Let us now appreciate my breasts. Or, as they’ve insisted on being called in these, their final days, My Breasts. Here they are, in 1993 (NSFW).

In the photo, My Breasts had just finished being questioned by the cop (visible there, lurking in the background) sent to keep an eye on Atlanta’s first Dyke March. He wanted to know whether My Breasts intended to carry on for the rest of the march uncovered. Indeed they did.

To my right in the golf cart is Brenda Henson, half of the working class lesbian couple who started Camp Sister Spirit in Ovett, MS. The women wanted a feminist retreat center for Mississippi, and bought 120 acres in the reddest neckest corner of their state to make it happen. For their trouble, the white Baptist church in Ovett put together a militia that phoned in death threats, shot at them, scattered nails and glass in their driveway, and hung a dead dog on their mailbox.

The day after this photo was taken, My Breasts and others belonging to Lesbian Avengers made their way up Peachtree Street before a banner that read, We Need More Stonewalls. We got both cheers and jeers. Every few blocks, a different emissary from the Pride Committee rushed over to tell us they really really really wanted us to please put our shirts back on. Some wrung their hands. Others were more inclined to wring our necks. Didn’t we get it? Lesbians had just a few weeks earlier made it to the front cover of Newsweek. Smiling, nice looking ladies who looked ready for a round of golf and a glass of chardonnay. Mainstream America seemed ready to tolerate gays, so long as we were well-dressed. What, the Pride Committee wanted to know, were we doing ruining their parade with our decidedly not well-dressed breasts?

In my memory, 1993 was the year we homos had to decide between more respectability and more Stonewalls. Being topless was our contingent’s vote for more Stonewalls.

It seemed we had a shot. Act Up, though in active collapse, had radicalized a generation that demanded healthcare as a right to save their own lives in the face of devastating indifference. Queer Nation, the Lesbian Avengers, and other direct action formations were in the streets and bristling with energy.

Alas, over the next few years, our contingent was outvoted. Respectability won out. Gay marriage – rather than freedom from oppression, universal health care, and smashing the patriarchy – became the focus of the LGBTQ movement.

I put my shirt back on and went to law school. A respectable one, up north.

When I returned to Atlanta, some of my friends had gotten top surgery as part of their FTM transition. I considered doing the same, but in the end I did not because I didn’t want to part ways with My Breasts. My friends who had decided on top surgery described their breasts as feeling out of place, or wrong in some other way. That wasn’t my experience. Quite the opposite. After walking topless up Peachtree Street, I understood My Breasts as something of a menace to society. I liked that. All I had to do to throw people into a tizzy was bare them in public. Why would I get rid of something that held such power?

The power of My Breasts turned into a superpower when I discovered this T-Kingdom binder. The binder is made of some special polyester/emu feather/dragon fang thread weave that flattens My Breasts into an impervious breastplate. It gives me a big Captain America chest that makes me look bulletproof. With My Breasts bound up in a fresh T-Kingdom binder, I feel sturdy as an oak. Solid as the Razorbacks’ offensive line. Rock-hard as a bowl of day old cheese grits. You get the idea.

Now, just because My Breasts have superpowers doesn’t mean they’re always wonderful. They can be a problem. At the airport, for example, I’m pulled aside every time and patted down because the metal zipper on my binder shows up on the scanner as a potential threat to national security. In the summer, things get icky and hot under that emu feather/dragon fang thread weave. And working out in a binder is no fun.

In the end, though, I’ve not gotten top surgery because the armor that is My Breasts makes me feel safe. They protect me from the world, shielding my heart from its slings and arrows.

Then I found out I have breast cancer. My Breasts, superpower notwithstanding, somehow got invaded from within.


What to do?

