Once, when I was a child, I milked a cow and didn’t like it. I remember the beast, sizzling with black flies, hair matted with dung, one cloven hoof dangling delicately in the air as I closed my fist around a teat and squeezed. Milk spurted into the bucket, a bluish-white warm liquid with something scummy on top. The beast pawed at the ground, turned her huge head, looked at me. Go on, she seemed to say. Her udder was hot and hard, her nipples as big as pinkies, indecent.
Years later, when my own breasts began to grow, I thought of that cow. My mammary glands turned so tender they would ache when the wind blew. Now, in my thirties, I am five feet, one hundred pounds, and my breasts, double-D cup size, have always exhausted and embarrassed me.
Therefore, it was easy for me to decide, when my most recent breast biopsy came back bad, that I wanted a mastectomy. It was a Tuesday. It was late winter, snow still gleaming on the ground, and the doctor called to tell me: atypical ductal and lobular hyperplasia. The lump that had been plaguing me for the past eight months turned out to be stuffed with rusty cells, misshapen and exuberant, multiplying much too fast. Atypia isn’t cancer; it’s the thing before cancer, the warning sign, the announcement before the building blows up. I asked my surgeon right there over the phone what percentage of women diagnosed with atypical hyperplasia go on to develop carcinomas, and she said no one knew. No one knew! Is this not ridiculous, blasphemous, that no one has yet done a simple study that follows, say, one thousand “atypical” women for a period of years and sees who dies, who doesn’t?
That day, I made an appointment to see a surgeon, to discuss next steps. I already knew what I wanted to do. I have two close relatives who have had breast cancer; I’ve had a child over the age of thirty-five; I am Ashkenazi Jewish; and for the past eight years I’ve had to subject my enormous lumpy breasts to countless mammograms, sonograms, MRIs, and biopsies, and this well before I’d hit forty. Early-detection technology obviously saves lives, but it wrecks minds; you live in the terrible grip of waiting. I made an appointment with my surgeon, and the morning of, I went to the farm near my home to look at cows. They were waiting to be milked, kicking at their painful udders, their breath hot-sweet blasts in the winter air.
My surgeon’s office is in a stark, practical building with little color. The halls are hushed, the few decorations rational. She started to tell me about all my treatment choices and I interrupted her, a slash with my hand, “I want a mastectomy,” I said. “Now.”
“Is that really what you want?” she asked. “We have so many advanced techniques, like the MRI, for early detection, and breast-conserving therapy, and you can take tamoxifen. . . .”
But I didn’t want to discuss it. I had touched a cow and found it distasteful. I had had my babies, so whatever utilitarian purposes my two external placentas might serve were all gone anyway. More important, I didn’t want the psychological torture of endless testing. Modern breast-cancer detection, while it’s obviously done great good, puts women in a stark conundrum. Advanced mammography, frequent and accurate biopsies, and nifty MRIs all enable both patient and doctor to see conditions whose prognosis they do not know. The hazy, maybe prognosis, like atypical hyperplasia, that could or could not become cancer, or ductal carcinoma in situ, that might or might not spread, means you live your life on high alert, hitched to your oncologist, who checks you at the slightest sign. No, I didn’t want that. I chose the most extreme medical intervention—bilateral mastectomy—to get out of a lifetime of more minor medical interventions with serious psychological side effects. It’s no way to live, as a screening devotee. Better to take what time you have left and be blissfully ignorant, than to whittle it away worried over what result, when and how.
My surgeon said, “Maybe you should think about it. There’s no emergency here. Take your time and think it through.”
“I’ve thought it through,” I said. “A) I’m not at all attached to these breasts, and B) I can’t live my life in an MRI machine.”
She said, “Give it a couple of months.”
I said okay, but I knew I wouldn’t wait that long. I was done with waiting.
My husband was tentative. “I really like your breasts,” he said, but he knew I didn’t like them. He’d seen me lift the ledge of them up on a hot day. He’d seen me sweat out countless biopsies too. He said, “Without your breasts you’ll look weird.” I said, “With my breasts I look weird.”
