SUSAN GOFFE
The other day I measured my mastectomy scar. In the three years since my left breast was surgically removed, it had never crossed my mind to do this. Perhaps in that time I was getting to know the empty space on my chest and the scar that defines it in other ways. Something as clinical as a measurement didn’t fit inside that process.
And then one day I wondered how long the scar was. I took out my tightly coiled tape measure and unrolled all five feet of it. I used the imperial measurements side. No question there. Growing up in the sixties meant that metrication came too late to change the early imprinting of yards, feet and inches on my brain. Centimetres mean nothing to me.
I stretched the thin white plastic along the length of the scar, the neat line running from the middle of my breastbone all the way to the side of my torso, just below the outer edge of my left armpit. Ten inches. Did the surgeons plan it that way, to be exactly ten inches long? Did they mark out a precise incision line in gentian violet marker before they cut into my disinfected flesh? Or was that just the length it turned out to be, after they removed everything they needed to and stitched the remaining skin together?
Planned things and things that happen by chance are threaded through my breast cancer story and the subplot of my scar. To start with, I didn’t plan to get breast cancer. Nobody does. With no history of breast cancer in my family, it wasn’t something I thought about much. (That’s not quite true. There was a maternal great-aunt in England who had surgery for breast cancer in the 1940s or 50s and went on to die of something else at a ripe old age. No one taking a medical history ever paid much attention to her, so neither did I.) Sometimes I did my mammograms on schedule. Sometimes I didn’t. I certainly didn’t plan not to do one for five years and was surprised when they checked my records and told me that’s how long it had been since my last one. Mammogram, ultrasound, core biopsy: within weeks I had confirmation of what I already knew from the moment I looked down and saw the protrusion, felt it and found no matching lump on my right breast. That’s what I always did when I felt something lumpy in one of my breasts. Felt the other one. Something similar on the other side? Then nope, not cancer.
That evening’s asymmetry was not a good sign. (They do say that your breasts are not exactly the same size, that one is larger than the other, even if it isn’t obvious. I never noticed.)
I was fortunate to get an early appointment with the plastic surgeon to discuss reconstructive surgery. Still in that post-diagnosis information daze when I sat in his office, I listened and asked few questions. He said because my breasts were very large, the reconstructed one would not be able to match the remaining one. So, I would need to do breast reduction surgery to cut the remaining one down to size. My words there, not his. But I shouldn’t worry about that now, he said; we would discuss it later, after the mastectomy, during which they’d insert an expander to create space for the permanent breast implant. The device would gradually be inflated, stretching the tissue around it over time, until the space was the desired size. Once the new implant had settled, we would move on to reducing the right breast. Yes, all right, I agreed.
The goal was to create visual symmetry. Post-mastectomy, post-reconstruction, post-reduction surgery, my breasts would achieve a perkiness and symmetry that they had never had before.
In the following days, clouds of questions swarmed in my head, and the multiple additional procedures began to settle like a fog of fuss over an already disrupted and uncertain future. At a time when I was still coming to terms with having cancer, facing the main surgery and recovery from it and contemplating chemotherapy (with whatever that entailed), I didn’t need more complications. And this was all taking place during the covid pandemic’s global derangement, just as Jamaica entered its second wave.
I reached for simplicity.
What if I didn’t do any reconstruction? If I had the mastectomy and just left that side bare?
I began to think about a flat chest and started researching this on the internet, looking up women who didn’t have reconstruction after their unilateral or bilateral mastectomies. I started to look at scars. Women with scars that were not flat, where folds of skin had been left in place. Scars that were thin lines, on skin contoured closely against chests. Scars that included nipples left behind. Scars with tattoos over or around them. Scars that were horizontal, or vertical or slanted at an angle. Scars in colour, on black skin, on white skin; scars in black and white photos. I read and listened to people’s stories of why they didn’t have reconstructed breasts, whether it had been a choice to remain flat, and how they felt about their bodies now. I made another appointment to see the plastic surgeon to discuss not having reconstruction, just going flat on the affected side with the neatest possible scar. The discussion did not go well, we did not see eye to eye. I left and didn’t go back. I had made my decision.
Drought. Portia Subran.
My treatment plan changed for other reasons, and I ended up having neoadjuvant chemotherapy, which is chemotherapy done before surgery, instead of after. Strange thing, to be able to feel the tumour shrinking during those six rounds of chemotherapy over four months. The lump that I could initially see protruding beneath my skin and feel easily with the lightest of touches, responded to the drugs as hoped; soon I couldn’t find it anymore, no matter how deeply I probed.
Those four extra months before surgery also allowed me to think more about my decision to go flat on my left side. I read more and thought more and asked more questions. Of a woman who was openly flat on one side; of a physiotherapist. I looked at more scars. I lost my hair and quickly stopped wearing a scarf or turban in public. Too much fuss. My baldness was a visible sign of my cancer treatment, as my flat chest would be. The more time passed, the more certain I became of my decision.
