Chapter 2: A Mastectomy is NOT a Boob Job

Nico and I returned from Italy the first week of January to face all of the monsters waiting for us in New York.   My city had never felt so unwelcoming, so cold and unforgiving.  It wasn’t her fault, I suppose, but returning from rolling hills, from pasta and tomatoes, cappuccinos in piazzas, and time with family and friends, only to be greeted by blaring horns, winter snowfall, miles of concrete and an impending cancer diagnosis made this particular homecoming more brutal than most.

We met with the breast surgeon at NYU the day after we arrived.   She told us that the left breast biopsy came back benign, that the MRI had not found any additional cancer, and that all the areas of concern within the right breast appeared to be showing Stage 0, Ductal Carcinoma in Situ.  However, because there was a fairly large area with calcifications (a marker that usually means some malignant cells) in addition to the lump, she felt the best option was a mastectomy. 

“If you do a lumpectomy, you will need to do radiation.  With a mastectomy you don’t.  Your breasts are small,” she said.  “And by the time we remove all of the necessary tissue and send you through radiation, you’re going to be much better off aesthetically with a mastectomy.  Plus in your case, I think we can do a skin and nipple sparing mastectomy and go straight to reconstruction in the same operation.”

I knew those words were coming, and yet nothing actually prepares you to hear them.  There was so much good news in what she had said, but my ears were still ringing from the word mastectomy.   I wanted to stop time, to reverse the clock and petition God to change his mind about the cards I had just been dealt. 

“I thought this was just Stage 0, some doctors don’t even consider it to be cancer,” I pleaded.  “Do we really need to do this?”

“The problem with DCIS is that it can become cancer,” she responded patiently.  “It doesn’t always, but we don’t know which ones do and which ones don’t, or why.  So at this stage, we have to treat it like cancer and remove it from the body.”

“Mastectomy.  Cancer.  Remove it from the body.”  Her words bounced around the room like a racquet ball going one hundred miles an hour, ricocheting from one wall to the next, over and over, the sound repeating again and again.  Those words seemed to be bouncing off me too because I sat there stoically unmoved, without a single tear to give away the seeds of trauma that my heart knew had just been shoved deeply into the soils of my soul.  I was too stunned and hadn’t yet grasped the reality of what I had just heard.  As a wave of shock and disjointed emotions washed over me, the culmination became a sort of overwhelmed numbness.  A feeling so big that it momentarily felt like nothing at all.  And just as I began wading slowly into the waters of fear and trepidation, I found a temporary lifesaver.  Questions.  So. Many. Questions.  Some I knew could never be answered, yet I asked them anyway.  Finally I said, “Is there a chance I have a BRCA gene mutation that could have caused this?” 

The Breast Cancer industry has gotten pretty good with its marketing, and thanks in part also to Angelina Jolie, I knew enough to ask this question.  If I were a gene carrier, it would have offered a logical explanation as to why I had gotten breast cancer at such a young age.  It would have also meant that I was more predisposed to certain cancers than the average person, making a very strong argument for also removing my left breast, despite the fact that it was cancer free.

What I would soon discover is that only 10% of cancers are actually genetically driven.  Most are caused by lifestyle, environment, or just bad luck.  After being tested for a full panel of over 32 genetic mutations, it turned out that I was negative for all of them.  And even though I was extremely grateful for that, it meant that there were still no answers as to why I had gotten breast cancer as a young, thin, and seemingly perfectly healthy woman.  Was it really just bad luck?  Had I done something to cause this?

I spent months trying to answer that question.  It was a painful process and one that would never come with the definitive answers I so desperately craved, but I did manage to come to terms with what I felt was some semblance of truth in my own personal life journey.  Despite what many people may say, I do believe it is a question worth asking.  Not as an opportunity to blame yourself for wrong doing, because let’s face it…some of the healthiest people out there still end up with cancer and some of the unhealthiest don’t.  So it’s not your fault.  Sometimes shit really does just happen.  But it is an opportunity to assess your life and ask yourself what unhealthy practices, both physical and emotional, you may want to move away from in your future.  And we all have them on some level.  Whether its eating too much junk food because you travel often or are always in a rush, or holding on to resentment from a broken relationship, or not allowing enough space in your day-to-day for the things that truly make you feel alive.  On some level, most of us are putting our own unique recipe of garbage into our bodies, minds and hearts.  And the sooner you can ask yourself the hard questions and come to terms with what your unhealthy ingredients are, the sooner you can start on the path of real healing.  But as I faced a looming surgery date of February 5th, 2016, I first had to decide whether to give up just one breast or both…even though I was BRCA negative.

This was by far the most painful decision I have ever had to make.  You may be thinking to yourself, “they’re just breasts, they reconstruct them and people get boob jobs all the time.”  Yeah, I might have thought that too before I knew better and you might be shocked to hear that a number of people actually did say to me, “It’s going to be fine, people get boob jobs all the time.”

