Your Breasts, Your Choice: What to Do After a Cancer Diagnosis
My surgeon informed me that almost every woman who comes into her office opens with a similar directive, if not as bluntly delivered. But I wasn’t actually being asked to make a decision just then; that was a calculus for another day. My tumor was large and growing fast, so surgical concerns would wait until we started chemotherapy.
Over the next few weeks, in the infusion chair, I slowly got used to having cancer, chatting with nurses about neoadjuvant this and HER2/neu that like a fellow medical professional, not a housewife whose most recent analytical challenge had been whether to remodel the kitchen. I also learned from the women around me that mastectomy and the accompanying reconstructive surgery don’t always go so great. Drains can get blocked and pumps can start oozing. Silicone implants can rupture or shift into unsightly positions on the chest; they can also harden and dimple and cause shooting pain. My position on surgery evolved with each new piece of information, the most thrilling of which was that the chemotherapy was working. The equation was changing as the variables became less opaque.
But not everyone is dealing with the same variables. Nor are they giving them the same weight. Consider my friend Jackie, who was diagnosed ten years after me. Stage 0, but with a strong family history on her father’s side. Her surgeon recommended a prophylactic double mastectomy, which would reduce her risk of developing breast cancer by 90 percent—meaning, as Jackie put it to me, that she might endure a three-hour surgery removing tissue from her collarbone to her rib cage and then still develop breast cancer anyway. I wanted her to be aggressive, and I said something clumsy to that effect: "What good are they anyway?"
At the time Jackie was diagnosed, she had just found the love of her life, a man who particularly appreciated her near-perfect breasts. And like all of us, Jackie has a specific set of life experiences that shape her point of view, including, in her case, having spent two years in a rural Nigerian village where women used chewed-up garlic to solve medical problems. Informed by that minimalist perspective, and bolstered by the support of her beloveds, she opted for a lumpectomy.
Will she regret it? If the cancer comes back? I hope not, but who can say?
And then there’s Jackie’s sister, Pam, who was diagnosed while she was still breastfeeding her fourth daughter. The cancer was diffuse and advanced. She shared Jackie’s unsettling family history but had a different set of life experiences that pointed her in another direction. "Just like that, my breasts went from a nourishing organ to the enemy," she says. "There was never a question that I’d have the cancerous breast removed."
As for reconstruction, an implant was the only option, as Pam and Jackie come from a line of lean Midwesterners who don’t have enough extra tissue to move around. Pam’s immediate questions: Silicone or saline? And would the new breast match the old? The bigger question: How dangerous would it be to leave the healthy breast untouched?
Pam talked with doctors and nurses, read extensively online, and came to her conclusion: double mastectomy. "Partly, I wanted to look normal," she says. "I wanted my breasts to match. But also, I knew—even though no geneticist could confirm this at the time—I just knew I had some kind of mutation." She did not want to risk a recurrence for fear of the massive impact it would have on her daughters—and on her own long-term chances of survival.
In the years since her surgery, Pam has had some surprises. "The aesthetics aren’t great. It’s not a pretty sight, me naked," she says. And she’s had complications. "My silicone implants needed replacing after ten years, and when that happened, I got an infection." When I ask whether she regrets her choice, she tells me she can’t entirely say.
"As much as I try to celebrate the upside—no bras or sagging, no mammograms or ultrasounds—there is something synthetic jammed under my pectoral muscle. And I have no nipples, which has significantly changed sex for me." Still, she took the most prudent course—the one she knows will protect her in a way that a less disfiguring and uncomfortable path could not. That’s the thought that allows her to sleep at night.
As for me, after 16 weeks in the infusion center, what began as a seven-by-four-centimeter tumor with calamari-like tentacles was reduced to a one-centimeter pearl. A lumpectomy was recommended. I craved the relief of deferring to a professional but also the assurance I thought only a double mastectomy could provide. No breasts, no breast cancer, right? So the question was, which kind of pain did I prefer: the physical discomfort of drains and expanders, or the psychological discomfort of carrying on with the breast that had betrayed me, as well as its potentially evil twin?
I went with my surgeon’s advice and got the lumpectomy.
Will I regret it? If the cancer comes back? I hope not, but who can say?
Every year there are more than 350,000 cancer-related breast surgeries in the U.S. Some medical researchers track emotional well-being scores postsurgery. The results are all over the map, which means women facing such choices must accept this awful truth: There is no right answer. There is only the best decision we can make for ourselves. No one else.
Kelly Corrigan is the author of the forthcoming book Tell Me More: Stories About the 12 Hardest Things I’m Learning to Say.