Sometimes on days when my chemo side effects and my energy allowed, I stood in front of the bathroom mirror and moved my left breast to one side, imagining what I would look like when it was gone.
When the chemotherapy ended, I returned to the general surgeon who would be doing my mastectomy to discuss again what that would entail. Once the date for the surgery was confirmed and all the hospital arrangements were completed, we were good to go. But I made one more appointment with him and went armed with a sheaf of pictures of women with mastectomy scars I had printed off the internet to ask him to say which was nearest to what my scar would look like. He said in all his years of practice, no patient had ever done this. Then he dove right in, looking at the pictures I had brought, fully engaged, eventually selecting the one that was most like what I could anticipate, but pointing out the expected differences. That session was invaluable to me.
A few days before the surgery, my younger daughter did a photo shoot for me. Out on an upstairs balcony, curtained off by the julie mango tree, the traveller’s palms, the Areca palms and the water oak. Bare breasted, bald-headed, wearing a buttonless, blue linen print jacket, open wide, silver and turquoise earrings. I felt the Sunday morning sunlight and cool breeze on both my breasts. I thanked my left breast for the functional role it had played in nursing my children. I thanked it for the pleasure it had brought me. And I said goodbye to it.
The first time I saw my scar was in the surgeon’s office during one of my post-op follow up visits. I felt the gentle tugging at my skin as he peeled away the surgical tape. He lifted off the thick pad of white gauze, and there it was. A long dark line, held together by little, black knotted stitches along its length. Pinkish healing skin at its edges. The skin above the scar lighter, tighter and smooth. The skin below the scar darker brown and puckered, like a frill of fish gills. No breast. A space and a scar.
It wasn’t a shock to me, and I am eternally grateful to all those people who had bared their chests, photographed their scars and posted the pictures online. Their sharing was a gift that softened this moment for me.
Over the next weeks and months, I began to touch my scar and claim the space it traversed. Standing in the shower, my palm on the warm, soapy skin, I moved my hand around in circles, moving the skin and underlying tissue with it. To discourage restriction and adhesions, my physiotherapist had explained. The bristly stitches gradually fell out and the cut healed. I often traced the scar, gently examining the tiny irregularities along it. I found the borders of the numb zones on my chest, where sensation disappeared and reappeared under trailing fingertips. Sometimes I sat with my hand on my flat chest, eyes closed, just feeling the rising and falling of my breath.
Before my mastectomy, I read something that said the brain has a map of the body and after a major change, it has to redraw that map. After a mastectomy, looking at and touching your chest and scars can help the brain redraw its map. The looking and touching helped me redraw my heart’s map too, helped me adjust to the new lines, the new contours, the new shapes of my body. My very visibly asymmetrical body.
In “The Cancer Journals”, Audre Lorde wrote of going to a doctor’s appointment after her mastectomy:
“I wore the most opalescent of my moonstones, and a single floating bird dangling from my right ear in the name of grand asymmetry. With an African kente cloth tunic and new leather boots, I knew I looked fine, with that brave new-born security of a beautiful woman having come through a very hard time and being very glad to be alive.”
“In the name of grand asymmetry.” A magnetic and majestic concept. I honour it in a small way, with the asymmetry of my earrings. I no longer wear matching ones, but a flat one in my left ear and a dangling one in my right. To match the asymmetry of my chest. (An unexpected and pleasing result of this new habit is I am now wearing all the single earrings I’ve lost the match to, including some old favourites.)
It can take a year or two for you to know what your mastectomy scar will look like long term. Three years on, mine has settled into a familiar sight. A thin, pale scar that blends into the skin around it. The skin above and below it matches now, and is smooth, with little puckering anymore. Standing in front of the bathroom mirror these days, I see an unremarkable new normal.
When we clear space, the instinct is to fill it. The top of the table is clear. Put a vase on it. A patch in the garden? Plant flowers, plant a tree. A breast is cleared? Fill the space with an artificial one. Make it less obvious that an amputation has taken place. I do not, do not, do not think my choice is the right choice for everyone. We each do what we need to cope, to heal, to survive. But a pause is sometimes a good thing. To sit with the space for a while. To feel, to think. To not rush in while everything is so new, so raw.
Pause.
What fits into this new space on my chest? My right hand, in a gesture of comfort. My two hands, in a gesture of thanksgiving. A dangling necklace, a large pendant. A spray of purple flowers, a piece of poinciana bark, the long leaf of a staghorn fern. Love for a pale thin scar and a newly shaped body.
Susan Goffe is a Jamaican writer, teacher and human rights advocate. And grandmother. Her poems have been published in Focus 1983, So Much Things to Say and Jubilation. She is a Calabash Writer’s Workshop Fellow. In 2018, her blog Right Steps & Poui Trees won a Press Association of Jamaica award for Best News, Sports or Current Affairs Blog. In 2020, she added breast cancer survivor to her list of identifiers.
