Breast tissue contains fat cells. Fat is considered the third ovary because it still produces oestrogen after oophorectomy. When science writer Florence Williams found substances similar to cannabis in her breast milk she delved into the history of the human breast. Endocannabinoids regulate a baby’s intake of their mother’s breast milk. One of the possible reasons for obesity in formula-fed babies could be the lack of hormones to regulate their appetite. Williams discovered that breasts also absorb chemicals such as fire retardants sprayed onto sofa foam.
Breasts absorb but they also create. Arimidex leaches my fat of oestrogen by being an aromatase inhibitor. Aromatase is an enzyme responsible for converting androgens (‘male’ hormones, like testosterone) into oestrogen. In breast tissue, aromatase is normally regulated, but when it’s not, you get hormone-receptor-positive breast cancer.
In menopause many women worldwide take synthetic oestrogens to overcome their natural relinquishing of it at menopause. Williams explored this phenomenon in Breasts: A Natural and Unnatural History. She wrote: By 1992, Premarin (the name stands for pregnant mare urine) was one of the most widely prescribed drugs in America, given to 11 million menopausal women and earning its happy makers nearly $2 billion a year. To create the unprecedented demand, drug companies and physicians appealed to women’s vanity and reason, essentially inventing a new pathology called menopause in the same way the surgeons had invented one called micromastia, for small breasts.
When I went through menopause instantly and younger than I would have naturally, I realised what it must be like for older women – for those no longer seen as being sexual or attractive to men (in a society that tells us that’s one of the most important ways a woman can be valuable). I was distanced from my true age, which didn’t bother me as I wanted to do other things like survive and write. But there was one major aspect of menopause that made me pause in my breast cancer treatment regime.
After chemotherapy my brain behaved very strangely indeed. I wanted an apple but asked for an orange. I misplaced my son’s first two pairs of proper leather shoes. I left things on top of cars: one week, I drove around the suburb with my lost mobile phone stuck to the roof. I only noticed its presence when I headed out the door and spotted it on the car instead of in my handbag.
When Celso came into the world my memory for names and lists fell away through sheer exhaustion. With chemotherapy my ability to retain recent events, dates, times and appointments had not so much fallen away as been buried by a pile driver. I often walked into a room and stood still, waiting for my brain to catch up and remind me why I was there. I’d go through possible reasons: get Celso’s meds, ring and make an appointment with X, organise weekend get-together, call someone back, put on washing, recall own name. It could take anywhere between five minutes and a couple of hours for the reason to spring back into my mind.
I declared myself the human goldfish. It was as if the drugs created a barrier that held my short-term memories at bay: in effect damming them. As the chemicals leached slowly from my body the ability to retain information and short-term recall of events returned a little.
It was the same with old dreams and memories; the damming process let whatever flowed closest to the filter inlet in my memory pipe pour out. I was a ten-year-old, aglow with warmth as I walked the high path back in Sydney’s north shore suburb Cremorne Point. I was three, reaching up to pluck a seed out of the tall sunflowers around the fence of my crèche, still in England on the grounds of Mum’s university.
I was 22 with my right cheek rested against the cool quartzite sandstone of an Arapiles climbing crag. Arapiles is a mass of rock in Victoria that sits among vast wheat fields and resembles Uluru. I was on the ‘Have a good flight’ wall: a slab of rock 15 minutes’ walk up from the bottom of a series of outcrops. I was about to pull through the crux of the climb. My heart was audibly thumping against my chest; two far better climbers were watching (one was my then boyfriend, the other was my future boyfriend).
Is that the sound of her heart? asked future boyfriend.
The current boyfriend (belaying me) kindly told him to shut it and turned to focus on encouraging me to go for it. I swapped my left foot to my right to stretch out towards the arête of the wall. A chicken-head-shaped clump of rock was the hold I needed to get past and then the climb was mine. It was a grade 24, with the scale going from five to 32. I pulled myself onto the arête and balanced on the chicken head. The hardest part was over. The relief coursed through my body, making my blood feel warm. This memory reminded me that it was rare to be the author of your own fate. I had once held my life in my hands. The situation got reversed with cancer.
