Breast cancer treatment is about saving lives, not breasts

The goal of treating breast cancer is to save someone’s life, not someone’s breast. 

This seems an obvious statement and yet, there is a strong narrative which values the appearance of a woman’s breast as the manifestation of her femininity and sexuality, of her identity.

It is clear that breasts are a site with much imbued meaning, whether individual women want their breasts to be viewed this way or not. A woman’s breast is seen both as a sacred and maternal body part which provides sustenance for children and also as a highly sexualized part of the body. Often, regardless of the viewpoint of a woman, partners, children, family members, and society as a whole place significant meaning on her breasts. 

Audre Lorde

 In her book, The Cancer Journals, black feminist lesbian poet warrior, Audre Lorde writes, “With quick cosmetic reassurance, we are told that our feelings are not important, our appearance is the all, the sum total of self.” (Lorde 58). The implication is that if a woman looks "whole" than she is whole. Preserving her appearance preserves her to be the same as before, irrespective of the impact cancer has had on her life.

Reconstruction after mastectomies or the use of a prosthesis can easily become a mechanism of the politeness of pain, a concept whereby those in pain feel pressured to downplay their suffering to the benefit of others. Hiding mastectomies and maintaining outward "normality" for the comfort of others can function as an example of this. 

During Audre Lorde’s experiences with breast cancer in the early 1980s, she was strongly encouraged to hide her mastectomy through the use of a prosthesis. When she tried to forgo this convention she was chastised. 

In her book, Audre Lorde reflects on her first post-op doctor’s appointment, to which she did not wear a prosthesis. The nurse chastised her, saying, “You will feel so much better with it on” “And besides we really like you to wear something at least when you come in. Otherwise its bad for the morale of the office” (Lorde 60).

It is crucial to note that there are  women who choose prosthesis or reconstruction surgeries freely, and that is completely their right. The issue arises when outside sources pressure or guilt women into these measures as a way to look “normal” or “get over” their cancer.

Audre Lorde wrote about her experience in the 1980s and yet today in some areas, very little has changed. In areas where the tides are slowly changing for women post-mastectomies,  it is primarily because women have fought to claim space for themselves and autonomy over their bodies.

Today about 25 percent of double mastectomy patients and 50 percent of single mastectomy patients choose to stay flat after the surgery. However, these women often still need to fight against doctors or friends and family when they decide to keep their chests flat.

Rachel D. Cohen advocating for Not Putting on a Shirt

Rachel D. Cohen, author of FLAT: Reclaiming My Body After Breast Cancer  writes about her experience with a doctor who encouraged reconstruction with a highly invasive technique which involves cutting the largest muscle in the back and creating flaps out of it. The doctor assured Cohen that most women never miss “the largest muscle in their back”.  Cohen writes, “this idea that we don't need our body strength, that we don't need to be strong because what's more important than strength is presenting to the world as having breasts, is really disturbing to me. And it was assumed that I would much rather look quote-unquote "normal" in clothes, that that would be my priority over feeling strong and confident in my body. So the only people this rebuilt breast would be for would be strangers.”

Rachel Cohen had to argue against the surgeon to choose to be flat-chested. To decide for herself how she wanted to live. Even when they advocate for themselves, some women’s voices are being ignored and their bodies are altered without their consent. Others believe they know what’s best for the woman, and decide how she should look for her.

Cohen reports on how some surgeons decide for themselves during surgery to leave extra skin on a woman’s chest, even after she decided to go flat. They leave these “pouches” of skin in case a woman “changes her mind” and decides to get implants and reconstruction later. This is a blatant violation of a woman’s autonomy and often leaves women with sagging skin that they must get additional corrective surgeries on, which their insurance often won’t pay for, calling it cosmetic. This is an outrage to women’s bodily autonomy and is unacceptable. Cohen is involved in a grassroots advocacy group called "Not Putting on a Shirt" which advocates for compliance with a woman's wishes and is currently doing more research on the prevalence of these violations of care compliance. They are working to bring voice to this issue.

Audre Lorde wrote, “Silence and invisibility go hand in hand with powerlessness” (Lorde 62)

With very little thanks to the pressures of society, many women are fighting past that silence and invisibility and reclaiming their bodies and their voices after breast cancer and mastectomies in new ways.

There are Facebook pages, such as “Flat and Fabulous” where women post outfit photos of themselves and share encouraging words and advice. Among the comments are many from women who elected to have their breast implants removed after reconstruction and go flat after the fact.

Another way in which some women are reclaiming sovereignty over their bodies and body image are chest tattoos. Nicole O’Hara decided that rather than trying to recreate her nipples and exact appearance of her breasts after her mastectomy, she would be more artistic and receive a tattoo. A short video of her tattoo experience can be found here. 

O'Hara's finished tattoo

Screenshots of the video of O'Hara's experiences

O’Hara specifically decided to have a portion of the tattoo extend higher up her shoulder and beyond her shirt so “she could tell her story to anyone who happened to see it”.

Lorde did the important work of being an advocate for giving women with breast cancer the space and agency to fully grapple with the impacts of breast cancer in their lives. Breast cancer is not an aesthetic issue; it is an issue that forces many women to face their mortality. Women must have the space to process this in their own way. They should feel no pressure to seek a "normal" appearance and silence their journey for the sake of others comfort or desires. As Lorde so eloquently wrote, "Any short circuiting of this quest for self-definition and power, however well-meaning and under whatever guise, must be seen as damaging, for it keeps the post-mastectomy woman in a position of perpetual and secret insufficiency, infantilized and dependent for her identity upon an external definition by appearance” (Lorde, 59)

Rachel Cohen asserts, “I'm not anti-reconstruction; I'm pro-information.” Reconstruction is the right choice for some women but not others. The point is that a woman should feel complete autonomy over her body and her choices. She should not be made to feel that the appearance of her chest defines her identity. There should be a strong emphasis on supporting a woman’s mental and spiritual journey through cancer, not just her physical journey. Amidst the challenges, hardships, and pain of cancer treatment, societal opinions about appearance and aesthetics should be secondary.

Class text:
Lorde, Audre. The Cancer Journals. San Francisco. Aunt Lute Books. 1997