Gender Expression and the Appeal of a Mastectomy

When I first got diagnosed with cancer at 25 years old, all the treatment options were on the table – chemotherapy, mastectomy, radiation, hormone therapy. I then had to sort through them and decide, with my medical team, which made the most sense.

Of course, any type of treatment was going to come with severe side effects. It was all a cost-benefit analysis: what percentage increase in survival rate would be enough for me to decide on chemo, radiation, etc.?

A numbers game. Arbitrarily, I decided on 5%. If any given treatment would increase my chance of survival (or decrease my chance of recurrence) by at least 5%, I’d do it.

And so, as the tests were done and more information about my stage and type of my cancer came out, I went through the list of treatment options.

The first to go was chemotherapy. My tumour had been sent to California for an Oncotype test. The results, if I’m remembering right, were that chemotherapy would have a less than 2% benefit for me. Conversely, the negative effects of chemo would be massive. Chemo was out.

Next on the docket was whether I should have a mastectomy. It was a treatment only fleetingly considered by my medical team because the test results quickly determined that a mastectomy would be of little benefit. A lumpectomy, radiation and hormone therapy were considered the most effective at reducing the likelihood of recurrence. Together, they far exceeded my 5% benchmark.

Even though a mastectomy was not considered for long, the decision had a lasting impact on me. And not for the reason that is typically talked about, i.e. fear of losing one’s femininity.

That fear is valid, of course. But for me, as a gender-nonconforming, queer woman, the idea of a mastectomy actually had a certain appeal (along with the fear of side effects).

To be clear, I’m not trans and I don’t experience gender dysphoria when it comes to my body. But I do gravitate to collared men’s tops and hide my breasts more than I accentuate them. And when I see transmen or non-binary folks with newly growing muscles and a flat chest, I sometimes look on with envy.

So, when the topic of a mastectomy came up, I found myself wondering if I’d like the new look. It was a thought I kept to myself (my oncologist had been quick to “assure” me of immediate reconstruction in the event of a mastectomy). But I looked up other folks with the same mentality. I got excited when I came upon the folks at FlatTopper Pride. An online community that focuses on LGBTQ* folks who decided not to have reconstruction. Their queer love of mastectomy-caused flat chests resonated with me.

There was one more reason that I sort of liked the idea of a mastectomy – I could mess with people’s assumptions. I could turn the typical pity associated with a mastectomy on its head. Or push back on the other likely assumption – that I must be trans. A reminder that gender expression can look all sorts of ways, even within the context of a cis gender identity.

I share all of this not to suggest that a mastectomy isn’t a traumatic experience (physically and emotionally) for many people. But I think it’s important to remember that a mastectomy doesn’t mean the same thing to all people. A lesson Audre Lorde shared decades ago in Cancer Journals – a book I keep returning to. – Kimiko Tobimatsu

Kimiko is the author of the forthcoming graphic memoir Kimiko Does Cancer. Check out the website, or follow along on Instagram, Twitter or Facebook.