‘Going Flat’ After Breast Cancer
Before Debbie Bowers had surgery for breast cancer, her doctor promised that insurance would pay for reconstruction, and said she could “even go up a cup size.” But Ms. Bowers did not want a silicone implant or bigger breasts.
“Having something foreign in my body after a cancer diagnosis is the last thing I wanted,” said Ms. Bowers, 45, of Bethlehem, Pa. “I just wanted to heal.”
While plastic surgeons and oncologists aggressively promote breast reconstruction as a way for women to “feel whole again,” some doctors say they are beginning to see resistance to the surgery. Patients like Ms. Bowers are choosing to defy medical advice and social convention and remain breastless after breast cancer. They even have a name for the decision to skip reconstruction: They call it “going flat.”
“Reconstruction is not a simple process,” said Dr. Deanna J. Attai, a breast surgeon in Burbank, Calif., and a past president of the American Society of Breast Surgeons, adding that more of her patients, especially those with smaller breasts before diagnosis, were opting out of reconstruction. “Some women just feel like it’s too much: It’s too involved, there are too many steps, it’s too long a process.”
“乳房再造不是一个简单的过程，”加利福尼亚州伯班克市的乳房外科医生迪安娜·J·阿塔伊(Deanna J. Attai)说。她是美国乳房外科医生协会(American Society of Breast Surgeons)的前主席。她说，越来越多的病人，尤其是那些在患癌之前乳房偏小的病人，选择不要乳房再造。“有些女性就是觉得太麻烦：太复杂，太多步骤，过程太长。”
Social media has allowed these women to become more open about their decision to live without breasts, as well as the challenges, both physical and emotional, that have followed. For a recent video created by wisdo.com, a social media platform, and widely shared on Facebook, Ms. Bowers and her friend Marianne DuQuette Cuozzo, 51, removed their shirts to show their scarred, flat chests. And Paulette Leaphart, 50, a New Orleans woman whose clotting disorder prevented her from having reconstruction after a double mastectomy, walked topless from Biloxi, Miss., to Washington this summer to raise awareness about the financial struggles of cancer patients.
社交媒体令这些女性可以更开放地谈论不要乳房的决定，以及身体和情绪所面临的后续挑战。社交媒体平台wisdo.com前不久制作的一段视频在Facebook上得到广泛转发。在视频中，鲍尔斯和51岁的朋友玛丽安娜·杜克特·科佐(Marianne DuQuette Cuozzo)脱去衬衣，露出有疤痕的平坦胸部。50岁的新奥尔良人波莱特·利普哈特(Paulette Leaphart)患有凝血障碍，在双乳切除后无法进行乳房再造。今年夏天，她裸露上身从密西西比州比洛克西(Biloxi)徒步走到华盛顿特区，以此激发人们对癌症患者经济困境的关注。
“Breasts aren’t what make us a woman,” Ms. Leaphart said.
The nascent movement to “go flat” after mastectomies challenges long-held assumptions about femininity and what it means to recover after breast cancer. For years, medical professionals have embraced the idea that breast restoration is an integral part of cancer treatment. Women’s health advocates fought for and won approval of the Women’s Health and Cancer Rights Act of 1998, which requires health plans to cover prosthetics and reconstructive procedures.
乳房切除后“走平胸路线”的新运动是对女性特质和乳腺癌康复固有观念的挑战。多年来，医学专业人士认为，乳房再造是乳腺癌治疗必不可少的一部分。女性健康倡议者争取并最终促使《妇女健康与癌症权利法案》(Women’s Health and Cancer Rights Act)于1998年获得批准，该法案要求医疗保险计划涵盖修复和再造手术。
Since then, breast reconstruction has become standard care. More than 106,000 reconstructive procedures were done last year, a 35 percent increase since 2000, according to the American Society of Plastic Surgeons. While it is not known exactly what percentage of women opt for breast reconstruction after a mastectomy, one study found that in 2011, 63 percent of women who were candidates for the procedure chose to have it. In some parts of the United States, the number is closer to 80 percent today.
从那以后，乳房再造成为标准护理。据美国整形外科医生协会(American Society of Plastic Surgeons)称，去年共进行了10.6万多例再造手术，比2000年增加了35%。虽然女性在切除乳房后选择再造的确切比例尚不可知，但一项研究发现，2011年，在准备做乳房切除手术的女性当中，有63%的人选择再造。如今，在美国的某些地区，这个数字接近80%。
In promoting the surgery, doctors cite studies that suggest breast reconstruction improves a woman’s quality of life after cancer. But some women say that doctors focus too much on physical appearance, and not enough on the toll prolonged reconstructive procedures take on their bodies and their psyches. Up to one-third of women who undergo reconstruction experience complications. A systematic review of 28 studies found that women who went without reconstruction fared no worse, and sometimes did better, in terms of body image, quality of life and sexual outcomes.
