May 27, 1994

4. Breast Surgery

The truth is this: no woman on earth is exactly like any other woman. Even in the thrall of a dread disease, she is unique and must be paid by her doctor the complement of being allowed partnership, within the proper framework of her illness, in deciding what is the best solution for her own special or even eccentric needs.

Rosamond Campion, 1972

Functionally, breasts are useful during the relatively brief period when a woman feeds her infant. In our modern society, they are often dispensed with as a source of food. Their nourishing function may be taken over by a bottle filled with a liquid supplied by cows or soy beans. A woman who lacks breasts, or whose breast will not function, is still able to bear and nourish an infant. Even in primitive societies, which may not have the benefit(?) of the bottle, the nursing function can be taken over by another woman; sometimes by an old woman who can no longer bear a child.

Breasts can be exquisitely sensitive and a source of great erotic pleasure to both women and men. They are the physical symbols of the female. Most female attributes are hidden from view except for the breasts. Unlike the male, whose generative organs are in full view, those of the female are hidden in the abdomen. It is the shape and contour of the breasts which helps to define the body of a woman, as the nose does the face.

There is no body part in a woman which has as much symbolic significance as the breasts. In adolescence, their growth and development define her coming of age as a woman. In youth and middle age, their shape defines her age and physical individuality. Many women are proud of their breasts, as an athlete is of his/her body. Some are ashamed. Some adolescents are ashamed when their breasts start to grow. Some women are ashamed of their breasts because they are too small or too large or are conceived of as being the wrong shape. You can sometimes tell how a woman feels about her breasts by the way she carries herself. A proud woman thrusts her chest out, while the woman who is ashamed tends to be round shouldered in an attempt to conceal them.

In an unclothed society, one can almost define a woman's age by the shape her breasts. If I had to pick a single attitude that would illustrate how irrationally people can behave, it would be the common attitude about the female breast in our culture. The male breast is rarely viewed in the same light. Male breasts are freely exhibited in many places without even a glimmer of interest. A similarly exhibited female breast would attract all sorts of onlookers and, sometimes, the police. Women have placed their lives in jeopardy by having their breasts enlarged to conform to some obscure ideal of perfection, much as Ubangi women enlarge their ears and lower lips. It goes along with the common attitude that bigger is better.

If someone told a professional runner that the amputation of one of his legs was necessary to save his life, he might well chose to die. To another person, it might not be of anywhere near as much consequence. Thus, one woman may accept a mastectomy as necessary, another would rather risk death than lose a breast. Many a woman has literally chosen death to mastectomy.

Just as attitudes are different for different women, so are men's attitudes. To one man, the loss of his wife's breast will be of minor significance. For another, it is grounds for divorce --and his wife may be very aware of it.

Approximately one out of ten women will develop breast cancer in her lifetime. If it were a small skin cancer, or one that is hidden in the abdomen, its treatment would be based solely on the curative aspects of the surgery -not so with breast cancer. Many women have been so terrified at the thought of losing a breast that they allowed a tumor to grow to where it became increasingly unlikely that it could be cured. If I were writing about the treatment of skin cancer or cancer of the bowel, the main considerations would be those elements that make for a cure or the prolongation of useful life. With breast cancer, it should be several articles: one for the woman whose breasts are dearer to her than life itself, and one for the woman who considers her breasts expendable.

Many rational women, when they have a choice of losing one or both breasts or losing their lives, consider it no contest --the breast goes and that's all that there is to it. Such a woman might figure that if her husband left her as a consequence, she is well rid of him.

Most women, even the most logical, would not want to lose a breast if there were some reasonable alternative that would not jeopardize her life. These days there are such alternatives, provided the cancer is small --and only if the cancer is small, and depending on what part of the breast the cancer is located. There are some additional risks attached to some of the options, which I will discuss later. As with most difficult choices, there are trade offs that have to be made. It is that fact that makes decisions, with regard to the treatment of breast cancer, so difficult.

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