One or Two or None
It fascinates me how a particular topic can dominate a day. Sometimes the reason is obvious--as in, when Elizabeth Edwards recently died, it made sense that everyone whom I saw needed to talk about this loss and the resulting fear and sadness. Some other times, however, there is no obvious reason why numerous women, on the same day, want to talk about the same issue. A tenet of psychotherapy is that patients will bring to the therapist issues that the therapist herself needs to process. In this case, I don't think this is so true as my own surgical decision was made more than five years ago.
The topic: Should I have a single mastectomy or bilateral mastectomies or "just" a lumpectomy and what about reconstruction? In other words, how many breasts do I want or need: two, one, or none. Dr. Susan Troyan, a beloved Boston breast surgeon, says: "Some women have two breasts, some have one, and some have none--and they are all beautiful." I have come to embrace and believe that philosophy, too, and try to impart it to other women who are struggling with this difficult decision.
Yesterday, I spoke with a woman with Stage IV breast cancer who is considering bilateral mastectomies without reconstruction (understanding that there is no data to support this decision or to discourage it, but it will help her feel that she is doing everything she can to stay well) and to a newly diagnosed woman who needs a single mastectomy and is distressed that she cannot have immediate reconstruction (because she will need radiation therapy, and the recommendation is that the reconstruction await the completion of that treatment). I also spoke with a newly diagnosed woman who only "needs" a wide excision/lumpectomy but worries that she will worry forever if she keeps her breast and to a woman who finished treatment a year ago and now finds that she carries a great deal of anxiety about her breasts and wonders if a mastectomy (or two) would help her. Finally, I spoke with a woman who is midway through adjuvant chemotherapy an greatly relieved that she has been able to keep both breasts.
It is obvious that there is no single right decision and that we all need information and support to make the best choice for both our physical and emotional selves. It has been my experience that, no matter what a woman decides, it will turn out to be right over time. That may reflect how well we truly know ourselves or it may reflect how well we adapt to our circumstances.
I heard yesterday from a woman who I have always liked and admired and whom I have not seen for several years. She has just been through a divorce and sent an email to update me on her life. I loved this comment and think you will, too:
And a new boyfriend after all these years - who took in my uniboob status with a sanguine loving hug.