And then there were none

It’s been a while since I’ve written here.

Life has felt full and I have felt full-up – externally, trying to find my way back to work and stepping back into the slipstream of the (too) fast-moving motorway of life, while internally still feeling very much like someone in recovery. I’ve also felt that, not now being in active treatment, my writing might be viewed as somehow self-indulgent. As if it might be met with a rolling of eyes and a chorus of ‘move along now, yesterday’s news…’ - despite the fact it still all feels very real and present to me, every day. But this has made me cautious about revisiting the page.

I have missed it though…me and this space. This place to work things through and clear my mind. (And boy has there been a lot to work through. Who knew how much stuff trying to piece your life back together after cancer could throw up).

I am drawn back here though tonight as in a few short hours I go back into hospital for a contralateral mastectomy – or, put more simply, having the other boob off.

This is something I argued for earlier this year, fed up with being lopsided and frustrated by the challenge of trying to give my remaining breast the support she needed. Wearing a bra is difficult – it rubs on my scar, twists around from the imbalance of weight and leaves me with a yearningly empty pocket on my left-hand side, which lies lumpily under clothes. I instead resort to wearing t shirt style soft crop tops, which sit comfortingly close to the skin on my flat side, but do nothing for the other side – simply flattening her shapelessly onto my torso.

Not all surgeons will agree to a contra-lateral mastectomy. They can not understand why you would not choose reconstruction of the missing side as the solution to this wonky conundrum. But I do not want reconstruction. I never have. I never will. For me, it is not the answer to my quest for symmetry.

Many breast surgeons (almost all of whom appear to be men) will insist on a psych test before agreeing to the surgery. To ensure that you are sound of mind and fully conscious of the implications of your choice. This used to make me angry. ”God forbid a woman might know what she wants to do with her own body” anger. But now, in the hours before my surgery, I can perhaps better understand the thinking behind this (even if I still don’t agree that a women should have the added stress of feeling they have to pass some sort of test to get what feels right for them).

My first mastectomy was not presented as a choice. It did not feel like a choice. Your life or your breast – which will it be? There was no decision to make. But this time it is an active choice. To remove a healthy part of my body. And that feels quite different.

Through all my discussions with my surgical team, they have been very careful to stress that this operation is not ‘risk reducing’. By this they mean that it does not remove my chance of developing secondary breast cancer. Secondary breast cancer will not appear in my other breast. Rather it would mean that the cancer has spread to another part of my body – most likely my brain, my bones or my lungs. Removing my breast will not protect me against this. If this is going to happen, it is going to happen. There is not much I can do to shield myself against this, other than focussing on the 4 all important self-care pillars of stress reduction, sleep, diet and exercise.

But it is possible for me to get another primary breast cancer – the same thing that I went through on the left, just this time on the right. Last time, I did not find my cancer until it was quite far developed – stage 3, grade 3, and had spread to 15 of my lymph nodes…what felt like a small beat away from being stage 4 metastasised cancer. It likely grew in months – and even if I had been having annual screening, could have been missed. In all honestly, even knowing what I know now, I am still not sure that if I had a similar tumour in my right breast, I would find it.

One in 7 women will receive a breast cancer diagnosis during their lives in the UK. I’m assuming half of these will be in the left and half in the right breast. By my logic that gives a one in fourteen chance for the average woman of developing breast cancer on any one side. As I understand it, my chances of another primary breast cancer are higher than for the average woman, but not significantly – so, off the top of my head, let’s say I have a one in 1 in 12 chance of developing another primary breast cancer. That still feels like a fairly significant risk to me, especially when I think of it as not only potentially having to go through treatment all over again but also, presumably, the resulting additional risk of going on to develop incurable metastatic cancer. While deemed by my team as not a ‘risk reducing’ operation, logic tells me that while not reducing my risk of stage 4 cancer, not having a breast in which to potentially develop another primary cancer must, in some small way, reduce some of my risks.

This argument though is not the one to make with your medical team. If you make this argument, they will question your psychological soundness and refuse the mastectomy. After all, if you were to follow that logic through – where would it end? “Best remove my leg incase I need a knee replacement in the future”? What challenges could this pose for the hippocratic oath of ‘do no harm’?

The solid argument is on the grounds of symmetry – that it is hard to exercise (and support your remaining breast), that having one breast places uneven stress on your back and neck causing headaches and backache, that it can be hard to fit clothes on a wonky body. All significant arguments, and the ones to use if you even need to convince a surgeon. Simple. Clinical. Emotionless.

And yet, as I find on the eve on the operation, it is not perhaps quite the simple, clinical and emotionless decision I had expected. Truth be told I feel a little more wobbly than I had imagined.

I have lived in my body for 53 years. I have had breasts for approximately 40 of those, and truth be told have rather taken them for granted. Even after losing one, I have taken the other for granted. But at the prospect of having none, of being flat chested, I am suddenly pulling up a little short. Wondering what it will mean for me to have no breasts. Will I still feel like a woman? Will I still appear to others as a woman? What does it mean for my identity, as someone who has always been proudly curvy? How will it be to have nothing between my eyes and my tummy as I look down, and for my 'buddha belly' (as it is commonly referred to by those living flat) to suddenly be the thing that sticks out most? How will it feel to no longer be ‘hour glass’ shaped but ‘pear shaped’? Will ‘dressing up’ mean the same anymore or will I want to cover my body away? Suddenly, after a life time gratefully devoid of body image issues, I am being hit by a barrage of questions and uncertainties about my new physical form.

Of course, these will pass. I will adjust in time, as we do to all change. I will, I am sure, find some liberation in never again having to wear a bra, of being able to wear halter necks and backless dresses, of being able to exercise without having to worry about supporting my other breast. I will perhaps get a tatoo. I will recognise that my identity is not defined by the shape of my body.

But, as with all change, it feels important to acknowledge that there is also upheaval. There is a loss, a sense of grief. Tonight, on the verge of crossing another threshold, with the future potential benefits still amorphous, I feel the need to take some time to sit quietly and mourn what is passing before being able to be open to welcoming in the new.