Last year, a man in Australia came across a round, rubbery object on the beach, about the size of a small tortilla. In a panic, he scooped it up into a plastic bag and hurried to the local police station, convinced a woman had been mutilated by a maniac who had prized her breast implant out of her body. The police had a good laugh when they saw the object. It was a jellyfish. That’s what I have implanted on the right side of my body—a silicone disc that’s a dead ringer for a jellyfish.
I discovered I had breast cancer the way a lot of women do—a routine mammogram revealed a lump in the right breast. One out of every eight women in America will develop breast cancer at one point in her life, but for some reason, when the nurse came into the waiting room to call “Ms. Johnson” back for a consultation, I just assumed it was someone else. In my defense, Johnson is a common name.
The radiologist described the suspicious mass as pea-size and recommended a biopsy. I asked if I could see it. She turned the computer screen my way and there it was, a distinct circle suspended in a ghostly web of white, like the egg sac in a spiderweb. “Is it cancer?” I asked. The doctor turned the screen back to herself. I have noticed this about doctors—none of them wants to be the bearer of bad news. If they can pass the buck, they will, and really, who can blame them? What kind of life is it, telling people they’re going to die sooner than they think? “We’ll need to do more testing,” she answered impassively.
And that is what we did. More testing. The mammogram gave way to the sonogram, which gave way to the biopsy, which gave way to the MRI. It was like hitting the plus sign on Google Maps over and over, getting closer and closer to the target. Soon we would be able to read the writing on the garbage cans next to the back door. Initially, my surgeon had assured me I could get a lumpectomy and keep the breast, but as the results of the testing got grimmer, the prognosis changed. My tumors may have been tiny—more lentil than pea—but they were numerous. Four, to be exact. In the end, it was an Alice in Wonderland moment: “Off with her breast!”
The night before my mastectomy, I stood naked in front of the bathroom mirror and held my right breast in my hand, like an old friend in need of comfort. Goodbye, I told it, thanking it for its years of service. Like every sentient woman in the First World, I have spent stupid hours bemoaning my physical flaws, but in all that time I could never think of anything bad to say about my breasts. Not too big, not too small. Not too droopy. During sex, they were a pleasant erogenous zone, and when it came time to breastfeed, they performed yeoman’s duty. I’d always thought men were a bit silly in their worship of breasts, but actually they are right. Breasts are wonderfully springy, joyful things. I had so much to be grateful for, but, of course, I only realized all that on the cusp of its loss.
The problem with breast reconstruction after cancer is that you have to make your decision in the midst of all these other traumatic life and death decisions. Only after discussing the possibilities of chemotherapy, radiation, mastectomy, and statistical outcomes for survival are you asked to consider reconstruction, at which point you’re thinking, Who cares? What’s a breast compared with a life? On the other hand (assuming treatment is successful), you will have the rest of your life to live with that void on your chest, so you really do have to pay attention. Plus, reconstruction is the one area where you actually get to make your own choice, as opposed to treatment, where only a fool would decline to follow standard protocol (don’t get me started on alternative medicine).
My options for reconstruction were (1) do nothing; (2) get an implant; (3) undergo a six-hour DIEP-flap (deep inferior epigastric perforator) surgery, in which a plastic surgeon removes flesh from the abdomen, assuming you have sufficient excess (not a problem!), and then painstakingly reconnects the blood vessels from your abdomen to the blood vessels in your chest, trying as best as possible to match the shape of the remaining breast.
I considered declining reconstruction—I like the idea of being that indifferent to convention. On the Internet, you can see lots of pictures of women who made this decision. They look proud, defiant, and like they could run an Ironman. That’s not me. I hate being the center of attention. If I had only one breast, anytime I wore anything formfitting, people would notice the lopsidedness. I was lucky not to need chemo, not just because I wasn’t going to have toxic chemicals dripped through my veins but also because I would not have to endure the sad face of strangers contemplating my bald head and its attendant message: “This person may be dead soon.” I know because I can’t help making the same sad face when I share an elevator with those bald people at Memorial Sloan Kettering, the hospital where I was treated.
I was tempted by the idea of reconstructing the breast with my existing flesh by doing the DIEP-flap operation. The result would be soft and warm, like my own body, but, as with all the options, it would still initially be numb, like a lobotomized cousin who comes for dinner every night. Once the nerve endings are cut during the mastectomy, full, normal sensation never comes back. Shaving under your arm will forever after be a guessing game—you know a blade is scraping your flesh, but you can’t feel a thing. After DIEP surgery, you also need to spend three or four days in the hospital, the cost of which can run into the hundreds of thousands of dollars (although insurance pays for it, thanks to the Women’s Health and Cancer Rights Act of 1998). In a world where people are dying for lack of basic medical care, I could not fathom so much trouble just so I could have a soft breast. So, the silicone implant. But only one. There is a growing trend for women with low-risk cancer (Stage 1 and under) in a single breast to opt for a double mastectomy with reconstruction. In 2002, 4 percent of diagnosed women chose this option; in 2012, 13 percent of women did. The thinking is, they’ll never have to worry about cancer again and will get a great rack to boot. In reality, the risk of developing cancer in the healthy breast remains the same as if you have never had cancer. And as for the myth of the “great rack,” read on. If I had been tempted, a conversation with a friend of a friend put an end to that. “I can’t tell you how much I regret giving up that healthy breast,” she confided. “It was probably the biggest mistake of my life.”