I convinced my surgeon that a mastectomy was truly what I wanted to do. In the week or so before the procedure, a kind of elation filled me. Here I was, diagnosed with a dangerous condition, and I was high, high on the cold, clear winter air and the fashion possibilities in front of me and the freedom: no more screenings, my breast-cancer risk plummeting. A mastectomied woman can still get breast cancer, but studies show that she has only a 5 to 10 percent chance, and that’s a lot lower than you. Or you. Or me, who, with all my combined risk factors, had a whopping 90 to 100 percent lifetime chance (my surgeon finally came up with some stats), good god. Why wouldn’t I cut off my breasts? Why doesn’t everyone? I sometimes wonder this.
I visited a plastic surgeon who told me to take off my shirt. “Well,” he said, “you are large. We’ll make you a B,” and then he showed me the breast that would go in me, a jellyfish-like saline-filled sac, almost pornographically pert.
As the days drew closer, my elation turned almost manic. Dr. Poires, my surgeon, said, “I’d like you to see a therapist. A woman should grieve before she loses her breasts.”
Is this true? Did I have grief I was covering up? I went home and stood naked in front of my mirror. I eyed my mammary glands for a long, long time. Through the pale skin I could see the roaming of veins, green veins, running from my throat, snarling in my chest, and fingering their way into my pale, pale breasts. I could see how the seam of the breast was connected to the chest wall, beneath which hammered the heart. When I breathed, my breasts rose up on the lobes of my lungs; breath and breast. Heart and breast. Flesh and breast. What I saw, standing there, was that the breast is an integral part of the body, its intricate ecosystem, which, when severed, would cause pain. I didn’t doubt my decision then, but I had a long moment of feeling bad for my body, and bad for my breasts, which I was abandoning in cold blood, a piece of me, killed off.
I went into the surgery with my head held high, a tight scoop-necked shirt from the Gap packed into my bag, what I would wear on the way home. There was a damsel fly in the surgical waiting room, one of those leggy primitive insects, and I thought that was strange, a bug in the hospital, but I wasn’t scared. I wouldn’t take it as a sign.
I was shown to a cubicle, where I undressed and lay on a stretcher. The man in the cubicle across from me appeared to have no legs and only one arm. He was pretty much torso topped with brain. I couldn’t stop staring at him. He saw me staring and waved.
The anesthesiologist came around. He told me his name was Dr. Drown. This is when I started to feel definitely scared, but I also thought it was funny. Dr. Drown had a teal-green surgery cap and a mask over his mouth, so I could not completely see him or assess him. Dr. Poires, the breast surgeon, came in; she looked funny in her scrubs and masked mouth, like a criminal. They wheeled me down the long hall.
Dr. Drown put me out; he flicked a neural switch and I was down, drowned, and then I bubbled up to consciousness again, nine hours later, in a room I had never seen. I knew immediately that my breasts were gone. My chest felt terrifyingly light, like it was filled with only cotton, and then there was a long, slow, curving pain that took its time with me.
I was baked on drugs, still swimming in the liquid-glass of anesthesia, but my mind was strangely, awfully clear. I could feel the sawed incisions, the enormity of the amputation, and how hard it was to breathe. “Breathe, breathe,” a recovery room nurse kept yelling to me, and a machine above me was beeping out some warning, and I didn’t want to breathe; I wanted just to sink, and I thought I was possibly dying, sometimes people do die from surgery, and right then and there, just after the operation, I regretted my decision.
I wanted my breasts back.
I wanted my body back: my breath, my ability to move, my blood pressure, which was something like 50 over 40, a common but problematic response to anesthesia. “Breathe, Lauren,” the nurses commanded, and I tried to recall what percentage of people do pass on, from complications. Did I have a complication, or was everything okay? “Am I okay, am I okay?” I kept saying, and they kept saying, “You’re okay,” and then the machine would beep and they’d shout, “Breathe!” so it was a mixed message.
Despite the anesthesia, I was in great pain. And right there in the recovery room, I got a bit more acquainted with death. I saw my baby girl, not as she was, a five-year-old, but as she’d been when she was born, her lids creamy and clamped closed.
