My most recent post touched on some hot-button issues, so I’m going to take a moment to clarify. I didn’t mean to open fire on a woman’s right to choose reconstruction. What I am incensed about is a society that narrowly defines not only what choices women have, but also what choices women can envision for themselves. I take offense not at the choices women are offered within the structure but with the structure itself. I’m no feminist scholar (some of my best friends are and maybe they will chime in), but I think this touches on one of the core fractures between liberal and radical feminism.*
More specific to my experience with breast cancer, I take umbrage with the fact that I consulted four surgeons—two breast cancer specialists, a general surgeon, and a plastic surgeon—and not one of them mentioned going flatchested as a viable “choice.” Instead, my “choices” were laid out like so many confections on a silver platter. Each and every item on the menu involved saving the tatas, and, as a good breast cancer patient, my job was to choose the one that looked the sweetest and not ask questions, especially regarding, say, pain, recovery times, or (god forbid) complication rates.
When I made my “non-choice,” I was treated more like a stubborn child who refused to eat her veggies than a well-informed woman who made a thoughtful decision about her health care. In refusing to play along, I felt dismissed as an anomaly. And I’m guessing I was.
Last month, in a short email exchange on the increasing number of women who choose reconstruction, Marisa Weiss, MD, founder of BreastCancer.org and a leading breast oncologist, wrote, “Most women whose surgeons bring it [reconstruction] up will pursue it.” For me, this observation begs a more complicated question–not about choice but about framing. How are the surgeons bringing up the topic of reconstruction? Or even of lumpectomy versus mastectomy? How do their own biases weigh into the discussion? Physicians are only human. They can’t possibly divorce their own loaded feelings about breasts from conversation with their patients. Or can they?
A couple of years ago, I posed similar questions regarding surgeon bias to Dale Collins, MD, director of the Comprehensive Breast Oncology Program at Dartmouth Medical School. Collins is a plastic surgeon who specializes in breast reconstruction. “The reality is that doctors push and pull in both directions, and they will typically pull patients in the direction of their bias every time,” she says. Then she added, “And a lot of surgeons are men, and men presume that women don’t want to part with their breasts.”
Whoops, now I’ve gone and gotten all down-with-the-patriarchy on y’all. And didn’t you just know it was coming? After all, I am a man-hating lesbian separatist. But, seriously, this circles back to my point about questioning the structure, not a woman’s right to choose her own chest. I don’t want to take away a woman’s breast implants or deride her desire to replace the breasts she lost to cancer. (God knows I miss mine every day.) I just want to see the choice to go “flat-and-fancy-free” right next to the choice to get triple-layer tatas with fake nipples on top on breast surgeon’s dessert menus. Because if a woman truly felt that she wouldn’t be seen as “less than” for being breast-free, I can’t help but wonder if more breast cancer chicks wouldn’t gravitate toward the flat side.
*Special thanks to my sweetie for helping me to think this stuff through during our many long walks together. You are amazing in every way.
I agree with your point about choices.
I have only been offered “delayed” reconstruction — no one suggested non-reconstruction as an option. Granted, I knew what I wanted right up front and that is immediate reconstruction using my own body tissue. But more than that I wanted my new breast to match my other one…in short I wanted a PS to make me a saggy old 45yo woman’s boob. Four PS’s flat out said it couldn’t be done and most wanted me to have a lift of the cancer-free breast and implants in both. Thankfully I’ve found one PS (a woman) who will do her best to make me a reconstructed breast that requires nothing be done to the unaffected one.
I knew it could be done and that all the other PS’s who said it couldn’t really meant they wouldn’t — a big difference. They just couldn’t wrap their head around why on earth I wouldn’t be leaping at the chance to get a free boob-job with my mastectomy.
It’s crazy out there.
I understood what you were saying with your first post and wasn’t offended by your outrage at not having your choice validated as much as mine. It should have been and I commend you for making it.
Oh, and I hate pink too 😉
Thanks for elaborating further. I “get” what you’re saying and it’s given me a lot of food for thought. I find myself thinking about what my own choice might be now that I know more about some of the long-term consequences.
For the record, I didn’t find anything in your first post “offensive.” After years in the parenting gig, though, I get a little nervous when I hear women questioning (or worse, judging) other women’s choices. I do it myself. You weren’t doing that, though–you were, I think, pointing out that some choices weren’t being presented at all or were given very little play time. Incidentally, I felt this way when I was choosing a mortgage. Our broker encouraged us to choose–and had a vested interest in our doing so–a riskier mortgage than we wanted. I had to absolutely insist that such a mortgage was not for us. I realize this is hardly the same thing as deciding on post-cancer treatment, but my experience made me very concerned for people who were not as knowledgeable about how mortgages work: Did they realize what the long-term consequences might be?
I probably wouldn’t attribute this phenomenon as much to our patriarchal society (perhaps I’m naive) as to the many things in the American medical establishment (including a doctor’s adjusted gross income) that encourage more procedures, more surgery, more treatment rather than less.
Anyway, I always love reading what you have to say. Thank you.
Thanks for posting this. As a woman who has just been diagnosed with breast cancer and who has only heard two options: lumpectomy and radical mastectomy with reconstruction, it was good to hear someone say that just leaving my chest flat was something else to consider. I find the idea of saving or rebuilding my breasts and reattaching nipples is very creepy. I do think a lot of this has to do with societal preconceptions about how women feel about their bodies. Frankly, in our breast obsessed culture, I’ve always felt flat-chested, even with my B cups, so what difference does it make if I loose them entirely?
Thanks so much for your comment. Another thing that helped me was knowing that I could always reconstruct later if I decided being flat chested wasn’t my style. For someone as indecisive as myself, knowing I wasn’t losing an option was a great comfort! When you are first diagnosed, so many decisions are presented to you as do-or-die, and of course some are, but you can always put the boob decision on the back burner and revisit it later, once you’re past the high-drama. Just a thought…