Every morning Carolyn wakes up before the sun to go running, except for four months in the spring of 2023. This was when she received her breast cancer diagnosis. After reviewing her options, Carolyn chose to have a double mastectomy with immediate reconstruction in hopes of a fast treatment, a return to her normal life and her sunrise runs. However, even two years after her surgery, Carolyn still doesn’t feel entirely like herself.

Many years before, doctors found abnormal cell growth during a routine mammogram which placed Carolyn into a high risk breast cancer screening category. This meant mammograms twice a year, an MRI once a year, and frequent self exams. When we spoke, she discussed aspects of this protocol, especially self exams, “I was almost kind of obsessive about self exams just because of my history.” One of these self exams became particularly important right after a routine MRI. Carolyn felt a lump on her right breast and went in for another MRI. The doctors found the mass on the right side, as well as one on the left, and both were biopsied. Carolyn then received a call from her doctor at the high risk clinic. The doctor asked Carolyn how she was and then revealed that she had news. The lump that she originally felt in her right breast was not cancer, but rather a warning. 

"The lump that she originally felt in her right breast was not cancer, but rather a warning."

Carolyn had two types of cancer in her left breast, ductal carcinoma in situ and invasive ductal carcinoma. According to the American Cancer Society, invasive ductal carcinoma is one of the most common types of breast cancer and has the ability to spread to the rest of the breast tissue and to other parts of the body. Carolyn’s high risk protocol had worked, and the cancer was still contained to her breast. In my eyes, after the surgery, Carolyn's breast cancer was gone and that was that. The whole process seemed to go relatively quickly. At the time, I didn't realize that her reconstruction journey was just beginning.

In “The Summer I Turned Pretty,” a TV show that aired in 2022, one of the characters, Susannah Fisher, is diagnosed with breast cancer. Before her diagnosis is revealed, she leads a super active life and has a big personality. However, after her diagnosis, she is portrayed as fragile and weak. In her scenes, she  is shown to be very skinny and sad music accompanies most of her conversations to convey the gravity of her condition. The show highlights how much cancer takes from her life as she is seen missing out on big moments, for example, her son’s prom. This depiction follows the key tenets of Talcott Parsons’ concept of the “sick role.” One of the key aspects of the “sick role” is that the sick person should be exempt from their normal social responsibilities. We see this when Susannah is lying in bed for a majority of the scenes and does not attend special events. However, this aspect of the sick role did not translate to real life as Carolyn continued to teach university students, be an involved mother, and play a multitude of other roles after her diagnosis.

Susannah tragically dies during the show, and a lot of focus shifts to the other characters grieving her. Carolyn thinks that many depictions of breast cancer follow that same path, “It takes a lot of time away from people's lives but then they are healed or cured, or they die, right? So, two extremes.” For Carolyn, it wasn’t so simple. After the cancer was gone, the reconstruction and recovery process began.

Carolyn chose to have an immediate reconstruction after her mastectomy with plastic implants. Carolyn discussed how after her diagnosis, most of her focus was on the cancer treatment, but now that she is two years out of treatment she wishes she put more thought into the reconstruction process. She recalled, “my immediate thought was I don't want to be flat.” This is a very common thought process for women with mastectomies as nearly one third of patients undergo immediate breast reconstruction after their treatment as reported by the American Society of Plastic Surgeons. According to Albornoz’s article in the Journal of the American Society of Plastic Surgeons, this reflects a clear pattern as from 1998 to 2011, immediate breast reconstruction rates increased by about five percent each year. These statistics shine a light upon a societal standard that may be impressed among women who receive mastectomies. Carolyn feels that there is a certain pressure for these women to receive “perky, reconstructed breasts” and that they are seen as “the gold standard”. 

There is a certain pressure for these women to receive “perky, reconstructed breasts” and that they are seen as “the gold standard”. 

“Being completely cut open, removing a whole lot of your own tissue and then sewing in plastic implants into your body. Like, that's kind of horrific.” Carolyn wishes that she had received more information about reconstruction before hers was done, and she is not alone. A study from the Journal of the International Society of Plastic and Aesthetic Nurses found that about 42 percent of women reported their breast reconstruction to be worse than they expected. This may indicate a clear pattern of a gap in reconstruction information. A process that is usually done for aesthetic purposes should not leave so many women unhappy with the appearance. 

After Carolyn’s implants were placed, they caused some problems. She became very sick after an infection from her skin entered the implants, causing her to need powerful antibiotics. The implants were also the reason Carolyn could not run for about four months. She needed to avoid chafing because it could put her at risk for capsular contracture condition. According to an article from BreastCancer.Org, the body’s usual response to implants is to form scar tissue around them to create a tissue capsule. Capsular contracture condition occurs when the tissue capsule becomes too hard or dense and squeezes the implant. Carolyn had to avoid triggering this or risk restarting the entire reconstruction process.

 Carolyn also faced adverse emotional effects after her reconstruction. Before the surgery, it didn’t occur to her how different things would be. When we spoke, she mentioned that she thought things would go back to normal after her surgery, “I'll just go back to wearing all my regular clothes and I'll look just the way I used to, you know, just with a few more scars.” Unfortunately this was not the case as Carolyn still struggles to feel comfortable with herself and her new appearance. With a condition that is so common and so curable, why is the most socially acceptable next step leaving so many women unsatisfied? More importantly, why is there a socially acceptable next step after breast cancer and a mastectomy?