So in case this is what you’re thinking, first let me clarify something.  A mastectomy is not a boob job!  Both operations happen in the area of the breast, but that is where the similarities end.  When a woman gets a boob job, it is a fairly quick and simple operation.  A small incision is made in the breast and an implant is slipped under the muscle.  The entire breast remains intact.  You can still feel it, you can still breast feed, you still have every single part that you had before with just a small (or a large) addition of silicone or saline.  A mastectomy on the other hand involves removing everything from the pectoral muscle to the thin layer of skin that covers the breast.  And in some cases, even some skin, muscle or the nipple has to be taken.  You lose the entire gland, all the ducts, the fat, the nerve endings, everything.  You can’t breast feed, you can’t feel them.  What was once flesh and blood is now plastic.

I was never much of a breast person.  Like my surgeon said, mine were small.  They weren’t a big part of my sex life like they are for some women.  But they were mine.  I had often wished they were bigger, or fuller or different in some way.  Faced with the prospect of loosing them, I suddenly became extremely aware of everything they gave me and felt remorse for all of the times I had labeled them as imperfect.  I had failed these beautiful parts of my body that had given me so much, for so long.  Had I known I would lose them one day, I would have spent every moment of my conscious life loving them and appreciating them.  Please do not wait for a loss to teach you this lesson.  Love yourself.  Love your body and all of its many parts.  Those legs that you spend hours obsessing over in the mirror, judging because they aren’t thinner, longer, smoother, tanner…those legs allow you to walk down the street to grab coffee with your best friend.  They allow you to run when you might be in danger, to jump when you are full of joy, to dance when you hear your favorite song.  They are perfect.  You can work out to stay in shape and to be healthy, but do it because you love yourself and want to get stronger, not because they don’t fit some ideal or standard that we’ve set for how a leg is supposed to look.  Because I promise you if, God forbid, a day ever comes when you are forced to give them up, cellulite will be the last thing on your mind and you will realize that they were, in fact, perfect all along.  I wish I had given my breasts this same respect.

As my surgery date crept ever closer, I wrestled with my mind, with my fear, with my heart, flipping back and forth between removing one or both of these beautiful breasts I had just moments ago learned to truly love.  In life we become attached to so many things, our possessions, our partners, our family, our jobs...and our bodies.  Everything in me wanted to keep as much normalcy as possible and so the jump from one breast to two seemed insurmountable.  It took an incredible amount of prayers, tears, meditation, council and ultimately courage to surrender control and attachment to my own body.  Eventually I began to understand that "I" exist, my soul exists beyond my body and that 2 breasts are a small price to pay in order to gain a longer and healthier life.  The decision was still extremely sad.  I cried a lot.  I cried at home.  I cried at the gym.  I cried when I woke up in the morning and had that first, groggy realization that this was not just a bad dream.  And I was scared to face such a serious surgery (my first surgery ever), but I also knew that I was strong enough to do it, that God would stand by my side and that the love and support of my amazing husband, friends and family would ultimately get me through the storm, one day at a time.  So ultimately I chose to surrender them both because I knew how difficult this surgery would be and I did not want to ever have to face it again in the future.  I also knew that one breast would continue to change as I grew older, would swell with milk one day if I was pregnant, would sag a bit more with each passing year and would forever pose a battle with gravity to stay symmetrical.  I did not want to face a lifetime of chicken cutlets in my bra, of future surgeries to even them out or the looming fear of getting cancer on that side too.  There are no good or right choices in these kinds of situations.  It is a deeply personal experience and one that requires summoning the courage of a mighty warrior, no matter which battle that warrior decides to take on. 

I have never regretted the choice that I made.  But I have certainly mourned.  The loss posed an emotional challenge that I never could have anticipated.  Until only recently, that pain would often sit so heavily on my chest that it would become difficult to breathe.  The surgery itself was hard, yes, but I’ve learned how quickly the body adapts and how prone it is to healing.  The heart, unfortunately, does not get off so easily.  When I scroll through Instagram, or magazines, or when I watch a movie, I am now so much more aware of breasts. I see these amazing women with beautiful, healthy bosoms and sometimes I get jealous. Do they realize how lucky they are? I wonder if people really understand how painful it is to lose a part of your body. Are you aware of how much you feel through your breasts?  Every hug, every touch, now feels forever different. I do not feel any less beautiful but these new parts are strange and they do weird things when I use my pectoral muscles. At times they feel like foreign objects that don’t belong to me. I’ve had them for two years now and while I have come to love them, I miss my flesh and my blood dearly. I mourn for them and for the child that I will never be able to nurse. But mostly, I miss the peace of mind that I used to have...back when my biggest worry was whether or not I needed a push up bra.