I gave up my breasts to save my life - SELF

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2006
May 16
12:00 AM
HEALTH (HTTP://WWW.SELF.COM/LIFE/HEALTH/)
I gave up my breasts to save my life
What makes a woman who doesn't have cancer decide to have a mastectomy?
Lauren Slater reflects on her radical decision.
By SELF Staffers (/Author/self-staffers/)
My sixth biopsy was the one that came back bad. Every one before that turned out to be a
hunk of harmless tissue, like a sock balled up beneath your pillow—"What's that? Oh,
nothing." But my sixth biopsy report was not nothing; it was something more than sock or
flesh. There was a mound in the mound of my chest. A sample of its cells were fixed in broth
and smeared on a slide. What those cells mean, even now, after I have lost my breasts and
had them replaced with implants, I still cannot quite say.
"You have atypical ductal hyperplasia," the doctor told me. "It's not exactly cancer. It's...a
marker for cancer." We were on the phone. I was in my study, our black cat napping on the
daybed, his paint-white paws twitching as he tracked dream mice. The sun was pouring in; the
curtains were sheer; everything was healthy here. "What does it mean?" I asked.
"Your cells are atypically formed," the surgeon began, "and there are too many of them in the
ducts, like rust in a pipe. These cells could mean you'll get cancer, or they could not."
This news was hardly comforting. We could have a smallpox attack, or we could not. India
might let loose a nuclear bomb, or it might not. I needed more than that. I was 38 years old
with a 2-year-old daughter, a husband, a house, a life. I needed percentages and treatments.
Is this not what Western medicine is best at? Seeing beyond the shapeless storm of suffering
and producing a measurable circumference, replicable stats? No longer. In the new
millennium, supercharged machines can find things so small that they are beyond our
I gave up my breasts to save my life - SELF http://www.self.com/life/health/2006/05/life-saving-mastectomy/
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understanding. Detection produces more mystery than certainty, providing a woman with
knowledge but no procedural road to follow.
"What are my chances?" I asked the surgeon. "What are the chances that these atypical cells
will turn into cancerous cells? Do you have any data on that?"
"We don't have definite data," she answered, which surprised me. Such a crucial figure, and it
wasn't there! "What we do know is that a woman with your history has about a 10 times
greater lifetime risk of developing cancer than the average woman does."
"I want my breasts cut off," I said.
"That's extreme," she said. "With women like you, we prefer to take the wait-and-watch
approach."
That's easy to say if you're the one doing the watching, not the waiting. I had already waited
through the anxiety of five prior breast biopsies in the last seven years, through 10
mammograms, one MRI and endless sonograms. I'd waited through the diagnosis of breast
cancer in two close relatives. I found the screenings, or, more specifically, the waiting, to be
excruciating. More excruciating still would be waiting with the new knowledge, thanks to
modern medicine, that I had this ream of funky-looking cells whose plans I could not fathom.
Thousands of women are now facing these hazy "maybe" diagnoses. Abnormal cells like mine
could go on to become a malignancy, but they could also just sit there, indolent as a lady on a
lawn chair, quiet and shut-eyed while the carrier moves through life, dying from age, not
illness. Part of the problem, it seems to me, is not only cancer but the ever-spreading
awareness of it. Sometimes I think this awareness is bad. Sometimes I wish I'd never known
about my rusty atypical hyperplasia, because knowledge is only as good as the treatment it
spawns. Wait and watch is not a strategy; it's a Zen exercise, and I'm not Zen. I'm Jewish. I'm
nervous.
When I got off the phone with the surgeon, the cat leapt from his nap and streaked out of the
room, alarmed by something I couldn't see. I stood there, in the sunlight, by the window
overlooking my garden. Puddles from an early morning rain shone like sheets of glass in the
ground. I touched my fresh biopsy scar. It gave beneath my fingers, still soft, the bruise the
color of a pansy.The next day I said to my husband, "I want my breasts removed."
"But you have such beautiful breasts," he said to me.
"I don't want to be closely followed for the rest of my life," I said. "I want to be free of it."
We went for a walk then. He held my hand. On the ground were many small stones, strangely
shiny. Back inside, in our room, my husband touched my breasts, mapped with turquoise
veins; pendulous, mountainous, ridged—sprouting lumps and bumps no one could quite
interpret.
"Your breasts and I have a relationship," my husband said.
I stepped back then, angry. "If you like them so much," I said, "then you take them. You wear
their weight."
He didn't say anything. He is a kind man, a gentle man, prone to optimism at all costs.
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This was not his body.
My body: I am a dainty teacup of a woman with a size-D endowment. I'm 5 feet tall, weigh
100 pounds and have hands the size of my third-grade niece's. The scaffolding of my chest
bones is easily visible in V-necks. From a purely aesthetic point of view, my breasts have never
fit my frame. This was no reason, of course, to have a mastectomy, even though some part of
me had always longed for a field-flat upper half. I'd imagined being lean, maybe with a rose
tattoo curling around the scar.
