Reagan

Just Say Mastectomy?
by Michele Forsten

In October 1987, when Nancy Reagan decided to have a mastectomy instead of a breast conserving lumpectomy, I remember thinking, "once a reactionary, always a reactionary." Even back then it was clear that there was no survival advantage to having the more disfiguring surgery. By choosing a mastectomy "she has set us back ten years," one breast cancer specialist said at the time, as thousands more women than expected followed in her footsteps rather than opting for a lumpectomy in the months after her surgery.

As someone who wore a "Just Say Moe" (as in The Three Stooges) t-shirt in ridicule of Reagan’s "Just Say No" to drugs campaign, I -- a lesbian feminist and a Democrat -- never pictured having anything in common with her. Yet when I was diagnosed with breast cancer a year ago, I went one better than Mrs. Reagan -- I had a double mastectomy.

"If a malignancy is ever found, you should think of having mastectomies," the radiologist who always spent hours on my mammograms and sonograms prophetically said a few months before my diagnosis. "Your breasts are so dense and filled with tumors that it’s hard to know everything that’s growing in them."

Trees have rings that reveal their age; I had visible marks that told the story of the six surgeries I underwent starting at age 16. Scars were etched around both of my nipples and faded incisions lined the surface of other parts of my breasts. In the late '80s, with several of these surgeries behind me and another looming, I went for a second opinion. The doctor asked, "Have you thought of having prophylactic mastectomies? You're at high risk. Why take a chance?" His flippancy about taking such a radical step that was, at best, of questionable value, horrified me. ‘Why would I want to protect myself from a disease I might never contract?’ I thought. It was analogous to deciding to commit suicide now because eventually I'm going to die.

Since all my many biopsies over a 30-year period had turned out benign and I had recently passed the age my mother was when she died of breast cancer (46), I was pretty sure I was going to beat the cancer rap. But a regularly scheduled mammogram showed an area of increased calcification that was eventually diagnosed as invasive ductal carcinoma.

The diagnosis was made while I was on vacation in Florida. I hadn’t given my doctor a phone number where I could be reached, figuring if the news was bad it could wait. A photo from the trip shows me at poolside, my natural cleavage peeking out from my orange bathing suit top, for what was the last time.

A few days later, back in New York, my partner and I listened while the surgeon told us his treatment recommendation: skin-sparing total mastectomies. I had been seeing this breast surgeon for checkups for 18 years, long enough to know that he didn’t frivolously recommend surgery. "If you were to opt for a lumpectomy instead, we would have to remove all the other growths in your breast and biopsy them to make sure there was no other cancer," he said. "That would greatly deform the breast."

And the other breast? "I suggest a prophylactic mastectomy because you have a number of lumps in that breast, any of which could hide a cancer." My partner and I left the surgeon’s office with the names of two plastic surgeons, about to start a journey neither one of us wanted to make.

At home, in between bouts of crying, I weighed my options. I had had it with being probed and biopsied. The only choice that made sense for me was the one that would require the least amount of follow-up in the future. I understood that having double mastectomies did not totally eliminate the chance of a local recurrence in the breast or a new primary breast cancer. But my chances of being diagnosed with another breast cancer were greatly reduced. Nor did having mastectomies guard against metastasis of the original cancer to another organ, like the brain or liver. The odds were in my favor, though, as the pathology report showed a stage one, non-aggressive tumor.

If I hadn’t had a history of prior surgeries and biopsies, if my breasts hadn’t been loaded with tumors, I never would have chosen such a radical solution. In the abstract, though, this decision made a lot of sense. I didn’t dwell on what a great loss my breasts would be because I never would have gone through with the surgery. Instead, I focused on fact that I was taking this action to improve the quality of my life, however long or short it might be. My reconstructed breasts have no lumps in them; it is the first time since I was 15 that this is the case.

I learned from this experience that every woman has to make her own decision about lumpectomy versus mastectomy based on her specific medical condition and her own gut feeling. There’s no right or wrong. Sixteen years later, Nancy Reagan is still with us, a survivor. So far, her choices seem to have worked for her. I hope I have this, too, in common with the former first lady.

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Michele Forsten is a writer living in New York City.