Feb 01, 2013
By Pat Sealy, RN, PhD

Breastless and braless by choice

Breast cancer survivor Pat Sealy urges nurses to think about how they can better support women who have had a mastectomy

I had a double mastectomy, after going through six months of chemotherapy, followed by 30 doses of radiation.

Originally, I thought I would get two perky saline implants after the cancer treatments ended. However, my radiologist oncologist warned me that the scarring from the radiation meant that my reconstructed breasts could end up pointed in different directions. Breast reconstruction became even less of an option once I experienced sepsis in my right chest, and a severe radiation burn that penetrated the right pectoral muscles and caused bleeding. Breast prostheses seemed out of the question as well since I could not bear the thought of wearing a prosthesis bra on my painful, wounded chest.

I was now truly breastless and braless. I became very self-conscious, thinking everyone judged me as less of a woman and less of a person. Breasts were linked with beauty and sexuality in the media and in daily conversation, and I started to get angry because I understood how women are indoctrinated to associate the lack of breasts with diminished self-worth.

Today, more than three years on, I am still breastless. My health is good and my outlook is positive. As a result of many sessions of registered massage therapy, much of my scar tissue has healed. I walk taller, with my shoulders back. I am now lifting weights. My chest no longer has a caved-in look. I feel less self-conscious. I know I will not undergo breast reconstruction or wear a prosthesis — a choice I made when I no longer felt vulnerable.

I want to challenge other nurses to think about how we can support patients who are weighing their options. A woman may find she is being encouraged by her oncologist to have breast reconstruction as an add-on to the mastectomy to avoid having a second surgery. Family members may want her to go ahead with the procedure to ensure that she’s still “the same.” When I asked if I could have my ovaries removed to lower my estrogen levels, my oncologist and endocrine gynecologist were adamant that this would be unnecessary surgery. How, then, could anyone argue that breast reconstruction is ever necessary? In fact, this procedure comes with risks that need to be considered. Should their cancer return, women who have breast reconstruction will not be able to immediately feel a new lump on the chest wall. If some of their abdominal muscles are removed, they may develop back problems as they age, a result of weakened stomach muscles and poor posture.

I wonder how many more women would choose to go breastless and braless if they felt accepted just as they are. My husband supported me through the breast cancer and left the decision about breast reconstruction and prosthesis to me. My teenage daughters and all my friends have supported my decision without question. Other women may not be so fortunate, and they will benefit from conversations we initiate about self-worth in relation to dominant cultural values. We can also promote massage therapy for them, before any reconstruction is scheduled.

I have encountered more than a few women who believe they are unworthy because they no longer have breasts. I want us to challenge our own beliefs about the value placed on breasts and to reflect on the reasons for the growth of the breast reconstruction industry. The choices patients make must always be their own. Our responsibility is to help them explore all the viable options and to reinforce their sense of self-worth. Breasts don’t make a woman a woman.

Pat Sealy, RN, PhD, is the Clinical Learning Specialist in the Faculty of Nursing at the University of Windsor, Windsor, Ont. She is also the author of A Family's Resurrection from Breast Cancer.
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