And what about those who don’t survive? Are they losers? In The Year of Magical Thinking, American author Joan Didion explored the grief and shock to her psyche after her husband died from a massive heart attack, sitting upright at the dinner table. Her only daughter was dead within a year from septic shock after severe pneumonia. If death catches you, you only have yourself to blame, was Didion’s suspicion of how others sometimes responded to her circumstance.
I found there was a kind of blame assigned to a person for developing cancer in the first place, as if there’s a cancer type of person. Like you brought it on. Isn’t that what I did when I said I wished my mother had chosen differently in her treatment – that she could have lived, but she died instead?
My death felt imminent. I didn’t want to die young. I was 35. My mother developed breast cancer at 45 and died at 56, riddled with metastases from her womb to the lining of her skull. No thank you. It was scary and over-powering, as if a Greek god didn’t like you. I wanted in on the survivors, on that group of people. I wanted to be someone who died of old age with a story to tell. But what about those among us who fight the disease and lose?
Beat and fight. Words that never sat well with my mother or me. She used the term to dance with cancer and that’s what she did. Sometimes she stepped confidently without looking, as decisively as she would in an Argentinean tango: guided by the hand at her back. Other times she swayed on the spot with every beat causing goose pimples, summoning up the passion of a life lived in sound and fury: alive to the moment. She either leant into the movement of her dying swan or stamped angrily on her cancer partner’s feet, hollering at its jerky rhythm and too-rapid pacing. At times she prayed the dance would never end.
I wouldn’t dance with cancer. It was no friend of mine. I wasn’t going to fight it either, declaring war on my own body. I didn’t like cancer, but my body had grown it. My body had once been good to me. It had grand jeté’d across stages, hauled me up cliff faces, held onto billowing spinnakers and trekked into high mountains. I wanted to work with my body to rid myself of it. Beating cancer made sense – I understood the term – I just didn’t use it.
To fight cancer meant standing in a castle’s turret volleying arrows down onto an attacking army as it tried to break down your reinforced healthy door – this wasn’t the right image for the way it was treated. To attack cancer wasn’t really the right medical term. To suppress its chances of developing was. With chemotherapy and hormone therapy I had suppressed the bejesus out of mine.
Breast reconstruction: what are the meanings of breasts?
… I was still feeling a strange stunned alertness, as if everything were taking place in slow motion, under halogen lights.
Brenda Walker, Reading by Moonlight
I arrived on time at my plastic surgeon’s rooms. Pale velvety-cushioned chairs lined all three sides of the waiting room, with a low-lying table brimming with eye-catching magazines in the middle.
Celso wanted to practise his walking. He slapped his pudgy hands on the seats, one after the other, making his way along the perfect line of chairs. A kind woman opposite told me about her nine-month-old daughter who did the same. By this stage my boy was pulling all the neatly stacked magazines onto the floor, and then stomping on them. A fabulous po
o stink reeked from his small person.
I’ll need to find a spare room, I said to the front receptionist. She was stiff and starched. She rolled her eyes.
Inside the room I prepared the spongy black consultation bed as if I were about to perform an operation myself. Celso tried opening the chrome cupboards and bin so I clasped him between my knees before picking him up and laying him back on the black bed. I got out a biodegradable bag ready for the soiled nappy. I opened it up, un-stuck the frilly bit around the leg hole that stops stuff getting out, and pulled the first of his wipes out of their container. Because of Celso’s reflux I placed his nappy bag under his head to elevate it. He squealed with displeasure.
It’s okay, sweetie boo, I’m just making you more comfortable – promise! I said.
He tried rolling off the bed.
I grabbed his ankles to hold his bum off his soiled nappy before whipping it away into the orange bag.