A mastectomy had some fashion appeal for me, I can admit that; but believe me, I would not
have done it had there been an alternative. Wait and watch was not an alternative. It would
have meant having clinical breast exams at least twice a year, annual MRIs and every lump
analyzed. I got, on average, five lumps a year, which could translate into five biopsies a year.
All told, a surgical biopsy is a one-month affair, from the discovery of the lump to the
pathology report, and all the while you're quaking. It didn't seem right for a type A person like
me to choose this as a strategy; it was like asking a purebred dalmatian to sit quietly in a crate
all day and just relax. But that's exactly what friends and family told me in the following days,
some even going so far as to turn it into a kind of spiritual hopscotch: "It will be good for you,
learning to live with this anxiety." For some people, maybe. But for me, prone to obsess, it
didn't seem right.
I made another appointment with my breast surgeon. I told her I'd thought it over and I really
wanted that mastectomy. My surgeon said OK, though I worried she wasn't happy. My mother
definitely wasn't happy. She said, "Don't overtreat yourself. Don't overreact." My brother, a
physician, said, "Surgery has its own risks, you know," but I didn't want to hear it; I still don't. I
realized the irony of my decision: I was choosing the most extreme medical intervention to get
out of a lifetime of medical interventions, one big biopsy to sidestep years of smaller surgeries
lying in wait. Many people told me that in choosing mastectomy, I was choosing to evade the
anxiety inherent in so much of life. One friend asked me, "What's next? Will you cut out your
ovaries, take out your cervix when a Pap comes back irregular?" Well, maybe. I'll go case by
case, body part by body part, assessing the risks to skin and psyche. To those who kept telling
me that all life is lived in the conditional tense, that I should see this as a gift from some god,
to those people I say: No thanks.
I have a beautiful daughter I want to see through. I have Benjamin, my husband, whom I love. I
have two dogs and a cat, a house, and a garden to grow. If there is any way I can increase my
odds for survival, I will. I get only one go-round at the little bit of life I have on this earth, and I
don't want to spend it with my breast surgeon. Medical technology has given me reason to
believe that I am aging poorly; I cannot ignore this knowledge, even as I see it leading me
straight toward a surgery with its own grave risks: losing my breasts. Possible nerve pain.
Movement restriction.
The dangers of general anesthesia. These are the facts. There is also the fact that women
who undergo prophylactic mastectomy have only a 1 percent chance of getting cancer.
That's a fact I can live with.
As soon as my surgeon said yes to my mastectomy, I scheduled the procedure for the first
available time slot. One week. "So fast," everyone said. "Don't you want to think about it some
more?" No, I didn't. I had done my thinking, hard and deep; quick as a scalpel on skin. In the
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seven days leading up to the procedure, I did my own kind of grieving, quietly, minimally. I said
"I'm sorry" to my breasts. I said, "I'm sorry to cut you off."
I remember how tender my nipples turned in my 14th year, how the breasts themselves rose
out of my chest like swans on a pond, white, pink-tipped, proud. I remember my pregnant
breasts, spectacular, latticed with veins, the gold drops of colostrum after the baby came.
Good-bye, breasts. Where would they go? I pictured them floating down some river with all
sorts of other hospital flotsam, syringes, gauze, my two breasts untethered, abandoned, the
hollow part in my body.
I was absolutely decided, but then I wasn't. Should I cancel the surgery? Should I postpone it
for a while? One afternoon, I went to the breast resource center at the hospital and brought
home books of women with one or both breasts removed, full-page photos of topless women
with zippers running from their sternum to their armpit, their stares defiant or shy; one woman
with her head thrown back, her hair the color of apple cider pouring down. "What do you think
of how they look?" I asked my husband. We turned the pages together. He said, "They look
fine, but you, I can't imagine you without your breasts."
"Would you still be attracted to me?" I asked.
"Of course," he said, as though he could possibly know.
It was springtime, and tiny nipples were appearing on the lilac's branches. My husband went
outside and dug in the earth; he made mounds of soil, plunging his hands in and pulling out
silky, segmented earthworms. Now he is doing his grieving, I thought. Then I thought, Maybe I
really should not go ahead with this. But then I squeezed my nipple and a little bit of blood-
tinged serum bubbled out of the duct; that would need to be checked; there was a strange
ridge in the upper-right quadrant—was it growing? That would need to be checked. And there
was my child, so small, her hair all floss and gleam, her language just beginning and incredible
to hear—phrases like, "I don't like to be lonely," or "Oh, my God! I forgot to say thank you!" or
"Is the moon Jewish or Christian?" I looked at my difficult breasts with their droplets of blood
and then I looked at my daughter growing, and I knew what I needed to do. I didn't change my
scheduled surgery. Each night, when I put my child to bed, she said, "Hold me tight, Mama,"
and I pressed her to me.
