious surgery where they removed my breasts. I feel that still have breasts- they feel like breasts, they look like breasts and I still associate them with all of the things that connected to my history with my breasts. It just leaves me with the question, what, then, is a breast?
My Anatomical Journal 