Once you're diagnosed with breast cancer,

you’re given a list of shitty options. None of them feel like your life will be improved (except to kill and remove the cancer. Period). Each woman has a very personal decision to make about her breasts. And like many, I had the added bonus of reflecting upon and making my decision while on chemo. Thankfully, I received boob intel from survivors which helped with my choice. Here was my list of shitty options:

1. Lumpectomy & Radiation 

If chemo successfully shrinks a tumor to a small enough size, you become a candidate for a lumpectomy. Thankfully, my tumor dissolved into virtually nothing so I was offered this choice. A large chunk (we need those clean margins!) of the lower portion of my left breast would be removed. In order for a lumpectomy to be effective, a daily dose of radiation for 4-6 weeks is required. Without radiation, my breast cancer would have a 40% percent chance of returning. 

Radiation burns the skin and inner tissue. And it is fatiguing. The radiated skin also becomes permanently scarred. Not to mention that my left breast would be a different size from the right one (although reconstruction by adding body fat into the missing area is an option). My personal thoughts:  After chemo, I didn’t want to be knocked down by another intense treatment. I didn’t want one of my breasts to feel differently (both the skin and the area where my mammary glands were replaced by fat) from the other one. I didn’t want to be heavily radiated and then constantly freak out about future air travel and X-rays at the dentist’s office. Sayonara, lumpectomy. Next option.

2. Single mastectomy

I had the choice to remove just my cancer tit. I could have had reconstruction only on my left side. However, it’s difficult for plastic surgeons to replicate a fake breast that accurately matches it’s living mate. You can’t get twins. Perhaps sisters. Or worse, cousins. Not to mention that there’s a temperature differential between the fake and real breast which becomes more noticeable when you work out or are in extreme hot or cold locations. And then gravity has it’s way with the living breast while the fake one begins to look less related and more like it’s neighbor. Besides, fake boobs without breast tissue don’t fit into bras, but the living one most certainly requires it. Moreover, the fake breast doesn’t have much sensation so I would always feel lopsided. 

And the biggest decision-maker:  I would have 30% percent chance of developing a second primary breast cancer in my living breast. Why? Because I’m considered very young for breast cancer and the odds are high that I will have it again in the future. My breasts are very dense, so mammograms are difficult to read. And I’ve already had a biopsy in my right breast five years ago. Even though it stays well-behaved, it’s a bit shady. A 30% possibility of more chemo? Forget it. Next!

3. Bilateral mastectomy & going flat  

My first reaction was that this might be the option that works best for me. Just chop them off and forget about it. I figured I could wear falsies whenever I wanted to get dressed-up and go out. But a flat chest isn’t so flat. When we think of zero boobs, most of us think of men’s chests, but on a woman, going flat is going concave—with a delicate bone that protrudes from the center of the chest. The majority of women’s ready-to-wear clothing is also cut for breasts, so depending on your clothing choice, there can be fabric baggage around the torso. And the falsies are unwieldy and heavy. They have to be held down with a special bra, but that doesn’t always work as they travel north, south, east or west depending on the activity. And you don’t always notice when one has gone renegade unless you look down. 

For me, this sounds like way too much of a hassle. And most importantly, I don’t want to become a conversation piece every time I walk around with a t-shirt. Going flat is noticeable. In warm weather, it’s constantly wearing a sign, “I’ve gone through hell—my tits are chopped off.” There were a lot of stares when I publicly went bald. I was okay with it because it was temporary. But if given the choice of a little anonymity, I’ll take it. Next. 

4. Bilateral mastectomy & reconstruction 

Oh the irony of me stating that going flat was too much of a hassle. The reconstruction has been a serious hassle. However, it’s only a four-month hassle versus a lifetime hassle (but there’s ongoing maintenance that can be explained later; I have much more to say about this experience). Be warned: it doesn’t end after the chemo is over. Four months of wearing chest expanders before the exchange surgery is a total hassle and you should be prepared for it. I chose reconstruction for four reasons: 

• 1) I want the illusion that a little piece of me has returned to normal after my extreme surgeries—like when I get out of the shower and look in the mirror. One survivor told me that eventually there will be days when I will forget that I ever had cancer. I can only attribute this to the fact that she had reconstruction and doesn’t have a visible daily reminder.

• 2) That anonymity thing. While people notice a concave chest behind a t-shirt, they do not notice reconstructed breasts. 

• 3) The only way insurance pays for reconstruction is during the mastectomy. Meaning: this is a one-shot deal. So far, it has cost insurance $36,000 for the reconstruction during my mastectomy surgery. That doesn’t include the follow-up visits, the fills or the exchange surgery. Holy tits! (I figure if I hate reconstruction, I can always remove my second pair of boobs at a much lower cost.) 

• 4) Jason. My breast cancer was more traumatic for him than for me. Jason had to be a bystander through this whole ordeal. He had zero control. One thing he really wants is to have his wife back. He wants me to be healthy. He wants me to have hair. He would like to see me with a set of boobs. While the decision about my body is ultimately my choice, Jason is my husband and I love him. His feelings carry weight, and I take them into consideration with most of my decisions in life, this one included.

Other survivors navigate their list of shitty options with different outcomes, so it’s important to note that the interpretation of my shitty options is exactly that: my personal translation. However, boob intel from others does help. Hopefully, you will never be faced with making a decision based on this list of shitty options, but in life, everyone gets a list. We don’t have a choice in that.