All woman

Last week, walking along a quiet estuary pathway and revelling in the warmth of the autumn sun on my face, I spotted two hikers in the distance. I noticed from afar their backpacks, walking boots, shorts and pale T shirts. They were speaking Italian and snatches of their animated conversation drifted my way. I turned my attention to Lola, our excitable (and inadequately trained) Vizsla, to ensure she didn’t run and greet them over exuberantly, as can be her way. As we drew parallel I raised my eyes to meet those of a confident, smiling young couple – brimming with life. We said hello. And then they were gone.

Only after they had passed did my brain process that the young woman had been topless, freely enjoying the sun on her bare chest as she walked.

I wanted to call after her and talk to her, but thought I might seem a little odd. I wanted to know where she came from, and where she was walking to. I wanted to know why she was walking topless. And frankly, I wanted to tell her a little of my story, and to encourage her to enjoy her body in all its glory. I wanted to tell her that if for her, that involves walking in the South Downs National Park topless on a clear, gorgeous autumn day, then more power to her. I wanted to tell her to enjoy what she has every day she has it (even if she meets others along the path who are not of the same opinion) and to not take any of it for granted. I wanted to tell her that I celebrated the fact that she was so fiercely all woman.

But they were gone and so instead I walked on towards the beach, a broad smile on my face.

In February, following a cancer diagnosis, my entire left breast was removed.

I was not offered reconstruction at the time of my mastectomy. In part this was due to COVID. My operation fell at the height of the second wave. All non-essential surgery was cancelled. Breast reconstruction was deemed non-essential. Reconstructive surgery would have been an eight-hour, two-surgeon operation as opposed to a relatively simple 90 minute operation (although it turns out mine wasn’t so simple) – a critical difference at a time when operating theatres were under acute pressure and securing a surgery slot at all was deemed a significant achievement.

It was also a clinical decision. In short, my doctors wanted to get me onto chemotherapy as quickly as possible. The aggressive nature of my cancer meant they did not have a host of other holding treatment options at their disposal. Reconstructive surgery would have potentially increased my healing time and the chances of post-surgical infection. Your body must be infection free before starting chemotherapy (the risk of life-threatening sepsis to those on chemo is very real), and my medical team did not want to risk any delay to my treatment.

And so I have what is known on the circuit as ‘a flattie’.

Decisions around reconstruction are deeply personal and I absolutely respect that many women will feel very differently to me, and will make different choices for their own reasons. We must each do what is right for us. In the end, I didn’t actually have a decision to make. It was very simple - reconstruction was not on offer. Perhaps I would feel differently if I had had a choice. But for me, bar a couple of days of soul searching and hurried research immediately pre-surgery, I was generally at ease with not having reconstruction. It was my initial instinct - in fact, in the brutal five-minute telephone call in which I was given my diagnosis and treatment plan, I made a flippant comment, saying 'at least now I know where to get the tattoo I've always wanted'. Needless to say, it was met with an uncomfortable silence.

As my diagnosis sank in over the following days and weeks, the issue of reconstruction felt like a minor detail in light of everything else that lay before me. I actually asked my surgeon if he would take both breasts, partly for flat chested symmetry, partly for reassurance. He refused - again, he did not want to do anything to risk delaying my treatment and a double mastectomy is a far more serious operation than a single (plus my request was certainly poorly timed – I was being prepped for my anaesthetic when I asked, but it was the first time I had met my surgeon…).

During the cooler months the asymmetry of my chest is hard to notice. Thick jumpers make it fairly difficult to discern unless you are looking very carefully. Initially, it did not bother me at all – infact, after the first few weeks I barely noticed it, and the children often remarked with surprise that they had forgotten that I only had one breast.

But life with one boob is not straightforward. Bras, quite fairly, assume you have two. My go-to since February has been the sort of jersey sports crop top that simply squashes your boobs flat against your chest wall. Although not offering much in the way of support to my remaining boob, these proved comfy, lockdown and self-isolation functional, and just about adequate under a jumper.

But the warmer weather made things trickier and the shedding of layers made my wonky chest far more apparent. Clothes simply don’t sit well on a skew-whiff torso and the one-sided sports bra look doesn’t quite cut it in a delicate summer top. Other non-underwired bras are possible (underwires are out forever now), but the gathered fabric of the empty cup sits oddly under a T shirt. There is a definite market (albeit it relatively small) for a truly one cupped bra – flat on one side, supportive on the other. No such thing exists.

And so, to the prosthetic boob. After all, I may have lost one breast, but I have gained three.

