Thursday, August 20, 2009

Thoughts on Body Modification, Aging, and BRCA

I was at a rock concert in college when the girl standing next to me, who was on acid, turned to me and, with a kind of panicked acceptance that usually accompanies great truths revealed by mind-altering substances, said “My arm is not my arm. Gotta go. Bye.” She abruptly left, apparently to search for her missing arm and return the one now attached to her torso to its rightful owner.

I think about this from time to time because I sometimes worry that, post-mastectomy and reconstruction, I will look down at my new bosom and think, “My boobs are not my boobs. Gotta go. Bye.” And then *poof* like a cartoon, I’ll disappear in a cloud of smoke, leaving behind a skin suit shaped like me—-eye holes empty-—to collapse, deflated, unoccupied, on the ground.

What will it feel like to no longer recognize your own body? Will I feel panic? Alienation? Regret? Will I learn to accept the changes I made to it? Or will I always feel like something is just off?

I have a recurring dream in which I get a large, poorly drawn, and frequently thematically unfortunate tattoo. The design and placement are different every time—-sometimes it’s a childish rendering of sea monster across my torso, sometimes it’s misspelled words and doodles on my upper back-—but the feeling is always the same: enormous and immediate regret, so acute I can feel it in my sleep, followed by unspeakable relief upon waking. I pull up my sweat soaked t-shirt and check my stomach: no tattoo. And I collapse onto the pillows and remind myself it was only a dream.

It's not like I have a problem with tattoos, even. I mean, I have a tattoo. It’s a small, tasteful line drawing at the base of my spine. I got it a week before I graduated college with my best friend, who also got a similar design in a similar spot. In the decade or so since I’ve been inked, this spot on a woman’s body has become a popular location for tattoos (and to think I thought I came up with it all by myself lo those many years ago), and what goes there is often called pejoratively a “tramp stamp.” Despite all this, I don't regret my choice and have fond memories of the experience and warm feelings about the bond it represents with my friend, who now lives hundreds of miles away and in a different world-—filled with babies and diapers and such-—entirely.

But clearly, I have anxiety about body modification, no matter how enthusiastically I engaged in it in my metallic youth (I could have set off an airport metal detector a few years back when my face was littered with piercings). And I have ambivalent feelings about plastic surgery. So having to deal with both now is a bit of a mindfuck.

I keep asking myself why I would voluntarily—-electively, as the insurance companies might consider it—-alter my body-—remove parts and substitute synthetic facsimiles-—leaving scars both physical and psychological. The short answer is that I’d rather have scars from a mastectomy than a chemo port. But the longer answer involves considerations of body image, self esteem, and confidence. And to tease out those implications, it helps to think about how my body has changed in both ways I’ve chosen and ways I’ve had no control over.

The tattoo is permanent, of course, as are the scars left behind by the piercings, but these are physical reminders of willing choices I made. There are marks on my body left behind by afflictions and mistakes I’d rather forget: these are the artifacts of choices I didn’t make. I’m thinking chiefly of the acne scars on my cheeks: the bearded legacy of a pimply youth, my skin no longer breaks out, but it announces to all who sees it its history of dermatological disaster. Lest I spend my life walking around with a paper bag over my head, I’ve had to find the confidence to literally face the world despite my imperfect complexion, and for the most part I don’t let it get me down (but if I could swap my ragged flesh for porcelain perfection, I would in a heartbeat). There are other marks, too, mostly shaving related: the pigmentless strip of skin on my left shin when the razor slipped in the bath in middle school, the isthmus of scar tissue on my thigh from a particularly nasty cut in high school. And of course there are the stretch marks, which, having not yet been pregnant, I can only imagine are the dress rehearsal for the angry, tentacled cracks in the foundation yet to come.

Then there are the ways women’s bodies change as we age, a process of unfortunate dropoping and uneven bulging which now, as I enter my thirties, is a fact of my life: the crow’s feet that gather at the corners of my eyes, the horizontal ass migration, the disastrous effects of gravity on the hangy things. Like all women, I have this idea in my head that my body was always much better off [insert the date of some time in the past], when in truth, at that time, I was actually pretty unhappy about the state of my ass or thighs or hair. The thing is, our bodies are changing all the time: sometimes we help them (when we get tattoos or nips or tucks) and sometimes we’re victims of acne or aging.

So where does a double prophylactic mastectomy fall on this spectrum? I hope it falls more on the end of “things I do to myself”--and the attendant pride that comes from making a choice--than “things that happen to my body”--and the helpless anger that follows from things you can't control. Because I have agency over it: it’s my choice, it’s my scars, it’s my peace of mind. I don’t think I’ll ever be as fond of my mastectomy scars as I am of my tattoo, but perhaps I’ll have less ashamed of them than, say, the pock marks on my cheeks. After all, like the holes left behind by my facial piercing spree of the late-twentieth century, the scars on my reconstructed breasts will tell a story. One, I’m hoping, will have a happy ending.


  1. You'll always look marvelous to me. And Angus has a giant crush on you, too.

  2. I'm 43 and just got a positive BRCA2 diagnosis. I'm glad you're writing about your experience. I'm thinking of going with a mastectomy and DIEP flap (or something totally muscle sparing like a SIEA if I turn out to be good candidate.
    I've never been especially fond of my big boobs so I don't mind showing them the door but the possible complications and recovery sounds a bit scary.
    I'm waiting for more info on what my short-term risk for ovarian cancer might be and hoping to go through natural menopause before I have to think about more surgery.

    This sucks. I wish it wasn't real but I can't just ignore it or wish it away. I hope surgery helps me stop thinking about it so I can just get on with living.