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Beauty and the Breasts

Learning to love your body again

A diagnosis of breast cancer can really knock your self confidence. In this article, take a look at how breast surgery affects people emotionally, Christina Relf explores the complex issue of body image with the help of Amoena Life readers in the UK.

It's tough being a woman. Images of women's faces and bodies are used to sell everything from cars to holidays. The 'personal care' industry, with its make-up, firming lotions and slimming products, seems determined on making us dissatisfied with what nature gave us. With physical beauty – judged by ridiculously artificial standards of perfection – prized in the media above all other personal attributes, it is no wonder we often feel we are falling short of the ideal.

When a woman experiences a sudden transformation in appearance, such as breast surgery, these feelings are accentuated, and it can be a real struggle to regain confidence. After all, the choice of body-altering surgery has in most cases been forced upon her to save her own life. Dealing with the issue of self image is a key stage in the process of recovery.

Less a woman?

In her book, No Less a Woman – Femininity, Sexuality and Breast Cancer, Deborah Hobler Kahane has this to say about the hurdles that women face following breast surgery. "Confronted with the possibility of losing her life, the removal of her breast and resulting disfigurement, a breast cancer patient faces a devastating experience. Perhaps one of the most painful parts of the experience is the belief that a woman with breast cancer is 'less a woman' and will somehow be rejected by loved ones or future suitors. This stereotype evolved from our culture linking a woman's identity to her attractiveness, her femininity to her breasts and body."

Like so many women with breast cancer, when Deborah herself was diagnosed she was terrified about having a life-threatening illness, but thanks to her work with breast cancer patients she knew she would get through it. "I knew from my own experience that the majority of women carried on with their lives as normal. Living with their partners, raising their children, some dating and most still sexually active. Breast cancer had not ended their capacity for sexual intimacy, nor did they feel their femininity had diminished."

Many Amoena Life readers felt that their confidence took a knock immediately after surgery. Says Rosemary: "I've never felt particularly glamorous, but my hair and my breasts were always my best features and I made the most of them. Before my operation I thought I would be able to handle the loss of a breast. I was surprised how difficult it was. My husband has been absolutely fabulous but the difficult times are summer holidays, parties and dressing up. When I get undressed at night and take my bra off and the prosthesis comes too, my stomach turns."

Nan agrees. "During each stage of the surgery, chemo and radiation I have tried to keep up with my 'appearance' but, somehow, after a mastectomy it is entirely different dealing with what to wear and a great deal of your self confidence goes. This, I know, compared to survival is really irrelevant, but a bit of self esteem goes a long way."

So how can you help yourself to a better body image?

Take a look

Some women find the first look at their surgery scars extremely traumatic. "I was absolutely horrified when I first looked in the mirror, as it looked so abnormal," says Theresa. "I still find it difficult to look – although when I have my prosthesis in I don't always know which one is the 'falsie'."

Yet confronting their scars is one of the first steps women can take to re-establish their body image, says Deborah Hobler Kahane. "The first look is never easy, but for most women who have a mastectomy the worst scar scenarios they imagine do not materialise. Many women I have spoken to had not seen a mastectomy scar prior to surgery and were expecting to find 'a big hole in their chest'. Fortunately, instead of a huge scar, most women are pleasantly surprised to see only a thin pencil line of stitches. Show the scar to those close to you – husband, family, friends etc. With the support of others you will quickly learn that you still look OK."

This advice worked well for nearly all the readers we talked to. "Everyone was wonderful, especially my husband and 18-year-old daughter who said 'You haven't lost a breast, mom, you've lost a cancer'," says Rosemary.

Sandra remembers thinking her scar looked very neat: "Just as though the surgeon had drawn a line across my chest. I was pleased that the cancer had gone and I remember saying to my daughter when she asked if I minded having my breast removed, 'if you had a bad tooth which was causing you pain, you'd have it removed – this is very much the same'".

Letting go

Accepting the loss of your breast and letting go of your old body image is also an important part of the move towards accepting your changed body and developing a healthy body image. "The loss is more difficult for some women than others, and depends on how you felt about your breasts prior to surgery and the role they play in your body image and sexual life," says Deborah Hobler Kahane.

During this phase it can be helpful to meet other women who have been through a similar experience, and who can show you that you can feel good about yourself and the way you look again – it just takes time.

Deborah quotes Susie, whose 'breast buddy' was an inspiration to her. "She was an attractive forty-year-old woman who was very comfortable with her one breast and her sexuality. I didn't look at her as a one-breasted lady. I looked at her as a pleasant, warm witty woman whose style was feminine."

Reality check

Finally, you need to decide for yourself what femininity, or being a woman, really means to you – it's a fundamental part of you, not something that can be surgically removed. If you continually tell yourself you'll never feel good about your body again, you are preventing yourself from ever recovering a positive body image. Femininity does not reside solely in a woman's breasts. Carol says that the loss of a breast doesn't bother her, or make her feel less feminine: "I was swimming within weeks, wearing a special swimsuit with a swim form. My breast form was carefully matched to my right breast – I look normal. No one looking at me would think I only had one breast."

And femininity is an intrinsic part of being female; it is not something that can be diminished by a mastectomy. Deborah Hobler Kahane quotes Francois Giraud, the Swiss French journalist and politician who felt it was absurd to suggest that a woman could simply lose her femininity: "As though femininity is something you lose the way you lose a purse. The question of breast cancer and lost femininity is based on an outdated social attitude that equates a woman's femininity almost exclusively with her breasts." says Deborah.

As one of the women quoted in Deborah's book sagely commented: "Many women are acting out of the culture's commercial notion of what it means to be feminine. With nothing better to do than shave our legs, put on make-up and do our hair, women with breast cancer feel that they are not worthy and that nobody will ever pay attention to them."

Almost everyone we spoke to believes that society places too much emphasis on the importance of breasts. "There is no escape in the media," said reader Pauline. "Every day you open a newspaper and see stars in stunning low cut dresses, and advertisements for plastic surgery." Diane agrees: "The pressure to have a perfect body, hair and skin is enormous. Fashion dictates how we all look instead of allowing self-expression."

Beauty in itself is not only a highly subjective concept, it is also a double-edged sword. Usually equated with youth, physical beauty is ephemeral and by no means an automatic ticket to love, success and happiness. If a woman invests all her self-worth in her physical attractiveness, she is undermining her personality and building a very unreliable foundation for her existence. After all, we are most often remembered and valued for our actions – not our looks.

Your own personal reality check, then, will aim to discover what you feel about your femininity and how you value yourself – and are valued by others, enabling you to reach into a deeper level of confidence in yourself as a woman.

Swimming against the tide

Many of the women whose stories we have drawn on for this article made their own journey back to self-esteem by going against the dictates of the media and popular concepts of what it means to be a woman, rather than accepting the so-called ideal.

In defiance of media hype and sexual stereotypes, many readers were adamant that surgery was not going to change the way they felt about themselves. Sandra says: "I can still look good. Nobody would ever know that I have had a mastectomy and I won't let breast cancer stop me from doing anything I want to do. My friends and family still feel the same about me, so why should I feel any different about myself? I have had an illness which I wish I hadn't had, but these things happen to all sorts of people and I am pleased to have got through it. I am a strong person and can be comfortable the way I am. Advertising promotes perfection, but in reality few people are perfect – we should look at the whole person."

Julie says, "I have to look down and check sometimes as I can't tell if I'm wearing a breast form or not." Julie's surgery has not changed the way she feels about her body: "When I wear a prosthesis I look as I always did. When I don't wear it I am proud to show people how normal it can all become to only have one breast."