With increasing rates of breast cancer for Canadian women in their 20s to 40s, young survivors must grapple with the lifelong after-effects of cancer treatments such as mastectomies and chemotherapy.
Mastectomies can leave profound and enduring impacts on body image, mood and interpersonal relationships, for which many survivors often feel unprepared. Some say that these drastic changes in daily living can make the years post-treatment even more difficult than their treatment ordeals.
“Cancer can be a very public illness,” says Sue Larkin, chief operating officer of Look Good Feel Better, an organization that helps cancer patients build confidence and positive self-image. Even so, Larkin says many patients avoid asking about cosmetic concerns.
“Often, women will be embarrassed to ask, thinking ‘Here I am facing a very serious diagnosis, and I’m quite worried about my appearance.’ But appearance is an important part of our psyche and identity.”
One approach to restore the breast form following a mastectomy is a breast reconstruction surgery. While the surgery has led to improved self-image and confidence for some, it may also confer additional health risks, especially for those with medical conditions such as diabetes or heart disease.
One in seven women having a mastectomy or breast-conserving surgery in Ontario opt for flat closure. In the U.S., 50 per cent of single-mastectomy patients and 25 per cent of double-mastectomy patients decline breast reconstruction.
A minority of breast cancer patients reported feeling sufficiently equipped to make an informed decision about breast reconstruction, according to a study conducted in 2017. The decision-making process can also be shaped by social pressures surrounding female body image.
Four women share how life looks after breast cancer and how they contended with challenges they never saw coming.
Khalilah Elliott is a 48-year-old HR professional living in Hamilton, Ont. She was diagnosed with breast cancer in 2016. For Elliott, changes in her body following a double mastectomy created a hyper-awareness of the perceptions of others.
“I went to my friend’s wedding, and my dress was stuffed with prosthetics, which kept rising up above the dress. So, for the entire wedding, I was very self-conscious that people were seeing the bra,” says Elliott. “It’s dealing with those little things that nobody else has to deal with, that I always have to be self-conscious about.”
Before she started wearing a prosthesis, Elliott recalls seeing people “double-take” when they saw her.
“I wanted to actually buy a T-shirt that says, ‘Yes, I don’t have any breasts.’ I interpreted the looks and stares differently, whereas before I probably wouldn’t have paid attention to it,” says Elliott. An altered body shape means that shopping for clothes, especially bathing suits, can also be a particular challenge.
With the loss of her breasts, Elliott felt her sense of identity and womanhood were deeply affected.
“I considered my breasts to be one of my best features before cancer, so not having them again completely shattered how I saw myself. I didn’t see myself as beautiful,” says Elliott. “I really felt like I lost pretty much a part of what made me a woman.”
Elliott did not undergo breast reconstruction surgery following her double mastectomy. While the reconstruction of her breast would have improved her sense of positive body image, she is still undecided as she worries the elective surgery could lead to health risks.
Balancing the need for self-confidence and the guilt of placing caretaking burdens on her family has made the decision difficult.
“I feel like this is something I need to do to help get myself back to a place where I’m comfortable and happy with the person I see in the mirror … but it’s that guilt of ‘what if I do it and something bad happens?’ ” she says.
“It makes me think, am I being selfish? Is (breast reconstruction) really necessary? Why do I care so much about what other people think? It shouldn’t bother me that much, but the reality is that it does.”
Elliott says she wasn’t ready for the significant life changes that followed the completion of her breast cancer treatment.
“Nobody prepares you for this part of the journey, for how you live with not looking or feeling the same after coming through something like that. It was just a really big shock to my system and my mindset,” she says.
Vassi Talampassi, 50 years old, was diagnosed with breast cancer in 2021. As a furniture artist living in Windsor, Ont., she compares the process of her body changing through cancer treatment to how she refurbishes furniture.
“The whole process was a transformation, the way I transform furniture. It’s the way you take something that is damaged, and you put it back together, and when people see the before and after, they don’t recognize it.”
Talampassi explains how she developed a sense of self-acceptance for her body, which had undergone drastic changes.