“That’s the dirty little secret of breast reconstruction: The risk of a major complication is higher than for the average elective surgery,” said Dr. Clara Lee, an associate professor of plastic surgery at Ohio State University who performs the procedure.
“乳房再造术有个可怕的小秘密：术后出现重大并发症的风险要高于普通的选择性手术，”会为患者做再造乳房手术的俄亥俄州立大学(Ohio State University)整形外科副教授克拉拉·李(Clara Lee)说。
Ms. Cuozzo, who appeared in the Facebook video with Ms. Bowers, spent a year having her breasts rebuilt after a double mastectomy, but after four infections in five months, she had the implants removed. The reconstruction, she said, “was getting worse than the cancer.”
While some states, including New York, now require physicians to tell women about the availability of breast reconstruction, women say they often are not informed of the option to remain flat. “I was never told there was a choice,” Ms. Cuozzo said. “I went from the breast surgeon to the plastic surgeon, and they said, ‘This is what you’re going to do.’” Dr. David H. Song, chief of plastic surgery at the University of Chicago and immediate past president of the American Society of Plastic Surgeons, said that the risk of complications was real, but that focusing on them was like focusing on plane crashes when “millions of flights land safely.”
目前，包括纽约州在内的一些州要求医生告知女性可以进行乳房再造。但女性们表示，自己通常不会被告知还可以选择让胸部保持平坦。“我从未被告知还有其他选择，”科佐说。“我从乳房外科医生到了整形外科医生那里，他们说，‘这就是你接下来要做的’。”芝加哥大学(University of Chicago)的整形外科主任、美国整形外科医师学会(American Society of Plastic Surgeons)上一任会长大卫·H·宋(David H. Song)说，并发症的风险真实存在，但过度关注并发症就像是在“成百上千万航班安全着陆”之际将注意力集中在坠机上。
Given advancements in surgical techniques, “the aesthetic result can be better than the native breast,” Dr. Song said. “Patients can come out the other end looking more youthful, with a better aesthetic in her breast than before.”
But it is that kind of talk — suggesting that a reconstructed breast is an improvement on a woman’s natural breast — that enrages many women who have undergone mastectomies. For starters, a reconstructed breast is often numb and can no longer play a role in sexual arousal. It often lacks a nipple, since the nipple is usually removed in a mastectomy.
After looking at photos of reconstructed breasts, “I was slightly horrified,” said Charlie Scheel, 48, of Brooklyn, who decided against implants after a double mastectomy. “You don’t have nipples and you have scars everywhere.”
Rebecca Pine, a cancer survivor from Long Island who co-founded a photography and writing project called “The Breast and the Sea,” said, “It’s a tremendous amount to put your body through, and it’s not like we’re going to get our breasts back.”
来自长岛的癌症幸存者丽贝卡·派因(Rebecca Pine)是一个名为“乳房与海”(Breast and the Sea)的摄影和写作项目的联合创始人，她说，“你的身体要经受极多的苦痛，而且也不是说我们能找回自己的乳房。”
Some women say physicians pressured them to get implants. When Catherine Stapleton, of Florida, woke up after her mastectomy, she discovered that her breast surgeon, a woman, had left unsightly flaps of skin and tissue that could be used for breast reconstruction later, in case she changed her mind.
“When I woke up from anesthesia, I was in shock,” said Ms. Stapleton, 58, who is now facing additional major surgery to correct the first procedure.
Geri Barish, president of the Long Island advocacy group 1 in 9, said a doctor had chided her when she opted against reconstruction. “One doctor said to me: ‘How can you walk around like that? You look deformed,’” she recalled.
长岛倡导团体九分之一(1 in 9)的主席杰里·巴里什(Geri Barish)说，当她选择不做乳房再造手术的时候，遭到了医生的责问。“一位医生对我说，‘你怎么能就这样走来走去？你看起来有些畸形，’”她回忆道。
Support groups and social media have allowed women to share stories about the realities of reconstruction. “A lot of the women in my support group had infections, and they were surprised at how many surgeries were involved,” said Alicia Staley, 45, who stayed flat after a double mastectomy. “As I compared notes, I wondered, ‘Why are all these women doing this to themselves?’”
Coming to terms with a flat chest after breast cancer can be difficult. While some women wear a prosthesis in their bra, it is not uncommon for them to stop using it. “They’re heavy, they’re uncomfortable, and they’re in a sensitive area where you have scars,” Ms. Pine said.