On Breasts

Feeling all the feels about them, and also not

“So, how do you feel about your breasts?”

The first time I met with the woman who would become my oncological surgeon, way back in May, I was impressed with her frank question, and also oddly touched. I don’t think anyone had ever asked me that before.

How do I feel about my breasts? I like them. I think they’re fine. They’re round and soft, and not too saggy. They are fun in the bedroom. They look cute in a tank top.

I didn’t always feel this way. When I was younger I thought they were too big, embarrassingly big, even though they’re not, really, that big. This dysmorphia was a toxic remnant of my early ballet training, which ran off the rails when I became a teenager and no amount of disordered eating could starve them back into my chest to achieve that perfect Balanchine line. And it was encouraged by, variously, 80s diet culture in general, the heroin chic of the underground, and the college dance professor who once cast me in a piece and then spent hours badgering the costume department to do something to strap down my apparently uncontrollable bosom.

But time changes things and now, thanks to therapy or the general not-giving-a-fuck of aging, I’m fond of them. They’re mine, they’ve served me well, and, faced with their imminent mutilation, I sort of regret not getting more into the bustiers and other glamour-grunge fashions of the 90s, which would have shown them off to best advantage.

In general though, they’re not something I think about very much. When I was diagnosed and found out I had to have chemo, I joked that I was far more worried about losing my muscles than I was about losing my breasts. With surgery around the corner it feels more serious now but still – the most concerning part of having breast cancer remains the cancer part, not its peculiarly loaded, culturally coded location.

As a friend of mine who recently had a double mastectomy put it, “I feel like I’m being told I’m supposed to care about my breasts a lot more than I actually do.”

When I met with the plastic surgeon a month or so ago we didn’t know yet what the results of new imaging would show, so he spent a thoughtful 90 minutes going through all the possible scenarios my breasts might find themselves in the weeks to come: mastectomy without reconstruction (aka “going flat”), mastectomy with reconstruction with implants, mastectomy with reconstruction using the fat from somewhere else in your body, and – what I am winding up with – an oncoplastic reduction.

A bilateral oncoplastic reduction is a two-hander. Since the cancer is confined to my left breast and lymph nodes, the oncological surgeon will go on that side to remove the tumor and needed nodes, while the plastic surgeon works on the right breast to remove an equal amount of tissue. Once the oncological surgeon is done, the plastic surgeon then sets to work making the two sides match.

As he explained this to me, he reiterated, several times, “You understand your breasts will be smaller, right?” Yes, I said, over and over. I am fine with that. I am FINE with that. 

It made me wonder how many people sit in that office and are not.

A week or so ago his office sent me a random questionnaire. My best guess is that it is intended to assess a patient’s mental health before surgery, but all it did was make me mad. “With your breast area in mind,” it asked, “in the past week how often have you felt:

• Confident in a social setting?

• Emotionally able to do the things that you want to do?

• Emotionally healthy?

• Of equal worth to other women?

• Self-confident?

• Feminine in your clothes?

• Accepting of your body?

• Normal?

• Like other women?

• Attractive?

Some of these are relatively innocuous. But others seemed beamed straight from Patriarchy Central Command. Of equal worth to other women? Yes. Because my sense of self worth has never been contingent on what’s happening between my collarbone and my navel. Feminine in your clothes? No – because I’m not particularly femme in general and what exactly does feeling feminine have to do with breast health anyway? LIke other women? No, because I don’t actually understand what the normative baseline is here for “other women” and also hasn’t anyone told you that being a woman is not predicated on having breasts – and neither is beauty?

It was enough to make me want to just lop them off and be done with it.

Obviously, breasts are big business. There’s a reason those plastic surgeons have such nice shoes. But the way in which questions of femininity, sexual desirability, and gender identity are wound up in a knot around the medical question of how best to address the malignancy growing inside them is confusing. I’m grateful that surgeons – famous for treating patients like cars with a mechanical problem to be fixed – are considering the emotional and psychological impacts of their profession, if only through an awkward online survey. And I’m very glad that the surgical treatment of breast cancer has evolved from the days of the radical mastectomy, when not just the entire breast but all the axillary lymph nodes and the pectoral muscle were removed, a disfiguring and disabling procedure that was the terrifying standard of care into the 1970s. When the surgeons asked me if I had decided whether or not I wanted, post surgery, to have a “breast mound,” I didn’t hesitate long before answering yes, well aware that generations of 20th-century women never got the choice.

Yet here at the tail end of breast cancer awareness month, with its classically feminized pink-tinged sloganeering, having to throw out my D-cup bras is the least of my worries, after pain, scarring, lymphedema, exotic side effects I haven’t even heard of, and, you know, dying. The anxiety I’m not successfully keeping at bay isn’t about the impact of surgery on my sense of self, it’s about two doctors cutting into and removing part of my body. I can’t say for certain, but I think I’d be having the same emotional response if I was going under for an operation on my broken ankle.

All of which is to say, confusedly, this is a confusing moment, a liminal space. I’m off work for two weeks. I have three doctors appointments tomorrow, and the actual surgery on Tuesday. My sisters have arrived to help with whatever they can help with. I’m already in the chute and there’s no turning back.

To mark this period of transition, my friend Lily offered to write me a song – an ode to my breasts as they prepare to shape-shift. She asked me to send her some notes to get her started, and here’s what I free associated: 

Too big, too small, just right? Pillows for lovers. Erogenous zones. Never used for feeding babies. Strap them down when they get in the way. Pinup worthy, so I once was told. Now they’ll be diminished, I’m leaving a part of me in the past. Moving into a more streamlined future hopefully free of any new, malignant invaders.

I plan to sing along in the days to come.