For younger women, an increasing number are opting for a double mastectomy with reconstructive surgery. The jump is driven in part by Angelina Jolie’s prophylactic double mastectomy, and in part by the 1998 Federal Breast Reconstruction Law that requires insurance plans to cover reconstructive surgery after a mastectomy. The push for reconstructed breasts is not subtle. If I wanted to replace My Breasts with new breasts, there are more than a half dozen options: gel implants, saline implants, a TRAM flap using muscle, fat and skin from the abdomen, a DIEP flap using abdomen fat, a latissimus dorsi flap using skin and muscle from the upper back, a gluteal flap using butt muscle…The replacement breasts would, according to the marketing literature, have a “natural look and feel” that will make me feel more “complete” and “whole.” The plastic surgeon doing the reconstruction would, incidentally, be paid more than the oncology surgeon.

For me, a double mastectomy followed by reconstructive surgery holds no appeal. Trying to replace My Breasts with implants is like trying to replace Freddy Mercury with Adam Lambert. I have nothing against Adam Lambert. But there’s only one Freddy Mercury.

This leaves three options.

The first option is to simply have My Breasts removed with a full mastectomy. In the days immediately after my diagnosis, I was certain this was the way to go. But soon enough, My Breasts made it very clear they are not in favor of this option.

The second option is a lumpectomy, leaving My Breasts largely intact. A lumpectomy, however, comes with radiation five days a week for six weeks, to kill off any cancer cells that might be lurking. Because of my age, standard of care does not localize the radiation – they would be zapping my entire left breast, right over my heart. The dose that hits my heart causes cardiotoxicity from incidental cardiac irradiation.

After much pushing and prodding, a couple of creative plastic surgeons came up with a third option: a lumpectomy to dig the cancer out, followed immediately by top surgery. This would give me a Captain America chest sans binder. This seemingly lovely option, however, would require the same amount of radiation as a regular lumpectomy. It would also require twice yearly mammograms, something that is not so easy to do with a male chest.

[A sidenote here re: the difference between a double mastectomy and FTM top surgery. They’re different, and we should probably stop making jokes about how a mastectomy for breast cancer is hahaha, free top surgery. A substantial amount of breast tissue is preserved and then molded by the plastic surgeon doing FTM top surgery because male chests have a good deal of breast tissue. An oncology surgeon performing a full mastectomy, by contrast, removes as much breast tissue as possible, as well as the nipples and the fascia the sits between the breast tissue and pectoral muscle. This photo of a man who has undergone a mastectomy on one breast shows the difference in the appearance of top surgery and a full mastectomy. Additionally, breast cancer mastectomies always include a procedure involving the lymph nodes, to check whether the cancer has spread. That shit is up in your armpit and hurts. This is not done in FTM top surgery.]

Mastectomy, lumpectomy with radiation, or top surgery with radiation.

You know when you were a kid and there was that one house on Halloween where the lady came out and offered you a choice between an apple, an orange, and a box of raisins, and when you were like, For real, lady? , she looked at you like you were an ungrateful little brat, which you were?

I truly appreciate the medical wonders and early detection that allow me to have this choice at all. Really I do. I know it is a gift to have these options. But still. For real, lady?

I made up a matrix to help me decide, giving numerical scores to long-term survival rates, recurrence rates, short term recovery time, emotional impact, and so forth. For what I have, the 5-year and long-term survival rates for options 1 and 2 are essentially the same. Option 3 is unknown. The other details of the matrix are too tedious to recount here, but I was able to fill in those details thanks to the patience and generosity of people who were willing to talk to me for hours about their experiences. Thanks, ya’ll.

The matrix had a nice mathematical feel to it. It was objective-ish and science-y. It was also, alas, unhelpful. The totals for the three options were all within two points of one another, and the winner kept shifting as I changed – over and over and over and over again – the number I gave to quantify the “emotional impact” of each procedure.

After about the tenth cycle of revising how I anticipated feeling about losing My Breasts to a mastectomy from 1 (meh) to 4 (grrrrr) to 2 (hmmm) to 3 (humph), my partner gently suggested it might not be helpful to try and put a number to the emotional impact of things.

