By Adrienne Kapstein
On my morning trudge to the subway the other day, I passed a poster of an assorted group of cool, edgy musicians. One celebrity posed wearing an outfit with an artfully placed pastie of what appeared to be duct tape, but on further reflection, was probably leather, over her nipple. Apart from the nipple being concealed, the rest of her breast was visible. Did the fact that the nipple was covered mean her breast wasn’t fully revealed, I wondered?
Facebook will sometimes censor posts that show breasts with nipples, but doesn’t censor images on the double mastectomy group of which I am a member. A group where brave women share pictures of themselves post-surgery, nippleless, with scars in their place. Do the Facebook monitors consider these not to be breasts if there is no nipple?
A brief survey of Western art history reveals endless depictions of breasts with nipples suckled,(1) bitten, tweaked, pinched, poked, groped, squeezed, sniffed, twiddled, delicately draped and yet fully revealed.
Is the nipple what makes a breast, a breast?
I’m asking because 11 months to the day I am writing this, I lost my breasts. That sounds careless. 11 months to the day, my breasts were taken from me. That doesn’t sound quite right either. They weren’t stolen, in fact; much to my horror, I had to grant permission. 11 months to the day, my breasts were removed. There. As cold and ruthless as it sounds. 7 months and 19 days ago I had “exchange” surgery to replace temporary “expanders” that stretch the muscles with implants. I was not a candidate for a nipple-sparing mastectomy, and so they were removed too. Now, almost a year out, I am left with the decision “to nipple, or not to nipple.”
The visible breast is made up of the nipple and areola. The English word areola comes from the Latin areola, diminutive of area – open space. An open space. This captures how I feel right now. Inhabiting an open space. Existing in the open space between the before and after of cancer; the open space between mourning the body I had for 48 years, and accepting a new one. The open space between having a breast mound, but no nipple. And therefore, the open space between, do I really have breasts, or not?
Diagnosed with invasive ductal carcinoma and with the pre-existing condition of lobular carcinoma in situ (LCIS) (which is not considered cancer, but are cells with a high chance of becoming malignant), I was given the excruciating choice to opt for a lumpectomy and radiation or a mastectomy. It feels like an impossible task to try and remember the avenues of research and self-reflection and anxiety and sadness I navigated during that time. So, to avoid that and summarize: There was no way of knowing how large an area of breast would need to be removed by lumpectomy, and with small breasts and the location of the cancer, I feared major physical deformation. Radiation would further complicate things – damage the skin and shrink the remaining breast tissue. Additionally, with the LCIS diagnosis, there was the strong possibility that more cancer would develop (I had already had 5 biopsies before the cancer was found), and my breast and skin would be significantly compromised with radiation, possibly meaning that I might not have the choice for reconstruction if needed in the future. After much agonizing, I made a decision I never would have dreamed of making. In fact, previous thoughts of mastectomies gave me visceral adverse reactions that made me feel physically ill.
Jump-cut in time and emotion: I now have implants. Although the surgeries went smoothly, I healed fast, and every medical professional compliments me on how “good it looks,” I have what can be best described as Barbie boobs. Too hard, too round, and nippleless. (Spell check does not like this word. Well spell check, neither do I.) But without nipples, my breasts are blank. When I see myself naked, I feel a little like an alien. Wearing a bra helps because it hides the missing part and tricks my brain.
Almost a year out from dealing with cancer, I’m picking up the pieces and trying to understand and come to terms with my new body. I have learned that there are tattoos one can get that create the optical illusion of an areola and nipple. From the pictures I have seen, they are convincing. But the “open space” between this illusion and the reality is that the breast surface is still flat and the very nippley nature (take that, spell check) of nipples – and especially how mine were – are to protrude, to point.
There is also the option of getting a nipple constructed, but I fear that although they would indeed stick out, the proverbial ‘open space’ here would be that the shape of the implant can never change. It is blunted. It is round, yes, but without the teardrop shape – the breast shape forever captured in the champagne cups made from Marie Antoinette’s breasts (and yes, I know breasts come in all shapes and sizes) – it just doesn’t look like a breast.
I had what I feel were particularly un-American breasts. They were small, sloping, with unruly proud nipples. (Sure, sometimes they were embarrassing, but I liked them poking out. I’m pretty much a rule follower, but my nipples weren’t. They did what they wanted and they felt slightly subversive. And therefore, sexy.) My husband used to call them “French boobies.” They were not the size or shape seen on television, or for the majority of the bras on the racks. They didn’t fit into what is deemed desirable – in fact, that was made hurtfully clear when a brilliant but indelicate breast surgeon at Memorial Sloan Kettering told me in no uncertain terms that I wasn’t a candidate for “nipple sparing” because of ptosis. In layman’s terms, my sloping French boobies were considered droopy. But I was happy with them, and I loved my nipples.
So, now I wonder, will adding a fake nipple – a protrusion – onto a flattened surface just seem like putting a cherry on top of an ice cream scoop? Will it give me what I miss, or make me miss it more?
And then there is the open space that exists between having and feeling; and between seeing and believing. I have no sensation in my breasts. I have, but do not feel; I see, but it is hard to believe. This is the cruelest part of it all. What was once a part of me that would feel the pressure and warmth of another body when I hugged them, or where I gather my children – my youngest at a petite 10 years old still comes to chest height; the place where I used to love the feel of my husband’s rough hands on the softest skin on my body, now has no feeling at all. The dissonance is hard to explain – I can see that they are there, but without sensing them, in some way it is almost like they don’t exist.
Whether I opt for tattoos or nipple construction, or both, I’ll never regain sensation. Although it has barely been a year and I am aware of still moving through various stages of adjustment – this narrative being the attempt to articulate one moment of that undertaking – I wonder if I am avoiding the nipple question as the last step toward it all being over and fixed and finished, this cancer journey, I mean. When I know deep down that all of those things are not and will never be true. It is over, but it could recur; it is fixed, but I am forever altered; it is not finished, even though it feels like the world has forgotten and moved on. Maybe by inhabiting this open space, I am allowing myself to postpone the inevitable – acceptance.
But there are two words, so similar to areola that they could be confused as being related. Aureola from the Latin aureolus means golden, splendid and aureole (via Middle English from Latin) means halo: “a circle of light or brightness surrounding something.” So maybe instead of thinking of the open space where my nipples once were, I can envision a sister space – closely related, but not the same – a golden halo, a circle of light surrounding something.
(1) Andrea di Bartolo’s Madonna of Humility, The Blessing Christ, Two Angels, and a Donor from c. 1380/1390; Guido’s Cleopatra with asp, 1630; Gabrielle d'Estrées et une de ses sœurs, anonymous, circa 1594; Cornelis Van Harlen, A Monk and a Nun ; H. Bosch, The Garden of Earthly Delights; Lovis Corinth 1902, Self Portrait with his wife; Liberi’s Allegory of the Weiblichkeit, circa 1660; Pittoni’s Caritas romana, 1710; Jupiter and Antiope, Goltzius, 1612; Primavera or Allegory of Spring, Botticelli c. 1482.
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