“I wasn’t worried about the way I was going to look until after all the surgeries, until the first time I looked in the mirror and saw all the scars. I never stopped loving my body, but it was a different body,” she says.
“I never see myself through someone’s eyes. I always see myself through my eyes and that’s how I learn to improvise, adapt and overcome.”
In her bedroom, Talampassi keeps two pictures of her wedding, which took place years before her breast cancer diagnosis.
“I look at myself in my wedding gown that complimented my beautiful breasts and I long for them. But then I tell myself, like it or not, changes with our body will come with ageing. All we have to do is embrace and love our bodies.”
Jaclyn Carter was 33 when she was diagnosed and was working on her PhD degree.
Even though several family members had been diagnosed with cancer, she was not prepared.
“For my parents, their diagnosis came at a much later stage in life. I didn’t know what I was going to do career-wise, I hadn’t had children, and my husband and I weren’t married,” says Carter. She was the youngest member when she joined a breast cancer support group.
That young age made it difficult at times for her family to relate to her experience with cancer, she recalls.
“I heard people say that the year after treatment is harder than the year in treatment. I didn’t really know what that meant until I was in it and was the most depressed I’d ever been in the entire experience of having cancer and the most exhausted,” says Carter. “You’re trying to navigate when you go back to work, and what does that look like? People are starting to pressure you. I had a lot of pressure from my family to go back to work.”
Carter wanted to feel as normal as possible during her treatment.
“I wanted to be able to walk around in the world and not have anyone know that I was wearing a wig,” she says. She also bought a hat, which had hair sewn seamlessly into the back and was easy to take on and off.
“When someone rang the doorbell, that meant I could feel normal and it wouldn’t be startling for them, and there wouldn’t be this awkward exchange.”
Her rationale for wearing wigs and hairpieces was to make others around her feel more comfortable.
“I don’t think I felt self-conscious necessarily about not having hair. But I was aware of other people’s reactions to it and how uncomfortable it made them. So, I often covered up more for that reason, more so than because I was ashamed or embarrassed.”
She opted to get an immediate breast reconstruction following her double mastectomy. “I was concerned about the silhouette of my body changing so substantially and wasn’t ready to process a completely flat chest,” Carter says. “It just seemed vital that I get a reconstruction as soon as humanly possible.”
After she was cancer-free, Carter says the fear of recurrence was striking.
“Every pain in my body sent me into a tailspin of worry that the cancer had spread,” she says.
But to her surprise, worries have subsided following her first year post-cancer. She feels she has resumed normal life, but with new skills, added resilience and greater patience.
Jennifer Schultz was a single mother when she was diagnosed with breast cancer in 2015 at age 43. Her daughter wanted her to wear a hat or scarf when going outside, even in the summer. “She was 10 years old, and a bit embarrassed,” says Schultz. “It affects children more profoundly than we think.”
She jokes that she didn’t have to wax for six months and didn’t realize the importance of hair until then.
“My nose ran constantly because you have no nose hair. I lost my eyelashes, and they’ve barely come back.”
She noticed how others started treating her differently as her appearance changed.
“Chemo makes you look sick. I’d be on the subway, and some would get up and give me their seat. And I’m like, I’m not pregnant.”
Schultz saw cosmetics and aesthetics as a means of reclaiming control in an instance when she had none. When she was diagnosed, she immediately wanted to buzz off all her hair.
“I grabbed a piece of my hair and [my hairdresser] took it away from me. He goes, ‘that’s the old you’.”
She says that presenting herself in the way she preferred helped her find strength in a difficult time.
“My make-up was perfect. God damn it, I was going to look good. Because it made me feel better. I’m not going to feel guilty for wanting to look good while I’m sick.”
Schultz says that the “chemo curls” that appeared when her hair grew back created a sense of disconnect with her previous appearance.
“I didn’t look like me, and I didn’t feel like me,” she says. After her mastectomy, she felt that she had lost a large part of what was socially defined as womanhood.
Because she had radiation prior to surgery, she was not eligible for a breast reconstruction for a year.
“You’re losing a part of you that society has made a part of your identity.”
Great article