The short answer is yes. And no. But more yes than no. There are parts of me that have persisted of course – important parts, but there are new parts too that have grown in response to decisions, to trauma, to recovery, parts that have developed through the need and desire to travel new routes into the future. New depths and heights to my identity because of the need to work through loss and grief, new muscles acquired to do the work that achieves this.
And there are parts of me that have grown as a result of the relief, the relaxation, the much reduced anxiety. Perhaps these parts were inside me all along but have only recently been able to come into their own. In fact, I have altogether come into my own since the surgery. Into my own body, into my own art, into my own life, and into the very essence of myself.
Change is process, and I have treated it as process. I believe that is why I have been able to cope with it quite well. By processing my inner concerns and listening to my whole self, the internal changes have been allowed to drive the external changes. That is the right way round. So many people undergoing radical surgery do not have this opportunity, this privilege. The outer changes happen to them and the inner changes are forced into being later, if at all. Sometimes, as in my mother’s case, I don’t think the inner changes are ever fully realised or integrated with the outer changes.
If I had not undertaken the preparation work I did (the writing, the reading, the hours of talking, the photographs, the casts) I would not have been able to cope as well with the many predicted difficulties after the operation and even less so with the unforeseen ones.
After simultaneous surgical removal of both breasts, there is shock and pain, even if the surgery goes according to plan, which mine did. I made sure that I was as ready as I could be for this – I had my homeopathic back-up and I had read enough to know how to minimise post-op problems (take plenty of vitamin supplements, go into the surgery fit, rested and calm etc). I was less ready for all the issues I could not have foreseen, and some that it might have been helpful to have been warned about by the medics. Among these were: the damaged nerve in my right armpit which caused involuntary twitching down the arm and into the hand; the odd sensations I experienced from two sets of drains in my chest and the intense pain on their removal a few days after the operation; the agony and tears of those first vital physiotherapy sessions; the extreme tightness and loss of breath due to the long incisions and many sutures; the boredom of having to sleep on my back for weeks; the exhaustion; the bruising; the extensive numbness; the side-effects of painkillers. Then there was the indignity and discomfort of seromas building up and needing to be drained; the phantom sensations of still having breasts (apparently the more pain that has been associated with an organ before its amputation, the more likely and more sustained these phantom sensations will be). All of these had to be negotiated before I could even begin to adapt to the reality of inhabiting a new shape.
But even so, my dominant emotions on coming round from the anaesthetic – and for months afterwards – were relief and gratitude. Together these feelings delivered the realisation that by losing my breasts I was actually becoming more whole than I had ever felt myself to be. Fears of breast cancer had dogged me from adolescence and through adult life and had generalised into recurring anxiety. Latterly this became an increasingly heavy burden that I shed literally overnight when my breasts were removed. Everyone who saw me straight after surgery said I looked younger, even though I was sleep-deprived, in pain and tired all the time. This had partly to do with the ‘girlish’ look of having a flat chest, I am sure (I had in a way been thrown back into a pre-pubescent body shape). But it was also due to the removal of my anxiety. Being in this post-operative body was like being given a chance to start again. A clean sheet of paper.
As the scars healed and I resumed my swimming routine about six weeks after surgery, I even found myself fantasising about swimming topless in our local pool. Well, I fantasised, many of the men who went topless had substantial breasts, and I had none now, so why shouldn’t I swim in trunks? These were thoughts I entertained with some amusement and almost shame at first, and then learned to embrace. I was now a new shape, why not sport it? But as yet, I have never gone swimming in public and bared my torso!
And while I am thinking about the continuity of aspects of my core self, here is how my swimming routine reflected that. In 2006 I was swimming 50 lengths three times a week in a 25 metre pool. On December 10th, the day before surgery, I swam just 35 lengths, and promised myself I would swim the other 15 on my first day back in the pool. Six weeks later, on January 19th 2007, I slipped back into the water and swam those 15 lengths, just like I’d never been away. I still swim two or three times a week. Swimming (I have always swum breast-stroke and never mastered the crawl!) has kept me supple and helps to prevent my shoulders and upper arms from stiffening too much.
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I had decided not to have reconstruction and as my scars flattened out and faded, I became more and more proud of the ‘nine-inch stripes of platinum’ across my chest. Even now, catching sight of myself in the mirror, I give thanks for their neatness and relative symmetry (when I mentioned to my surgeon that they are not quite symmetrical, he smiled and said ‘That’s because your breasts weren’t’).
I relish the freedom, the lack of bra-straps, the fact that I stay cool in hot weather. Ever since my surgery, I have had a new relationship with gravity – I am not weighed down by breasts. I liked them when I had them (when I wasn’t worrying about them) and they were admired and appreciated by myself and by others – especially once they were under sentence of removal. But I am lighter without them, in every sense.
With or without my clothes on, I remain flat-chested, since from the outset I had decided not to wear prosthetic breasts. Again, this route is not for everyone and I have no mission to convert others, but it suited and still suits me. The reasons? First, I had witnessed my mother’s discomfort with her falsies. She found them hot in hot weather, chilly in winter, heavy, unreliable, sore against the scars. She abandoned them at times and stuffed her bra with cotton wool, but then her bra had a tendency to rise up, causing her embarrassment and shame. Second, my breasts had not been large and I felt that with a relatively small frame my shape would not be too dramatically changed if I went flat-chested. Third, for me it felt more ‘honest’ not to cover up the lack of breasts with fakes as my mother had seemed bound to do. That’s my feminism speaking too, of course, and I have often asked myself if men who had to have their testicles or penis removed would ever consider hanging false equipment on some kind of awkward and uncomfortable contraption just so that they looked more ‘normal’ in swimming trunks or clothes and so that the rest of us would not be dismayed by their lack of bulge.
