We are women. We are human - Sarah
Like many women in Australia, before I had breast cancer, I assumed that the best course of action if I was ever faced with the disease was the “least invasive” method available to me: a lumpectomy. I assumed, benignly and naively, that this meant I could continue on with my life with the tiniest of scars, barely noticing the speed bump which had sought to derail my life.
““When a woman says she wants something “least invasive”, what she really wants is to have her body back, and to live wholly again.””
The first thing to say is that there is no such thing as “least invasive”. The methods available to surgeons at the moment are ALL invasive, in the sense that should there be cancer found in a woman’s breast after a biopsy, the chances of life being the same every again - surgically, medically, psychologically - are not very high. What I did not understand prior to having breast cancer is that the disease requires you to make life altering decisions on the hop, as it were. Whatever you do, it will be life altering.
Unlike many women in Australia, I chose to have a mastectomy and an immediate reconstruction via a sensation preserving, nipple preserving, DIEP flap reconstruction. I chose to undergo this surgery after I knew I had cancer, and before the pathologists could examine the lump in my breast. Many disbelieving family members asked me why I chose this option. Why not the “least invasive” option of a lumpectomy?
A few months before I was diagnosed - and what led to my diagnosis - is that my own mother was diagnosed with breast cancer. She went to see a well decorated breast cancer surgeon and asked for her options. That surgeon told her that he could do a lumpectomy and take the cancerous flesh out via the top part of the breast, and leave about a 5cm scar. For those of us with breasts, this is the tender, beautiful skin above the nipple, the décolletage.
Mum refused to take this as an option and went elsewhere. Then I was diagnosed. One option given to me was that I could also have a lumpectomy, taken from beneath the nipple, slicing the beautiful skin that no-one ever sees but of which I am always in awe, that gentle curve from nipple to crease. Then the pathologists would examine. Then another surgery to fill in the gap with a saline pump. Then, depending upon what pathology said, a mastectomy or continue on with one saline or silicone breast and one natural. So, in short, that option left me with a possible three operations, all dependent upon what the pathology told me to do. It would also, I came to see, leave me with two breasts which were not the same, and because there had been three operations, less chance of ever recovering sensation in the breast which had cancer.
The determining factor in the option these doctors were providing both my mother and I was the cancer itself. I wanted the determining factor to be my humanity. What I now understand is that, ironically, a longer surgery would leave me “whole” while the shorter surgery would leave me “less”.
Breast cancer is an endless supply of little griefs, where loss after loss crashes over you like a brutal set of waves, and where you are required to feel thankful for each one because it might stop the biggest loss of all.
What got me through the chemotherapy - exercising every day, eating right, wearing clothes that made me feel like myself and not a sick woman - was the wholeness of the body when I woke to breasts that were not cancerous.
As I write this I’m at the end of a course of chemotherapy and about to go into radiation. The chemotherapy was brutal. Losing my beautiful, waist length, thick red hair was gut-wrenching, and feeling my body behave as if it was somebody else’s was deeply distressing, but I did not go through chemotherapy feeling that my breasts had been cut up.
Instead of being encouraged to move on quickly, I was advised to linger and grieve the loss of my breasts, to give myself time to feel sad. This had the effect of allowing me to fully process what was happening to me and setting me free from unacknowledged grief.
The way I would grieve would be central to my healing.
““Those of us with breast cancer are not patients. We are women. We are human.” ”
Sarah, immediate DIEP flap reconstruction
Note: just as no two individuals are alike, no two surgical results will be exactly alike. Seek surgical advice from a FRACS qualified professional.