When Body Image Collides with Breast Cancer

"We found a dense mass in your left breast and we need you to see a surgeon right away," says a nurse with an obscure voice over the phone to me, a 22-year-old recent UC San Diego college graduate. I had just had my first mammogram and it was 1984.

I was set to get married to my fiancé in less than two months and all I could think of at that moment was, "I am going to be a newly-married bride with one breast hacked off."

False alarm. At my appointment with the surgeon, he said I had fibrocystic breast disease (dense breasts) and advised me to stop drinking caffeine.

Fast-Forward to My 40s
As recommended by the American Cancer Society guidelines, I started having regular mammograms at age 40. At that time, I was struggling in recovery from anorexia. With low body fat, there wasn't much breast tissue to compress in the mammography equipment; however, they could still get a screening that I continued to have dense fibrocystic breast tissue.

I hid my anorexia (or so I thought) through my runner's boy-like body. Breasts, to me at that time, were to be avoided. I didn't know why, they just needed to be small. The only time I could truly say I had more of a woman's body with breasts was during my two pregnancies in 1986 and 1987. I went from a small B-cup to an overflowing D-cup in nine months.

As I was treated for my anorexia, I learned that past sexual trauma in my childhood played a big role in why I felt this need to keep my body and breasts small. My disease was my way of protection, until I realized my disease might kill me.

A New Diagnosis
I recovered from my eating disorder. My weight was in a healthy range, yet my breasts remained "small dense breasts," as the radiologist would say to me after my yearly mammograms.

Due to my dense breasts, cancers were difficult to detect in mammograms. Often, I would have to come back and get additional mammogram studies with advanced views to check areas the doctors would be concerned with. It was scary to get "recall visits." My mind, like I believe most women feel in this situation, floated to this place: "I have cancer."

Last December at age 52, I went to get my annual mammogram and I was called back again due to something suspicious. I thought to myself, I am not going to get all worried this time. I am going to just 'be in the moment.'

Yet, being in the moment didn't keep me from receiving an unexpected phone call from my longtime and trusted gynecologist Patrick Thein, M.D., who received the results of my mammogram screenings. Dr. Thein invited my husband and I to his office the next day and gave us the news I had cancer in my left breast. My doctor had been with me though numerous "suspicious" mammogram findings over the years and he said to me with his caring and honest heart, "If you were my wife, I would recommend a double mastectomy."

Stepping Through the Surgery Process With My Voice
It had been 30 years since I first thought of my left breast being cut away. Having a single mastectomy, double mastectomy or lumpectomy -- breast cancer surgery is very scary to hold.

To me, it's the most invasive, body-altering surgery for a woman... because breasts are so linked to the identity of a woman as well as her body image. Yes I had small breasts, but the thought of them being surgically removed from my body felt like a part of me as a whole person was being removed too.

My mastectomy surgery took place on January 13, 2014. My plastic surgeon was able to start the reconstruction process at the time of the mastectomy. I mentioned to my surgical team before the surgery that I had prior trauma and I was sensitive emotionally as well as physically to my breasts.

As a psychotherapist who treats clients with all types of trauma, I knew I needed to use my voice with my doctors so they could understand how I felt about my body, breasts and my cancer diagnosis. Even if I didn't have prior trauma, getting diagnosed with breast cancer and having breast surgery is a significant trauma.

Following my surgery, I was blessed that I did not require radiation or chemotherapy. My cancer was caught early. I was able to stop my cancer treatment at that point and focus on the reconstruction and implant surgery.

Yet, I know many women at this juncture must continue on courageously with cancer treatment to fight for their lives. I uplift every woman fighting breast cancer today.

Surgery Brings On New Body of Emotions
After my mastectomy, my plastic surgeon said to aid in the recovery process, I needed to massage the surgical scars where my breasts once were and the new implant expanders were taking its place. My doctor's instructions were to take my two fingers and place them on the scar and massage in a rotating manner.