A set of numbers, she pointed out, cannot possibly express something as profound as the poetry of feelings.

I had to concede she had a point. Simple math cannot capture the emotional complexity of this decision.

Clearly, I needed more sophisticated math. I went looking for actuarial tables.

An actuarial table uses statistical modeling to predict how much longer people have to live. Life insurance companies use them to make sure they turn a profit. The IRS uses them to value things like annuities. Social Security uses them to calculate benefit levels.

I found this actuarial calculator, which allows you to plug in the particulars (histologic type, stage, size of tumor, estrogen receptivity, etc.) of your breast cancer. One of the numbers it spits back out is how much the chance of cancer death shortens your life expectancy. If you have cancer, think twice before plugging in your numbers. It’s pretty brutal.

It’s also kind of awesome in a weird sort of statistical way. I plugged in my info and found out that for people my age and sharing my cancer particulars, we as a cohort are going to lose about 12% of our remaining expected life expectancy.

So let’s say the rest of my life is a fresh baked, deep dish strawberry rhubarb pie. Because who doesn’t want the rest of their life to be a strawberry rhubarb pie? Having cancer of this particular sort is opening up the oven door, pulling out your pie, and discovering that it’s missing a slice.

Damn you, cancer.

The missing slice of pie made me very sad, because a well baked, deep dish strawberry rhubarb pie is really amazing. I don’t want to be one piece short. I thought about the missing piece a lot. For a few days, it was all I could think about – the flaky crust, the tart and the sweet, the perfect gooiness of the liminal space between filling and crust.

And then I wasn’t so sad anymore. Because a well baked, deep dish strawberry rhubarb pie is really amazing. The flaky crust. The tart mixed with the sweet. The sheer audacity of whoever decided to make a pie out of rhubarb stalks even though rhubarb leaves are poisonous.

Whoever did that was either brave or really hungry or a little crazy.

Or maybe all three. Like the Hensons when they decided to open Camp Sister Spirit in Ovett, Mississippi. Brave and hungry and a little crazy. Like the Black Freedom Movement that inspired them. Like the Black Freedom Movement that is happening now. Like the hunger strikers in now ten immigrant detention centers refusing food. Like every new parent who now has their heart walking around outside their body. Like all you brave and hungry and crazy souls who persist in leading with open-hearted love, despite all evidence of the dangers abounding around you.

I’m not having to choose between an apple, an orange, and a box of raisins. I’m getting to choose to bake a strawberry rhubarb pie, despite knowing it’s going to come out of the oven missing a piece, despite knowing I could screw it up and it will come out too tart or too sweet, despite knowing the leaves of rhubarb are straight up poisonous.

I could choose to bake a pumpkin pie instead – you can’t screw up a pumpkin pie. But strawberry rhubarb pie is just so much better than pumpkin pie. If there’s going to be a pie with a piece missing, it might as well be the best pie ever, even if it’s a little scary, like living open-hearted in an unkind world.

Does this make any sense? The food metaphors sometimes get away from me.

It’s very late. What I’m trying to say is that My Breasts have served me so well for all these years. Their protective superpowers have kept me safe from all stares and side-eyes. Walking into unfriendly spaces, I puff up my chest and they are what enter the room first. They have always been the bravest part of me. I appreciate them.

By having them removed, I am going to have to walk around the world without my familiar and trusty shield. It’s what we were fumbling around for back in 1993 when we marched topless up Peachtree Street. We were trying to carry forward Stonewall, and the movement for queer liberation that would have us, all of us, walking around the world unafraid and open-hearted.

My double mastectomy is scheduled for this Wednesday. I’m supposed to eat leafy greens and drink lots of water to help with recovery. But there’s only so much collards and kale one can eat before starting to crave something a little more dangerous and lot more delicious. My Breasts are still unhappy about the surgery, but I’m not mad about the strawberry rhubarb pie.