Immediately after a mastectomy you are given a ‘softie’ – essentially, a vaguely boob shaped cushion. Rather rudimentary, softies are largely meant to keep the pressure of a bra and any clothes off the scar in the early days and weeks, preventing aggravation and soreness. They also serve as something of a comfort blanket during radiotherapy, as your skin becomes inflamed from repeated radiation exposure.

I also have a fake boob - a silicon prosthesis. A few weeks after my mastectomy I was invited for a fitting at the breast care centre (these prostheses are provided free). I was taken into a small side room and asked to remove my top. Slightly disconcertingly, the fitter then eyed up my remaining, naked breast, and after a few awkward moments declared “mmmm, I think you are a 353….or perhaps a 649, size 7”. She then slid open the floor to ceiling cupboard doors lining the walls of the room, to reveal shelves and shelves of boxed breasts, of every size and shape you imaginable (although, shamefully, it would seem the range in anything other than ‘ivory’ is far more limited…). She pulled down a box from the top shelf and asked me to pick something from a rather uninspiring selection of wide strapped, expansively cupped bras – the sort your great grandmother might have worn, decades ago (you cannot wear a normal bra with a prosthesis – it has to have a special pocket into which you insert the false boob, preventing it from slipping out when you lean over to tie your shoelaces…). She then handed me my new companion. It feels something like a cling film wrapped extra-large chicken fillet and weighs a disconcertingly hefty amount. Did my missing breast weigh that much I wonder out loud? I definitely did not notice an evident drop in my weight post-surgery.

I also have a special swimming breast. Textured on the body side to allow for better post dip drainage, it again requires a special swimsuit, and again, the choice is uninspiring and designed largely with the older woman in mind.

I am very aware that for some women, such prosthetics will be lifesavers – allowing them to interact with the world with both breasts seemingly still intact.

But personally, I hate them. They are hot and heavy, and make my skin sweat underneath. I find that the pressure of them and the lack of breathability make the scar sore. They make me feel strangely panicky when I wear them. The range of bras and swimsuits feel, by necessity, structural and, for me, do little to help me reclaim my body confidence.

I am coming to realise that the accepted orthodoxy is that you should want to replace your missing breast, rather than flaunt your flattie. To focus on replacing what is not there, rather than celebrate what is. Obviously for some women, the thought of going one breasted is a non-starter. I respect that, and recognise that were I back in the workplace or certainly if I was younger, I might well feel the same.

But I don’t and I really can’t help but wonder quite who the drive to replace what is ‘missing’ is really for? At one stage it was even suggested to me that I should wear a silicon prosthesis so that if someone accidentally brushes past my breast it will feel more ‘real’. WTF? If someone brushes my chest and is upset by the absence of my breast then a) they are way too close to me and b) that is very much their issue, not mine. I am very clear on that.

I have never been comfortable in high heels. I don't wear much make up. For me, I couldn’t be bothered with a wig or even a chemo hat (other than to protect my newly bald head from the extremes of the weather) and prefer to go bare headed. I relish comfort, and simply do not have the patience for anything that compromises that. For this reason, I have generally preferred to wear nothing. To go flat. I am not ashamed to have only one breast. It is who I am now.

But, to go flat means to go wonky. And that is not a walk in the park. Clothes don’t fit or sit well - I may crave comfort but I do love my clothes and like to look good. Tops I loved previously no longer work for me. Bras don’t fit. My other weighty boob no longer gets the support she deserves (and requires).

I have learnt that for this reason, just as I did, some women request a contralateral mastectomy – either at the time of surgery or later. You have the right to reconstruction on the NHS on the grounds of symmetry. There is therefore a logical and valid argument that you should also have the right to a contralateral mastectomy – on the grounds of symmetry. However, it is a bit of a lottery as to whether your surgeon will be sympathetic to this request. I have discussed it with my oncologist and, should I get through the next year ok, it is something I will consider next autumn - both on the grounds of symmetry but also to remove the risk of developing other primaries in my right breast.

In the meantime, in my search for solutions to the challenges of life in the asymmetrical lane I have discovered there is a whole movement of ‘flat friends’ – women who have chosen to not have reconstruction after breast surgery (most with bilateral mastectomies). A movement of women who support each other with the practical and emotional impact of living flat, and who advocate on behalf of women who do not choose reconstruction, but who instead embrace their new flat reality.

It is currently Breast Cancer Awareness month. It is also Flat Fortnight - two weeks where women who have chosen not to have reconstruction are celebrating their bodies, attempting to change the narrative and raise awareness of living flat.

For this reason I have chosen to share a picture of myself topless below.

I may not have both breasts, but I am complete.

I may not have both breasts, but I am proud.

I may not have both breasts, but I am still fiercely all woman.

x

PS For support with living flat, please check out Fabulously Flat and Flat Friends on Facebook and Instagram.