Yet, these simple instructions were not simple for me.

After surgery I couldn't or wouldn't look at my chest. The massaging exercise was to be performed in the shower. I remember the first time I attempted this. I held up my right index and middle fingers in front of me with the shower on, but I was frozen. I couldn't place my fingers on my scars. Tears, along with the water from the shower, were running down my face and I cried out, "I can't do this. I can't do this."

I know having this strange new body with my past trauma kicked me into a headspace that left me unable to touch myself. I needed help. I made a phone call to my angel. Her name is Kris Vroom, a physical therapist and friend I knew who specialized in mastectomy rehab.

The following day, I entered the clinic where she worked and Kris took me to a private room. As I lay down on the table, I started to cry. I was so uncomfortable with my body and figured she would be too.

Kris was kind, gentle and reassuring to me as she started massaging my scars as tears rolled down my cheeks. I do not know where I'd be today without her help. She understood my difficulties with touching my new breasts that were in the process of being expanded for the reconstruction/implant surgery in three months.

As a physical therapist specializing in mastectomy rehab, Kris' role was to develop and implement a plan of care to enhance my recovery, restore function and reduce the side effects of pain, weakness, fatigue, loss of motion and scar tissue formation. Physical therapy helps patients enhance physical and psychosocial recovery ensuring a significant improvement in terms of quality of life.

After mastectomy surgery, when a woman's body is torn down to a primitive place, the physical and emotional changes are rampant. If a woman must continue cancer treatment, saving her life runs a bit ahead of body image concerns. For those who do not need additional cancer treatment, as in my case, and are awaiting reconstruction/implant surgery, body image is right in front of you.

I had to accept this new body developing, one which was different. One that was taking on a more "womanly" shape. Yet, I humbled myself to remember it's one without cancer. Even so, you can't discount what role body image plays following any breast cancer surgery.

Besides the aid from my physical therapist and doctors, I also received support from my therapist, who helped me psychologically work through the breast cancer diagnosis and everything that came with it.

My Journey Takes One More Bump on the Road
I completed my reconstruction/implant surgery on April 2, 2014. Something important to me that was supposed to be fixed in this surgery to my breast -- nipples -- was not. Then, six days later, I was in an auto accident in which I fractured my sternum and caused injury to one of my breasts.

I realized that to have my breasts fixed, I was going to need another surgery. I also realized I wanted to find a new plastic surgeon where my physical and emotional needs were taken more seriously.

I researched my options for breast cancer plastic surgeons and I found Dr. Eliza-Jasmine Tran. Immediately, I felt my body and mind were in good hands. It's now three weeks post "revision" surgery and I'm happy with the breasts made for me. My breasts will never be the same as they were before my mastectomy. I am a new me and I'm accepting her.

Through this experience, I've learned I've become more of a woman than I ever thought I could be. I'll be wearing my pink ribbon, too!


Stats of Breast Cancer and Sexual Trauma
My breast cancer case is not typical, as not every woman diagnosed has had sexual trauma. However, I think it's important to note these following statistics. According to the Rape, Abuse and Incest National Network 1 out of every 6 American women has been the victim of an attempted or completed rape in her lifetime. Additionally, sexual trauma doesn't always include rape, so we are missing a lot of women who have been victims of some other types of sexual violation.

According to Susan G. Komen Foundation, 1 out of every 8 American women will develop breast cancer in her lifetime. Just from the comparisons of these statistics it is evident many women diagnosed with breast cancer may also have a history of sexual trauma.

My question is... how many of these women tell their doctors this past trauma? A lot can go under the radar if women don't share, due to shame, and doctors don't ask. These identified women may have more difficulties with treatment/recovery of their breast cancer and body image issues.

Resource Links

For information on breast cancer, visit the American Cancer Society

For information on breast cancer treatment and the role of physical therapy, visit Blogtalkradio.com, a radio interview in affiliation with the American Physical Therapy Association.