A body resculpted

Saying goodbye to breasts was harder than one woman imagined

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updated 2:28 p.m. ET March 23, 2008

“I’ll cut them off.”

For years, that’s what I said after my doctor explained my risk of getting breast cancer. It’s not that I considered my breasts to be expendable. It’s just that with my family history — my mother died of ovarian cancer at 48; her sister died of breast cancer at 39; and I’d tested positive for the BRCA1 gene mutation, which increased my chances of developing both diseases — my doctor had been abundantly clear that if I was ever diagnosed with cancer, my safest option would be to have a bilateral mastectomy. But losing my breasts isn’t what frightened me. What scared me most was dying young and leaving my kids, Josh and Maddie, motherless. Then again, it’s easy to be cavalier when the prospect of a double mastectomy is merely a possibility in the distant future.

I’d already had my ovaries removed at 39; my doctor told me it was my best choice, considering what had happened to my mother. In the meantime, my M.D. monitored my breasts with exams and mammograms. Still, technology doesn’t necessarily trump DNA, and I worried about the faulty rung in my ladder. However cautious I was, I knew I might someday get The Call.

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‘We’ll get through this’
The doctor phones and asks, “Is this a good time?”

No. Call back in 40 years.

Decades of waiting have not prepared me for this diagnosis of cancer in my right breast at age 45. When I see my husband a few hours later, he and I clutch each other. “I’m sorry,” I whisper into his wilted cotton shirt as though I’d spun my own defective double helix.

“No, don’t apologize,” Steven says to me gently. “We’ll get through this.”

I hope he’s right.

Maybe sacrificing my breasts, emblems of womanhood, will buy me back my life as mother, wife and friend. I tell Steven, “I’m having my breasts amputated.”

I go to see my doctor in person, and she reconfirms that given my risk of developing another primary breast cancer, bilateral mastectomy makes the most sense. Actually, I’m lucky. My cancer was discovered early, and my prognosis appears to be good, although we won’t know for sure until we get the final test results. I just want my diseased breasts gone. We leave the doctor’s office and pass a sign I’ve seen countless times: POSTMASTECTOMY SHOP. I wince and turn away.

In the car, Steven and I plan how to tell the kids, as though artfully cloaking a death threat can make it less menacing. “Hey,” I say, “at least there will be no more mammograms or underwire bras. That’s a perk.” We both smile. “Y’know, I bet we can do a top 10 list. Number three: What a way to lop off a few pounds!”

“I’ve got number four,” Steven pipes up. “You’re losing only two of your boobs.… You’ve still got me!”

‘Will you make me nice breasts?’
The next week, we meet the plastic surgeon to talk about reconstruction. I choose the simplest procedure with the fewest potential side effects. During my mastectomies, he will insert tissue expanders under my pectoral muscles, which he will then inflate over the course of three months. Afterward, in a second surgery, he’ll replace the expanders with saline implants.

He asks to see my breasts. Awkwardly, I open my paper gown. “Nice?” I think. “Not for long.”

Trying to be cheerful, I ask, “Will you make me nice breasts?” although my voice sounds strained to my ears. The doctor forces a half smile. “I’ll try.”
Slide show
Breast cancer, what happens next
Breast cancer survivor Debbie Horwitz and photographer Missy McLamb documented Debbie's recovery and breast reconstruction in the book, "Myself: Together Again." Click "Launch" to see the images and hear Debbie's story.
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In nine days, my breasts will be gone. Reconstruction will leave me with a passable cosmetic pair, but once the nerve-rich breast tissue is removed, they may not have any sensation whatsoever. That night, I lay in bed next to my husband, aware of the covers against my body.

“I’ll never feel your hands on my breasts again,” I choke out. “Touch me. I don’t want to forget — I want your touch to be imprinted on my skin.”

Steven reaches over, but his touch holds no promise of escalating excitement. It’s as if his hand, mechanically cupping my breast, magnifies our sadness, priming us both for the dead zone my chest will soon become.

Less than a week before surgery, pre-op testing reveals abnormalities in my liver. Metastasis? “Our priorities would change,” the doctor says. I’m terrified. The day before my scheduled surgery, the doctor calls my cell phone while I’m jogging with friends on what I’ve come to call my 10-mile Run for Strength. Her news: My liver cysts are benign. I can proceed with surgery. As passersby sip coffee, I spring into the air, pumping my fist, and whoop, “Yes! I only have breast cancer and can have them both cut off! This is great!”

That afternoon, I take a trash bag to the bedroom and dump all my bras, bathing suits and shirts that will no longer fit. Before bed, I catch a glimpse of myself in the mirror, then close the door, slip off my nightgown and stare. Should I take a photo? Too mawkish. I lift each breast, dense with sensual and maternal memories. You’ve nursed Josh and Maddie. Your job is done. “Good-bye,” I say, sighing.