My journey to flat

After reading the Judy Blume blockbuster, I would sit on my parents’ dark blue plush carpet in the living room with my younger sister and chant, “I must, I must, I must increase my bust!” We would then fall back and roll around and laugh with abandon like the young girls we were, unselfconscious about our joy and our bodies.

Fast forward a few decades to my mid-forties: 43, to be exact, when my cousin was diagnosed with ovarian cancer, and her mother (my aunt) was soon diagnosed with cervical cancer. These two diagnoses prompted my sister and I to test for the BRCA mutation since my cousin tested positive. My sister’s results came back negative. When I arrived at the OBGYN’s office for my results, and my doctor sat me down and said, “I need to talk to you about your results,” I knew. I had a BRCA2+ mutation. I had a mammogram and a follow-up appointment. Six months later, I found a lump in my left breast and was diagnosed with Stage 2 DCIS, ER+, PR+, HER2- breast cancer.

When I have taken one of those color personality tests, I tend to be green. That is, spatial and analytic. My breast cancer experience has certainly proven these traits. For instance, I was in the doctor’s office without a companion when my doctor told me the results of my biopsy report. What did I do? I got out a pen and pad to take notes. Isn’t that what one does? The office scheduled my bilateral mastectomy for two weeks from that day, and my breast surgeon suggested that I call the plastic surgeon that he works with for reconstruction.

What was reconstruction? What would happen to my chest? Could I ever work out again? What would the scars look like? I had so many questions. Who would answer them all for me? I would. After every visit I would research what exactly was happening to me, how it was going to happen, and how it would impact my mental state. At every step of the process, I  would visualize each surgery to prepare myself mentally and physically. I started a binder with all of my findings and  took the binder to all of my appointments.

The next step in the process would be for my breast surgeon to contact my OBGYN who called me to schedule a full hysterectomy for one month after the bilateral mastectomy because the BRCA2+ genetic mutation poses a particularly dangerous situation for the reproductive organs. My mind would spin with the thoughts of having no breasts and no internal reproductive organs.

Amid a whirlwind of new appointments, I ventured to the plastic surgeon. Now, I played two sports in college, I’ve run marathons, and I have been proud of my smallish B cup breasts my whole life; they did provide nourishment to my daughter for the first year of her life! The fact that I was walking into a plastic surgeon’s office for my chest was ironic. I joked -- and still do joke -- with all my doctors about cup size, nipples, lack thereof, and any other thing that takes my mind away from pain or the reality that is cancer. My first consultation with this doctor was about saline implants and expanders and their placement after the bilateral mastectomy. The words “aesthetic flat closure” were never mentioned, and I did not know to ask about this option. For me, if I was not going to have any female organs, I wanted to have breasts, even if they were saline. The time allotted for this decision was about 12 days.

The surgeries were successful, and the doctors were able to get the tumor and all the cancer while only removing one lymph node. The expanders were placed, and I had the full hysterectomy. After the expanders were in, I was told to visit the plastic surgeon to have the expanders “pumped” up. It was at this point where I became anxious and needed my sister to come to the visits with me. The small breasts I had asked for were looking bigger after every visit.

After one year with implants, I had increasing pain under my right arm. The pain turned to lymphedema and before I knew it, I was using a pump every day. I decided I was finished with the implants! I saw a different plastic surgeon, who was recommended by my physical therapist, and I asked him to remove the implants. He looked at me a little dazed at first and then said, “Yes, the requests for implant removal as opposed to implant placement is now 70% (women wanting them removed) to 30% (women wanting implants for enhancement).” I was going to be flat, two long scars across my chest.

Right away I felt better physically and mentally. The pain in my right side from the inflammation was gone, the heaviness from any expander pain was gone, the headaches and extreme fatigue had lifted, and I felt more like myself. What I hadn’t realized was that being flat gave me an independence that I did not know I needed after cancer. Perhaps I needed the implants to know I did not need to have implants? Without them I felt more comfortable in my own body.

I was flat -- what some of us in community call a “flattie.” I was not sure how I would wear my clothes or how they would fall on me. Some women wear prosthetics, but I chose not to wear anything but a camisole. I advocated for physical therapy to strengthen my neck and shoulder muscles and returned to work.

Immediately, I heard comments from people who meant to be empathetic: “I feel so bad for her, it must be so weird.” They didn’t understand. This was my choice. Society’s perception of how women should look was never etched in my brain, and now cancer has solidified that idea for me. I certainly catch people glancing at the flatness of my chest, and that is fine, because I am not only comfortable in my skin, but I am cancer-free. Do I wear loose fitting clothing? Not at all. I want people to see me as a woman who has been through cancer and have chosen to live unapologetically flat.

At first my scars were difficult to look at, but now I view them as reminders of the fight I endured. I strive to be a role model for my teenage daughter and the young people I lead every day in my role as a school principal. I feel comfortable in my own body, because I am secure in my choices and that is why I exude confidence.

I have had nine surgeries total on my chest, including revisions. Now my sister and I chant, “We must, we must decrease our bust!”