Each option, it turned out, was its own political minefield. Not long after I made my plan, I ran into an acquaintance who’d had a mastectomy but decided not to reconstruct her A-cup breast. After hearing about her diagnosis, I had lent her all the breast cancer books in my library, but when I told her I’d been diagnosed and opted for the implant she said, “Really? I didn’t think you were the type.” Meow! “Unlike you,” I answered, “I actually have breasts.” Not my finest moment.
When I met with my plastic surgeon to discuss the operation, he explained there were two shapes of implants to choose from—round or teardrop. “I want the teardrop,” I told him confidently, imagining the fake-looking hockey-puck boobs on strippers’ chests. I looked at my husband for confirmation, but he only nodded, a ghastly expression on his face for which I couldn’t really fault him. “We’ll see,” the doctor answered. Apparently, some decisions get made on the operating table when the surgeon can finally see how the scar healed. Unfortunately, the person who will have to live with what is implanted in her body for the rest of her life is unconscious at that moment. I looked down at my handsome doctor’s perfectly polished Italian loafers and panicked. A man I did not know at all was going to choose my new breast?
Suddenly, I regretted my impulse to always dress up for my appointments, something I did because my doctor’s office was right across the street from Barneys and sometimes I would wander in there to cheer myself up. But the Mikimoto pearls, the Marni jacket, the Robert Clergerie shoes, maybe they were sending the wrong message? The bulk of my days were spent in UGGs and yoga pants at a computer.“Listen,” I told him, “if I were a pair of shoes, I’d be Birkenstocks.”“So,” he answered, “comfort above all?”“Absolutely.”
When I woke from surgery in the Evelyn H. Lauder Breast Center on Manhattan’s Upper East Side, I released all my years of bitterness at paying $30 for a tube of lipstick. My room had marble floors, a killer view of Manhattan, and a private nurse who told me people beg to stay a few days longer.
It took me weeks to look at my new breast. When I finally worked up the courage to give it a good, hard stare, I felt shock at all the angry red scars, followed by relief. The surgeon had gone with the round implant and done a lift on the other so the two would match. In a million years I never would have gotten a breast lift, but the look of it wasn’t bad (assuming you saw past the scars, which would eventually fade). The feel of it was the problem. In the doctor’s office, the implant had felt squishy and almost playful—like something you’d give a three-year-old to get her interested in science. But once it was placed under the muscles of my chest wall, it felt hard and strange and just wrong, worthy of a Germanic portmanteau word—Brustschmerzangst. Whenever I hugged my then ten-year-old son, the top of his head would hit it and I would wince, not from pain exactly, but from the physical dissonance of knowing something alien was in my body.
On the websites devoted to breast cancer, I read other women’s complaints about tightness and discomfort. One mentioned how weird it felt to go swimming in cold water, when the rest of your body stays at 98.6 degrees but the silicone hardens into an immovable lump. I am a tennis player. The moment during the serve when the racket makes contact with the ball while the arm is fully extended overhead is when I feel the implant the most. It’s like the plucking of a giant harp string. I never cease to wonder if everything is going to unravel at the point of impact, causing the unloved blob of gel to slip its bonds and travel through my body, ending up somewhere around my ankles.
Whenever I went to visit my oncologist for checkups, she would ask how things were going, and I would bite my tongue about the odious implant. She spent her days with people dying of cancer, and I had gotten off pretty easy in the cancer game. No chemo. No radiation. Just the mastectomy and the drug tamoxifen for the next ten years. To complain about an implant seemed churlish and ungrateful. “Fine,” I always lied.
We don’t do a great job of preparing women for life without a breast. If a soldier loses her leg in combat, the whole world can see. If a woman loses her breast, she carries her scar in secret and rarely talks about it out loud. Angelina Jolie quite bravely told the world she was having a prophylactic double mastectomy and oophorectomy in order to avoid the cancer that killed her mother, grandmother, and aunt, but after that we heard little until the bombshell news of her divorce. While the tabloids were scratching away for clues to the marriage’s dissolution, I couldn’t help feeling that I understood better than most. Life after reconstruction isn’t just hard on the woman, it’s hard on the man who is with the woman. We’re weepy, we’re sad. We miss our breasts. I never felt like “less of a woman,” a stupid phrase if ever there was one, but I felt like less of a human because I had lost something I cared deeply about. When it came to sex, I was impossible. If my husband didn’t touch it, I accused him of being grossed out by it; if he did touch it, I was grossed out by the sensation of being touched but unable to feel. Aging brings its own depredations to the human body; this just felt like one more insult to deal with. The first time I undressed in the gym, I carefully covered the fake breast with a towel so no one could see, but now, almost two years after the surgery, I have come to a reluctant truce with my new breast.
Our bodies are maps of our lives—I have a scar on my thigh from the time a thug pushed me off my bike on the Brooklyn Bridge, a chip on my front tooth from when I slipped on the wet tile of the YWCA pool, a long scar across my abdomen from the C-sections that yielded the greatest joys of my life (Hi, Simon! Hi, Toby!), and now I have these scars on my chest that bear witness to that brush with death. I’ve never liked the cancer-survivor metaphor and its implicit message that anyone who dies isn’t a warrior, as if cancer were simply a matter of will. I did not “battle” cancer; I meekly (sometimes snivelingly) followed every single thing the doctor said to do so that I could squeeze out as many years as possible on this planet.
When I was told my remaining breast was cancer-free at my one-year-anniversary scan, I felt enormously lucky and grateful to every scientist and doctor who has worked to make breast cancer less of a death sentence. If the towel slips and someone sees the scar that tells that story, it’s not the end of the world.