Why I decided to go flat after my double mastectomy
Fully recovered from my Moderna hangover (second jab last Friday!), I write to you from my recliner — the recliner where I’ll recover from my next and hopefully final surgery. I’ll share the most pertinent information first, and if you’d like to know why I made this decision, read on, I am honored to share this with you.
This Wednesday, June 16, I’ll undergo a double mastectomy without reconstruction and a sentinel lymph node biopsy to determine whether the cancer has spread. Surgery is at 8:30am and if all goes well, I’ll be home that evening back in this same cozy recliner.
What started as a routine physical in February turned into a mammogram, then biopsy and cancer diagnosis in March. Russ and I moved to Michigan in April, and I had a bi-lateral lumpectomy in May. We hoped for a benign lump on the right, clean margins on the left, and the lumpectomy would be the end of it. The right was benign (yay!), but they found significantly more cancer, deep in the left breast back on the chest wall. When we met with the surgeon a few weeks ago, everyone, including her, was surprised. There were no clean margins, and they found 4–5x more cancer than what they’d initially thought based on mammograms, ultrasounds, and an MRI. At this point they strongly recommended a mastectomy over another lumpectomy and radiation.
Fortunately, they caught all of this very early, and I have options. Unfortunately… I have options. The most taxing part of all of this was the weight of knowing the decision I make is the one I’ll live with for the rest of my life. But I believe, wholeheartedly, that I’ve made the best decision for me.
First, why a double mastectomy when there is only cancer in the left breast?
My cancer is grade 2, and necrosis is present. Simply put, grade 2 means the cancer cells are growing faster than normal cells. Tumor necrosis means dead breast cancer cells can be seen within the tissue. Its presence suggests a more aggressive breast cancer. As I thought about everything I’ve been through, I can’t imagine going in for checkups of the right breast every six months, wondering if I’ll have to go through it all over again. By choosing the double mastectomy, I lower my risk of getting breast cancer again by 90–95%.
Second, why no reconstruction?
I had the option to do immediate, delayed, or no reconstruction. I journeyed with a friend who had one breast removed, no reconstruction, and is delightfully witty about it. I had coffee with an old friend who had immediate reconstruction, zero regrets, and let me feel the implants (much to the amusement, I’m sure, of the barista). I spoke with a woman who had complications after her reconstruction, the implants were removed, and her vitality returned. I’ve heard a wide range of stories, consulted surgeons and oncologists and genetics counselors, and did my own research.
All of the information, opinions, and choices came crashing over me, wave after waver after wave. However, I had one moment of perfect clarity about what I needed to do. It was like a small, gentle ripple that snuck in between the waves. I sat on the front porch with my mom, and she shared what she’d learned about the potential effects of breast implants on physical and mental health. We talked about Breast Implant Illness (BII). Symptoms can range from joint and muscle pain, chronic fatigue, memory problems, breathing problems, sleep disturbance… anxiety, and depression. For a fleeting moment, everything became clear, uncomplicated. I said to her, “I know exactly what I need to do. No reconstruction. I’m going flat.” The quiet ripple of truth was overtaken by all of the waves again, and we cried deeply. But I vividly remember that moment and the feeling of peace and surety that rested in me. When doubt or fear creep in, I hold on to that exquisite moment.
As confirmation with my surgeon loomed, I shared my decision with a small handful of people who intimately know my mental health journey. I’ve lived with bipolar depression for 25 years. It’s been a demanding journey to understand and embrace my diagnosis. The necessity of building healthy habits has also been fulfilling and auspicious. Formed over time, my personal ethos is simple: do what is good for your mental and physical health. I refuse to potentially “undo” the hard work I’ve done. And I am repeatedly affirmed in the ways this animating principle shapes my life, making this the best decision for me.
I do not share this to justify my decision to you. This is an intimate and personal decision. Some women choose reconstruction and are happy and healthy. For some women their breasts are a beautiful piece of their identity. I was cautioned that it may be hard to wake up after surgery and have nothing on my chest. I replied, “it would be harder to wake up after surgery and have something on my chest that isn’t mine.” So I share all of this because I know all of these thoughts and opinions come from places of support, care, and love. And I believe there is a profound need to create the same open networks of support for mental illness as we have for physical or medical disorders. There’s no MRI or ultrasound equivalent for my bipolar diagnosis. There are no blood tests for depression or anxiety. The nature of mental illness is nuanced, ambiguous, and sometimes inconspicuous.
Increasingly there are movements toward mental health and wellness, but there is still a thick stigma around mental illness.
I have mental and emotional scars from years of navigating life with bipolar II disorder. I am proud of those scars. I am proud of the woman I am today and am becoming because of a life with that illness. I know I will be proud of these physical scars too.
As mom and I sat on the front porch, wiping my tears, I started to giggle. She looked at me perplexed and I said, “you know how I know this is the right decision? One of my top, unwavering values is humor… and I’m already thinking of jokes about not having boobs.”
To every woman who knows the sweet relief of taking your bra off after a long day, it’s ok to be jealous of me. This will be the last day I unhook. 😉
That’s enough time in the recliner for now. (Not a bad view though, eh?)
Peace and Love to you.
May you also know your tiny ripples of truth amid the waves.
❤️ Ang
PS. Please send (or comment below) boob and non-boob jokes, memes, funny stories, or movie and tv show suggestions. Because there will be grieving but there will also be jokes. 😆
