Remembrance of things breast
À la recherche des seins perdus Note 1

Margie at the Club Med in GuadaloupeThe photo shows my wife Margie wearing one of my favorite bikinis during a vacation at the Club Med in Guadaloupe in 1975. The pictures of her on the beach without the bikini top are for my eyes only.

As an adolescent boy, breasts were mystical things to me. Is it different for boys now? Do the ubiquitous internet images of breasts make them less mysterious? Do these images present an unreachable ideal? Different societies treat breasts differently. I recall hearing of a couple of American women placed in an African village by the Peace Corps. The locals made fun of them because they didn't want to bare their breasts like the other women of the village. But one day when the Americans wore shorts, showing their thighs, the natives were horrified.

That's why there's no way to absolutely define "modesty" - it can only be defined relative to the norms of a particular society, at a particular time. If a woman had appeared on a US beach in 1910 wearing a modest one-piece bathing suit of today (2010), she would have been arrested for indecent exposure.

I think men (well, some men) take on a more detached attitude towards breasts as they leave their randy adolescent stage, and get a bit more mature. But whatever attitude I might have had towards breasts was radically altered when Margie developed breast cancer at the young age of 41 (it was detected by feel, and was invisible on a mammogram). When the surgeon who did the biopsy reported to me that the lump was malignant, my mind flashed ahead to the worst-case scenario, the horrifying possibility of losing Margie. The second thought I had was of raising two small daughters on my own.

As is still the case, there were two treatment possibilities: lumpectomy (excision of only the tumor and some tissue around it) followed by radiation, or mastectomy (removal of the entire breast). With my usual slightly obsessive, detail-oriented engineering approach to any problem, I started gathering data about the disease, and about Margie's options.

But what I didn't do, and wouldn't do, was to make a recommendation. Although statistically the two treatments were equivalent in terms of survival, what if Margie kept her breast on my recommendation, and then had a bad outcome? Would she have felt that she might have sacrificed her health, and possibly her life, to my desires? This decision had to be Margie's alone. I made it clear that I would support whatever choice she made.

In fact, I tried, rather successfully, to not even have an opinion. That might be hard for some people to imagine, especially if they are used to making snap decisions. But I don't. Ever the engineer, I gather data and work over any decision over a period of time. While I'm still thinking about it, I don't have an opinion yet. So by gathering the data to present to Margie, but deliberately not thinking the options through myself, I could to a great extent avoid having my own opinion on the subject, and hence reduce the chance that my choice would apply pressure to Margie. She was going through enough.

Margie chose a mastectomy, for various reasons. Her mother having died of leukemia, she didn't want to undergo unnecessary exposure to radiation. She also thought of the rest of the breast as a time bomb, with who-knows-what going on inside. Subsequent to her decision, the surgeon phoned with a report from his favorite expert breast pathologist who had looked at the slides. He felt, although these findings are all rather subjective, that the tumor was of a type that had a higher probability of recurring in the same breast, and he recommended a mastectomy, reinforcing the decision that Margie had already made.

Since the surgery revealed cancer cells in one lymph node, Margie underwent nine months of chemotherapy. Note 2 It was a harrowing ordeal, but this early treatment is your one shot at a cure. And cure it did. It's now almost 25 years later, and that cancer has never returned. Metastatic cells (cancer cells that have escaped from the original tumor like the ones in one of her lymph glands) don't have an easy time living in the body, and within a twenty-year period, they are nearly certain to either generate a new tumor, or die out.

This sort of experience changes one's emotional reaction to the other breast, which Margie lugged around for the next twenty years, along with a matching prosthesis of similar weight. The heavy tug of the bra straps eventually produced shoulder damage requiring rotator-cuff surgery.

But then, to finish out the story, Margie had the bad luck of developing a second breast cancer, unrelated to the first Note 3. Due to never stinting on her follow-up testing, it was caught early (this time by a mammogram) at a size of only 0.7 cm, and this time no nodes were involved. Although the same lumpectomy/mastectomy choice was offered, the choice was obvious. The second breast was removed as well, and Margie was once again symmetrical, after twenty years. We are now approaching five years since the second mastectomy, with no recurrence, and all factors considered, the probability of the second cancer returning is very low.

In the end, breasts hardly have the importance I attached to them as a teen-aged boy. I didn't marry Margie for her breasts, much as I found them attractive. The only thing that's important is that she's still alive and well and enjoying life. We'll always have Guadeloupe.

Curious as to why women have two breasts, and not, say, three or four?
See the companion entry to this piece, called (duh!) Why do women have two breasts?

#0022   *FAMILY2

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© 2010 Lawrence J. Krakauer   Click here to send me e-mail.
Originally posted April 8, 2010

Footnotes (click [return to text] to go back to the footnote link)

Note 1:   With apologies to Marcel Proust.   [return to text]

Note 2:   The drugs were called "CMF": Cytoxan, Methotrexate, and 5FU, and a nine-month course of treatment was standard at the time (treatments are now shorter).   [return to text]

Note 3:   How can we know it was not a recurrence of the first tumor? First of all, as already noted, a recurrence after twenty years is very unlikely, so it was thought to be probably unrelated the moment it was detected. But in addition, the pathology report showed the tumor to be surrounded by an area of DCIS (Ductal Carcinoma In-Situ), which never occurs in a recurrence. The second tumor was estrogen-receptive, meaning it is susceptible to treatment by anti-estrogen drugs. And no, Margie has no genetic predisposition towards cancer that is detectable by any currently known test.   [return to text]