Once cleaned he sat upright, turned onto his stomach and dangled his legs over the sides. I like your ambition, but it’s not going to happen, I said, sitting him back up on his change quilt.
You cannot leave the dirty nappy in the bin, and you have to take it with you, I’d been told.
Yes, darling, I wanted to say. What else would I do with it? Eat it?
I knotted the stinky bag and dumped it into the pram’s basket, planning to throw it into the first bin I saw outside on the street. I secured Celso back in his stroller and cleaned my hands.
Once inside, I faced my plastic surgeon, the man who was going to perform my breast reconstruction after a double mastectomy. Dr Theile was a dignified figure, too young for his light grey hair. He was reassuringly direct when I asked him about nipple-saving options. Well, if you’re doing this to significantly reduce your risk of recurring breast cancer then why would you leave any breast tissue?
Good point.
I don’t want to leave my nipples. I just wanted to ask about the difference, statistically, between nipple saving and removal. To know the chances of my surviving breast cancer, I said.
He put a rough figure together. It likely goes from 97 per cent to 90 per cent.
Can I look at some photos of reconstruction?
Sure.
He lit up his flat screen and an assortment of women’s breasts appeared, their owners aged 29 to late 60s. The youngest woman had opted to forgo her nipple reconstruction and just use stick-on nipples, which worried Dr Theile as he hadn’t finished his job for her.
An older woman’s breast was reconstructed on one side using a TRAM flap procedure. A TRAM flap creates a new breast from abdominal fat, skin and muscle. The woman’s other breast had to be lifted to match the newly bouncing bosom.
Celso reached across to grab a notepad. I pulled his hand back and jiggled him about on my knees. You can give him this, Dr Theile said, passing an unbreakable ampersand ornament.
Celso grabbed it and tried to fit it into his mouth. It wasn’t a choke hazard so I let him and continued viewing the photos.
Another older woman had had a double mastectomy and immediate reconstruction. I saw her breasts in the inflation stage, where the flesh of the breasts was removed during a mastectomy and saline implants were inserted under the muscle on the chest wall – her chest held two child’s balloons. It looked unnatural. Then I saw the result once the silicone implants were in after expanding the skin to the desired breast size. They looked pretty good. There were scars of course, long lines across the middle of the new breast, where a nipple used to be. The surgery and tattooing came later.
It would take four distinct steps to go from a double mastectomy to the finished result. My breast surgeon would remove the breast tissue, then the plastic surgeon would put in saline tissue expanders. When the scars healed enough I’d return to Dr Theile’s rooms once a week for approximately ten weeks and he’d inject saline solution, through my skin, into the expanders, thereby stretching my skin and making my breast mounds bigger.
Once they inflated to the right size I’d go in and have the expanders removed and replaced with silicone implants. The surgical technique of a nipple tack, where they would cut and fold some skin from where the nipple had once been, would come after this, then areola tattooing once the ‘nipples’ healed.
Should I go with the size I am now? The thought went around as I looked at the other women’s breasts.
At 34, in the early stages of pregnancy, I finally had a proper bra fitting at Myer and discovered that I wasn’t a 12B after all, but a 10C. After Celso was born and I expressed for six months my breasts deflated. They were even smaller than they were pre-pregnancy. This was fine, but with the chance of a ‘choose your own adventure’ a robust 10C did sound nice.
Dr Theile remained calm with my squirming son and allowed him to sit on his desk as I asked questions. I’d given Celso an Old McDonald puppet book to play with, in which each finger had an animal to animate while singing. He was chomping down on the cardboard pages of the palm book and some of the paper had come away in his mouth. He choked on it straight away, so I flicked it out of his mouth and held a handkerchief up to his face, assuming he’d vomit. He didn’t.
He okay? asked Dr Theile.
Celso resumed playing with the black and white cow on the puppet’s thumb.
Yes, I replied.
