As a small-breasted woman, my boobs have rarely been ogled. Yet this year I’ve noticed people staring at my chest. At the dog park a woman who stopped to chat spent the entire time with her eyes locked well south of my chin, like those sleazy tit-talkers whom big-busted women complain about.
I wanted to say, “Go on, ask me, where has my breast gone?” But I didn’t, because then I’d have to answer my own question. And telling people you have cancer is exhausting, eliciting a mix of pity and fear, where you know what they really want to ask is: Are you going to die? Or, as one acquaintance boldly put it: “Is it the sort they can treat, or the other sort?”
When I was told I had breast cancer and would need a mastectomy, I was also immediately advised to meet with a plastic surgeon, to discuss a breast reconstruction. Yet I instinctively balked at the idea and, the more I learned about it, the more reluctant I became.
Breast reconstruction is a major surgical procedure, far more taxing than a simple mastectomy. Some women experience numbness in their reconstructed breast. No matter how skilful my surgeon, it would never feel like the breast I’d lost.
These practicalities all played a part in my decision but the most important consideration was that the more I thought about it, the less I wanted to pretend I hadn’t lost a breast to cancer. So much of the information and advice I received from the hospital was premised on the assumption I’d want to hide the fact I’d had a mastectomy. Cover it up, if not with surgery, then at least with a “foob”; breast cancer lingo for a breast prosthesis.
It seemed as though the simplest option – that of not disguising my new body shape – was a radical act. A friend told me I was “brave” when she saw I wasn’t wearing a prosthesis. Another commented that I must have been ambivalent about my breasts to begin with to have refused a reconstruction. When I told a relative that I’d need to have my other breast removed later in the year, and was comfortable with how I’d look, she responded: “Well, you always did seem very gender fluid!” As if an acceptance of my breastless situation could only be understood as involving a rejection of my gender, or an acknowledgment that I’d never been a “real” woman in the first place.
None of this is surprising. Breasts are potent signifiers of our sexiness, our fecundity, our womanliness. This means losing them is an affront to society’s collective understanding of what it is to be a woman. A breastless woman is an anomaly. I started to wonder whether the pressure to hide my missing breast/s was less about me and more about making other people comfortable with their absence.
Unfortunately such attitudes have significant consequences in the medical setting. I was lucky to have a caring and empathetic surgeon who respected my wishes, yet many women in online breast cancer communities report that their desire to “go flat” was not respected by their healthcare team. In some cases women even wake up from surgery with skin flaps on their chests, left by their surgeon “just in case” they later change their mind and want a reconstruction, even though they made their preference clear before surgery.
These anecdotal accounts are backed up by the work of a team of consumer researchers facilitated by Flinders University. Their findings indicate that many people who required a mastectomy after a breast cancer diagnosis did not feel fully informed about the option of going flat. One-third of those surveyed had a healthcare professional try to change their mind or query their decision to reject a reconstruction.
There’s an assumption here: that no rational, clear-headed person would make such a decision. Women who do so must be hysterical or confused and will probably change their minds once they have calmed down.
A cancer diagnosis is traumatic and losing part of your body because of that diagnosis adds to the distress. We shouldn’t lose sight of the fact that efforts to provide women with optimal reconstructive options were motivated by a genuine desire to minimise that trauma.
Everyone’s relationship to their breasts is unique and all people should be supported in their choices, whether they choose a reconstruction, a prosthesis or to be openly flat. Yet how many more might find a kind of post-surgical acceptance and choose the simpler option of going flat if it were no longer seen as a curiosity, an act of bravery, or a symptom of gender dysmorphia – but merely a practical decision, taken under difficult circumstances.
Many women struggle with body-image issues and a surgery that radically changes your shape is likely to amplify those feelings. Yet for me my mastectomies have ultimately helped build a deeper appreciation of my body. I’m now someone without breast tissue or nipples. I’m all ribs. And I refuse to be ashamed of it. Yes, my body carries scars that tell a story about a cancer that tried to kill me; a cancer that may one day come back and do just that. And it’s this new reality, this existential threat, rather than the loss of my breasts, that’s the hardest thing to carry.
Of all the reactions I’ve had to my post-mastectomy body, it was the woman I buy my veggies from who most delighted me. When I told her I’d lost my breast to cancer, she didn’t give me one of those “is it the sort that will kill you?” looks. Instead, without missing a beat, she raised her arm and mimed drawing a bow. “You’re an Amazonian warrior now”, she said, “You can shoot arrows!”
• Monica Dux’s latest book is Lapsed: losing your religion is harder than it looks (HarperCollins/ABC Books)
