Anita Vesuvala, 54, a breast cancer survivor, underwent a complete mastectomy 14 years ago. The radical surgery involved removing her entire breast and the surrounding lymph nodes. At that time, she wasn't well-informed about the possibility of having her breast reconstructed. <b1>
There was a lot of debate about silicon implants and whether they were good or not, she said. I didn't bother to enquire further about undergoing reconstructive surgery.
Now, Vesuvala has considered reconstruction, but is quite used to her prostheses, and comfortable in her own skin.
There are those like Vesuvala, who have made their peace with the appearance-altering and potentially life-changing nature of mastectomy.
However, a study conducted by the University of Michigan in October 2000, that was published in the journal Plastic & Reconstructive Surgery, found that women who have their breast reconstructed after a mastectomy make larger improvements in their emotional, social and functional well-being than those who don't.
Does losing your breast mean only a physical loss? Can reconstructive surgery heal mental scars and mend broken relationships? Conserve or cut-off ? These are some of the questions we posed to survivors and experts on both sides of the mastectomy debate.
The other C-word: conservation
The breast is definitely an important attribute of the feminine figure, said Dr P Jagannath, chairman of the department of oncology at Lilavati Hospital. Complete mastectomy involves the removal of the entire breast and lymph nodes.
In the past two decades, a procedure called breast conservation has become the norm, where only the cancerous lump is removed. The rest of the breast remains, and is treated with radiation and chemotherapy, he said. From lopping off the entire breast to now aiming to conserve most of it: Does this signal a change in the medical mindset?
Yes, definitely, says Dr Jagannath. There is a popular misconception that complete mastectomy will prevent recurrence, he added.
The fact of the matter is, removal of the lumpis enough, as the chances of recurrence remain the same.
Reconstruction is an option
According to Dr Lokesh Kumar, president of the Indian Association of Aesthetic Plastic Surgeons, most onco-surgeons (who recommend mastectomy) fail to recognise the breast as being aesthetically significant to a woman. Most of them do not tell their patients of the possibility of breast reconstruction after a mastectomy, he said. <b2>
Depending on whether the reconstruction is partial orentire, the cost ranges roughly from Rs 25,000 to Rs one lakh. Can all those recovering froma mastectomy undergo reconstruction? Apart from an individual's own choice based on age or money, there is no reason why reconstruction can't take place, said Kumar.
Kumar, who practices at the Apollo Hospital in Delhi, receives requests for reconstruction, but sees many patients pass it up as there isn't much awareness about the procedure.
Living without a breast
On the other hand, there are survivors like Vesuvala who emphasise looking beyond the corporal and redefining conventional notions of beauty and femininity. After her surgery, Vesuvala realised that there were many like her who had undergone the trauma of losing a breast to cancer.
In 1994, she started a voluntary organisation called the Cancer Rehabilitation Centre at Prince Aly Khan Hospital in Mumbai to provide support to mastectomy survivors. From protein powder packets to a list of wig makers to information about trustees to fund treatment, the CRC has it all handy.
“We try to get the survivors to volunteer with us,” said Nadi Jalali, an onco-volunteer and counsellor at the CRC.
“We educate them about the different sorts of prostheses, and we even have a tailor who makes customised bras at highly subsidised rates.” Many of the women who visit the centre are accompanied by their husbands, said Jalali.
“Family support, especially your partner’s, is crucial for emotional recovery,” she said.
Erasing the scars
“Many survivors undergo depression post surgery,” said psychiatric counsellor Dr Rukhsana Aiyaz. “When they come to me, most are anxious that their husbands would think of them as less of a woman.”
Post mastectomy, there is radiation and chemotherapy, because of which the woman becomes tired and loses her hair. And then there are the scars on the chest.
Aiyaz has seen many marriages fail because of the surgery, often leaving the woman more devastated because the root cause—her cancer—is no fault of hers.
“The woman needs to be reassured that just because she has lost a breast, she hasn’t lost her dignity,” she said.
Breast cancer survivors have a strong presence online. Women bloggers and e-zine editors — including those who have undergone double mastectomy as a preventive measure and those willing to wear their scars as a badge of honour — provide support by sharing their experiences.
One representational comment reads: Every woman’s scars should remind her of her strength of having survived a killer disease.
“For a single woman like me, losing a breast will add a rather definitive variable to the already undefined space that attraction between the sexes is,” said Shvetal Vyas, who has never been diagnosed with cancer.
“Although mastectomy won’t affect my work, it would perhaps affect my chances of having a relationship. Will it affect my perception of myself ? Perhaps. To an extent.”
However, she is certain that if her partner were to leave her because she is lacking a breast, she would ask him to go “marry a breast.” Femininity can be redefined. As Aiyaz puts it, “At the end of the day, it’s about how much the woman is willing to live with/out.”