The night before the surgery I thought I should do something special, something ritualistic to
mark this momentous passage. I thought maybe I should write myself a letter explaining why I
was doing what I was doing, so if I regretted it later, I'd have those words to look back on. My
husband said, "We should take pictures of your breasts," and that seemed the obvious thing
to do, but I didn't do it. He tried to touch my breasts and I flinched away. I'm sorry I did that
now that they're gone. But I didn't want my breasts awakened, aroused, for then I would feel
their loss more keenly. We went to bed. I put my nightshirt on over my bra. He said, "Take off
your bra," for he wanted, still, to touch me.
"No," I said. "I can't."
The next morning we drove to the hospital. We waited in a room with a young boy in a
wheelchair who operated the chair by breathing into a tube. There was also a man without a
leg and a perfectly healthy-looking woman who nevertheless probably had something wrong
with her at some invisible level. My name was called. I went into the pre-op place. A man
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named Dr. Drown introduced himself as the anesthesiologist, and then I said good-bye to my
husband and was wheeled down a hall with Dr. Drown into the operating room. A mask was
placed on my face. Then I went down, drowned, and awoke nine hours later in a dimly lit room
with someone saying in my ear, "Are you nauseous?" I was, and in tremendous pain with the
knowledge, immediate and stark, that my breasts were gone, lifted off my body, a raw
lightness on my chest.
The recovery has been difficult. The first night I pressed the morphine pump repeatedly as
nurses came to roll me over and then back. Now, two weeks later, I am at home and on my
feet again, free of my breasts, yes, but with strange stabbing pains and tingles, burns and
scrapes in the bulldozed flesh where my breasts used to be. Sometimes I distinctly feel my left
nipple, though it is no longer there. I feel it erect and aroused, begging to be touched. Other
times, my missing right nipple goes into spasms of itching so serious it wakes me in the night. I
reach down to scratch, but the skin is numb, the itching a phantom sensation. "Yes," says my
surgeon, when I ask. "Like in any amputation, you can get phantom limb, phantom breast. It
will go away."
I removed one pair of breasts and got, in return, a pair of phantom breasts with nipples far
more sensitive than my own ever were, with aches and desires and cries and tingles. These
breasts that are not breasts are so alive! Sometimes I think they are punishing me for what I
did, sending me nerve and desire from the spirit world, where they are now, floating. But that
is just bad thinking. As the weeks progress, the phantom breast sensations lessen; the nerves
adapt. It gets quiet where my heart is. I decide to get implants, a surprisingly simple
procedure. The doctor calls.
"We got the pathology report back," she says. "The left breast was fine, but the right one
showed some severe atypia—bordering on precancer. All things considered, I think you made
the right choice."
How many women, I wonder, are being told to "watch and wait" as I was? Having no breasts
might be less beautiful, but is it, in fact, safer? What I know is that my S-shaped scars are
healing, though more slowly than I thought. Truth is, the pictures in the book look better than
what I had after my surgery, before my implants. A banged-up suture site.
And yet, I do not regret my decision. As soon as I heal, I will see my surgeon only once a year. I
will no longer need to be tracked and biopsied until every place on my breasts is pocked.
Mammograms mean nothing to me now—I won't need them. I went from hazy atypia to a
smooth shelf, and if cancer grows there, it will do so while I'm living my life, loving my girl,
tending my garden; not while I'm waiting for it, perpetually recovering from small surgeries
that are the stuff of modern breast cancer detection. I went back 30 years in medical history
to a time when mastectomies were common and I said, "Do it to me." And they did.
Every day now, I grow stronger. My daughter pulls up my shirt and says, over and over, "Mama,
are you OK?"
"Yes," I say.
She touches the incisions, the black waxy sutures. She is only 2 years old.
"What happened to your breasts?" she asks me.
5 of 6 12/2/14, 3:26 PM

RELATED LINKS:
Drastic measure or smart solution? (/health/2006/05/facts-about-mastectomies)
Mary Ellen Mark
KEYWORDS: BREAST CANCER (HTTP://WWW.SELF.COM/TAG/BREAST-CANCER/),CANCER (HTTP://WWW.SELF.COM
/TAG/CANCER/),MEDICAL ISSUES (HTTP://WWW.SELF.COM/TAG/MEDICAL-ISSUES/)
"I had a boo-boo," I say. "The doctors made it better."
"Are you OK?" she says.
I look at her, my girl, with her mineral green eyes, so fair and towheaded. I did not know,
before I had her, the quality of this particular kind of love. She touches my scars again. The
phantom sensations sizzle and sing. I feel sadder and safer both. We sit on the couch. "I'm
OK."
6 of 6 12/2/14, 3:26 PM

I gave up my breasts to save my life - SELF

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