I recall feeling very vulnerable when I first appeared to others with my new shape. In the early weeks and months after surgery, I would drape scarves across my chest and I sometimes still do this in a setting where I’m with people I don’t know at all (like a writing residency or the first session working with a new student group). But generally I relax quite quickly and am happy for people to notice or not notice or ignore my shape.
I try not to let my shoulders fall forward, try to thrust my chest out, try to remember to do my regular shoulder rolls and shrugs in the shower. I think that not wearing falsies and bra also helps this. I aim for a confident posture – I want to look how I feel, which is entirely happy in my skin, at ease with my body. I learned early on that if I am comfortable with my body, others will be too.
Of course there have been occasions when others have, by their lingering gaze or by their looking away, made me feel awkward, but I know to tell myself that this is their awkwardness not mine. If ever I feel myself taking on their awkwardness, I try to bring to mind what my son (then just turned eleven) said on seeing my bruised and stitched torso soon after I came home from hospital in December 2006, ‘You’re even more beautiful now’.
I have met the occasional baffled or forensic gaze. I was in a restaurant in Italy the summer following surgery and noticed a German woman at the next table transfixed by my flat chest. She stared at it for so long that I thought I was going to have to say something or even get up and leave the room. But in the end she turned to her partner and whispered into his ear before refocusing on her bowl of pasta. I smiled and in turn stared at her chest, which was very full indeed.
Much more recently, in 2015, I had an encounter with two young men which took me by surprise. I was driving alone on a warm autumn morning and stopped at a pub to get a bottle of water. I have mentioned how even now I sometimes cover up my flat chest with a scarf or jacket in a public setting, but on this occasion I simply jumped out of the car and went straight into the pub. I was wearing jeans and a simple cotton top. I ordered my drink, and then paid for it when one of two young men behind the bar brought it to me. I had noticed him and his fellow bar tender studying me somewhat closely, but it was only when I turned to go back out, and had nearly reached the door, that I heard one say to the other, ‘Was that a male or a female?’ and his colleague replied, ‘I don’t know, but there was lipstick’. I was quite taken aback. I had never doubted for one moment that, despite my lack of breasts, I came over as female. It was an intriguing first-hand insight into the maze of gender identification, and whilst I did not find it upsetting I was also glad that it had not happened post-operatively when I was vulnerable to the reactions of others and could have felt hurt or confused.
I have had to adapt the way I dress. Some necklines really don’t work if you have a totally flat chest (polo necks, most bateau necks, all low-cut necklines) so after the operation I parted with quite a few clothes. But it was a chance to refresh my wardrobe, and I soon found out what suited me. I invested in more jackets, tops with crossover designs, tops with some detail that would distract the eye. During the months immediately following surgery I stuck to one or two boutiques I knew and trusted, and where I could try things on without worrying that someone would catch sight of my scarred chest in the changing room (I was concerned that they might be upset). I got to know a delightful woman who ran a smart fashion boutique near my home, and I explained my situation. She could not have been more helpful, encouraging me to try on anything and everything that might work, and always giving me supportive but honest feedback.
For all this seeming confidence, positive outlook and adaptability, I could not for a long while throw out my collection of bras. It just felt too final, too painful to dispose of them. So I kept them in a drawer for a year or two and occasionally looked at them and handled them. Remembering, grieving. I knew when I felt ready to let them go. Then out they went.
Of all the challenges posed by double mastectomy, losing my nipples was for me by far the most difficult and fraught. In my view, the nipple, not the breast, is really the site of most intimacy, ecstasy, and pain (think of extreme cold, or of breast-feeding). One of nature’s miracles is the sheer variety of nipples – their pigmentation, shape, texture, size, reactivity! When my scars were well healed, and I was feeling resilient enough, about four months post-op, I thought it would be fun to go to Anne Summers and find some false nipples. The main benefit of this expedition ended up being the endless laughter shared with the friend who came with me. The other benefit was the poem that resulted. That expedition signalled a bolder me, a self no longer embarrassed or awkward. It was a fabulous moment, full of promise. The poem ‘No adhesive necessary’ is one of my favourites in Self-portrait without Breasts and I always enjoy performing it.
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There’s been plenty of novelty since my surgery, and plenty of continuity. I would say that my personality has been partly formed by the entire experience of family breast cancer and then recently tempered and refined through my own path of risk-reducing surgery. There have been losses and there have been gains. For me the latter far outweigh the former.
But I would not be honest if I did not mention the significance of the surgery as a point of no return. It may seem obvious but it is the most tender aspect of the whole journey. Loss is loss, and the very fact of having parted with my breasts means that I have in some fundamental way also parted with the memory of them and the memory of sensations associated strongly with them, even residing in them. More than ten years on from double mastectomy, I have, quite literally, now forgotten what it is like to have breasts. And that means that I have lost touch with some of the highs and lows of my life – full sexual delight (though there is still plenty, of course, without breasts), the extraordinary memory of breast-feeding my baby son, the intense pain of breasts swollen and heavy for weeks following the loss of an infant in utero. The pleasure of wearing certain clothes.
I could go on. Like any death or ending, there is before and there is after. And now I live in the after, for better and for worse. But mostly, for better. I have learned so much about patience, tolerance, love and courage. I appreciate the value of the life I have and for which I give thanks every day. I know in the right way that each person’s life is finite and must be lived to the full. I am lucky, and blessed, and delighted to live in a world where cancer is no longer taboo, where bodies in all their wondrous forms can be sources of pride and not shame, where gender politics and ideas of gender fluidity are helping to expand the narrow definitions of the past. I feel privileged to exist in a world and a life where I can be the person I need to be, in the shape I need to be, and be loved for who I am.