Flat and OK With That: How Societal Pressures Are Placed on Breast Cancer Survivors

Growing up in the 60s, I got my first glimpse of femininity from the popular movie star, Marilyn Monroe. With her voluptuous figure, her sexy voice and "come hither look," it was easy to understand why she garnered the attention of men around the world. Women wanted that, and societal pressures encouraged it. Marketing capitalized on this image of femininity with everything from tight corsets to ruby-red lipstick. For a while, being curvy was en vogue and then came the era of Twiggy.

Twiggy was female, but was definitely not voluptuous. Her thin, youthful, boyish figure helped change the world of modeling and cast a new light on what sexy could be. Not many could achieve Twiggy's unique look, but some tried. And while there were still Marilyn wannabes around, that look was evolving and changing.

With every new era, it seems a woman's body image reflects current trends. We're expected to look feminine in some way, shape or form. But, is the pressure to look feminine real or perceived? And how does this affect the woman with breast cancer?

Women who've lost one or both breasts to breast cancer know the pressure to look feminine is real. Not only does society expect us to maintain our outer physical appearance, but so do medical professionals. Take, for instance, the woman who's just completed a mastectomy. Her breast surgeon probably assumes she'll want reconstruction, but that's not always the case. In my situation, reconstruction wasn't something I considered even for a second. There was no way I wanted to go through another painful surgery. When I conveyed my decision to the surgeon, she looked at me with surprise and asked why I didn't want to reconstruct. I explained the decision was a very personal one and one I hoped she'd respect. It wasn't necessary for me to go into details about the decision. My husband and I had discussed it and felt we'd made the right choice for us.

The decision to reconstruct is one that must be made carefully. Often, after surgery for breast cancer, women are forced to make the decision under duress. Sometimes it's emphasized that reconstructive surgery will help a woman return to normal while nothing is further from the truth. Yes, reconstruction will give the outer appearance of normalcy, but no, it can never return a woman to her pre-cancerous state of normalcy. Breast cancer is life altering.

If the woman opts out of reconstructive surgery, what then? Two choices remain — the choice to wear prostheses or the choice not to wear them. Those choosing to wear prostheses find another way of deceiving the public eye with the look of feminine normalcy. Those choosing to forego prosthetic breasts either muster courage to face public scrutiny or adopt a devil may care attitude. I find myself in this limbo. I’m expected to look feminine, but why do my breasts have to define my femininity? I believe it goes back to the preconceived images we’ve received since childhood.

Femininity conjures up visions of ceilings painted with beautiful Rembrandt beauties, or big screens full of sexy women. It does not paint the picture of flat-chested women. But more and more women with breast cancer are choosing to forego reconstructive surgery and we are seeing an increase of women choosing to remain flat. Can society learn to accept those of us choosing to live our lives as flat chested women? In today’s society, I believe they will be more apt to accept our appearance.

As a breast cancer survivor living without breasts, I find myself caving to societal pressures at times. When I’m home or around family members, it’s easy to go without prostheses. I know they’ll love and accept me even if I don’t look feminine. When I’m in the public eye, however, I usually wear my prostheses and often, to make others feel more comfortable. It’s funny, but sometimes, when I’m in the company of other females and I’m not wearing my prostheses, I can see the discomfort my abnormality brings them. They look at me with fear — a fear that the breast cancer might somehow rub off on them. In her book, “Flat: Reclaiming My Body From Breast Cancer,” author Catherine Guthrie shares a similar perspective. At a gathering of friends, after surgery to remove both breasts, she says, “Until that moment, I hadn’t realized that my breast cancer could make other women feel uncomfortable about their intact bodies.” She also shared, as she wrote about her deep love of spending quality time with other women, that she felt that feeling was “slipping away.” Although Ms. Guthrie is a lesbian, she still found the acceptance into the world of flatness a challenge, but today has learned to not only accept it but to embrace it.

The pressures of our society do affect the way women with breast cancer view themselves, but my hope is that all women will see themselves beautiful, with breasts or without.

It’s a shame woman are usually viewed as being feminine only if they possess breasts. Would men feel our angst if they were viewed solely on the presence of their masculine body parts?

Societal pressures will always be with us, but if we speak out and help others understand our views, perhaps we can make a difference bringing about a better tomorrow for all breast cancer survivors.