Behind Dr Theile were framed pictures of his family. His good-looking wife once anchored the news in Brisbane and had her own professional standing in the community. In the photo she had her arms around their three children but still maintained the well-dressed-and-presentable-at-any-occasion appearance of a newsreader. The consultation room was large but seemed larger because the windows went from wall to wall and revealed a cityscape of office buildings.
Dr Theile’s main concern with Celso sitting on his table was that he might fall off. Not that he might barf all over his private documents and silk tie. Big tick.
The first time I went to Dr Theile’s rooms, B was in tow. Celso was cared for by a relative so we could focus in an adult way and spend time later talking through the decision in a café. It was four days after my diagnosis of breast cancer. In that first week B and I ran between doctors and decisions, trying to gain as much insight into the situation before saying yes or no to a lumpectomy or other medical interventions.
I saw pictures of women’s breasts then too. I also stood in front of Dr Theile with my jeans undone and my top off so he could examine my caesar scar and stomach. After declaring, You don’t have enough fat for a TRAM flap procedure, he got up and stood behind me, regarding my breasts in the mirror: Arms up. Okay. Arms down.
As I watched Dr Theile examine me I floated a little away from the situation. Here I was with two sets of male eyes staring intensely at my breasts. I wasn’t sandwiched between two lusty but gentle Spanish beauties in some mega fantasy, but in a glowing white medical suite with a surgeon and my partner. It was as unsexy an experience as you could imagine.
Your breasts are small, he said.
And neat, thank you very much, I thought.
They haven’t dropped, and they’re firm. A good option would be silicone implants.
Err, thanks, I’ll be on my way then.
You could go bigger if you wanted, he added.
They shrank a bit after Celso, I said.
Just that some women choose to change their shape if they’re going with the silicone implant option.
I don’t want Dolly Parton boobs, but I might go slightly larger – to fill out my bra more.
He smiled.
I shrugged. And that was that: new breasts were on the menu.
If I were a chimp I wouldn’t have breasts unless I was lactating. We’re the only mammals to grow breasts from puberty. I learnt from Breasts: A Natural and Unnatural History that the father of modern taxonomy, Carolus Linnaeus, named us mammals due to the female species having
mammary glands. As Florence Williams wrote, Breasts are us.
I was still a relatively young woman, though the old automatic questions of How do I look? Am I attractive? were fading from importance in light of my diagnosis. Women can feel defined by how they present to men; in turn, how they present to themselves is defined by a man or by male desire. I hoped to rid myself of that concern. If there was one internal assessor I didn’t need, it was the ugly stick barometer.
Three weeks after I finished chemotherapy I walked back through the sliding doors of the day oncology unit. It can feel like a most useless place. The Waiting Place, as Dr Seuss said. There were four sections for different kinds of waiting – for different doctors and different types of treatment. I sat in the section for people waiting for their bloods to be taken, oncologist appointments and then chemotherapy sessions. We were a craggy, raddled bunch of women and men. I was the youngest. Again.
I handed a bag full of beautiful woollen balls to the ever-kind nurse at reception for volunteers to knit beanies, telling her, Here’s a bag donated care of my mother. This reception nurse would die three years later from heart complications brought on by her diabetes. I’d grabbed the wool from a box labelled Mum’s Stuff that morning. I’d been sorting and clearing. The boxes also held slides in pale cardboard cartons, each the size of an elegant cigarette packet from the 60s.
First year Humanities, Teaching: shape, function, feeling/form was written on one carton – from one of my mother’s first lecturing positions. She’d taken photo montages of Liverpool (the port the Titanic set sail from) and a Free School (one of the radical movements in the 70s towards democratic education, where schools were run as a collective without a headmaster dictating terms). The montage was part of what I imagined as a course on Marxism and the class struggle: kids rough-housing, industrial buildings, slum-like working conditions, nice parks, municipal libraries, uniform backyards with clotheslines, perfect squares for growing your own vegetables behind ugly red brick terraces. Mum had educated herself out of her working-class upbringing. She’d escaped.
In Danger Page 8