Then my blood pressure stabilized enough so that they could bring me to my room. It was midnight; the surgery had started at two that afternoon. My husband was in the room, and in the dark he held my hand. I could just make out the crimson skulls of flowers, and behind them, in the glass square, flecks of stars with no names. I said to my husband, “Don’t leave me here,” but at some point he did, he was just too tired, and so I stayed alone, and I listened to my heart, clomping like a heavy hoof, I could hear it. Without my breasts, I was that much closer to my bones, my body.
Mastectomy is not a makeover. I was mistaken in thinking it would be. No. Mastectomy is a brutal operation where your breasts are ripped out at the roots, where you wake up in significant pain, where, when you finally see the hatchet job, you want to gag. My chest was bulldozed, like a refugee camp, a lot of blood and rubble.
I stayed in the hospital for four days. So did my breasts, the ones that had been removed, they were ten stories below me, smeared on some slide, being read for cancer. Dr. Poires told me, on my third hospital day, that the left breast had been okay but that the right was full of misshapen cells, and later, when I saw an oncologist, the oncologist said, “The line between what you had and cancer is arbitrary. Two pathologists read your slides and one saw carcinoma.”
When I heard this, I was truly glad I’d removed my breasts, but I wasn’t elated anymore. It is not a makeover, and it is not a guarantee. The recovery is difficult. I couldn’t lift a coffee cup, or my baby, for months. I had drains inserted, and for two full weeks a zinfandel-colored pus collected in the plastic bulbs, which I had to empty every hour or so. The anesthesia, which I was under for so many, many hours, seemed to seep into my bones like radium, and that, combined with a steady dose of pain pills, made me dumb and eventually very depressed.
I write today, a little more than one year after the procedure. It has been a June of fantastic weather, river-blue skies, a profusion of roses, the scent of sheared lawn from the man and the mower next door. June is a fine month, a hammock month, and I have been doing that, lying back. I am finally feeling better now, although it’s taken me a long, long time. I can lift my child with effort. I can scrub the floor, even though that hurts. I can sleep without the pain pills. And yesterday I went shopping, for the first time, buying the little shirts and Lycra I had said I so wanted, and still do, but with much, much more sobriety.
I don’t know that I won’t get breast cancer, or that the cancer one pathologist said I had will not return. As I said, mastectomy reduces but by no means removes the chance. What I do know, though, is that I won’t be living my life in a mammography studio or an MRI machine, or waiting for billions of biopsies to come back, because, while I have some tissue, it’s not even enough to biopsy, really, and it’s not nearly enough for a mammogram. As for the body-image issue, I do like my body better, in clothes anyway, with my pert B-cups—but I don’t want to overstate it. Implants are not pretty when you see them “in the flesh.” They are obviously fake, nippleless mounds, with dark-pink shiny scars and puckers on them. Sometimes I miss my old big breasts; I wonder what became of them, if they were thrown into the trash bin at the back of the hospital, if they somehow sense my betrayal.
I say I’m sorry.
I say it to my real breasts, my true breasts, that I betrayed even as they betrayed me, and I say it to the body left behind, for it has had an intricate part of its ecosystem just carved out, and I say it to all other women who must tussle with a difficult choice between mutilation and temporary peace of mind, and I say it to my daughter—I’m sorry—because when she sees me naked now, she looks away.
This is the truth, and she’s so young.
“What happened to you?” she says.
Next door to us, Corinna, our lovely neighbor, has had her second baby. Corinna’s body is intact. My daughter and I go to visit the baby, and not long after, the baby starts to squall, and Corinna lifts her shirt and brings the infant to her chest. My daughter, who knows nothing of etiquette, stares at Corinna’s giving nipple, she just stares and stares, at the breast, the baby, the white markings of milk on its tiny mouth.
Later on at home, my daughter turns to me. “Let’s pretend I’m a baby,” she says.
“Okay,” I say.
“Ga ga,” she says, and then she comes over and lifts my shirt.
“What are you doing?” I say, I practically shout, but she says, “I’m a baby, you have to feed me,” and then, my god, she puts her mouth where my nipple once was and pretends. She just pretends. I want to cry. I hold her close. I am so sad she doesn’t have me as a full-bodied woman, but I’m so glad I have a better chance of lasting until the time when her own breasts fill.