Preparing for my first day at a breast surgery clinic as a third-year medical student, I pre-charted a patient who had been diagnosed with invasive ductal carcinoma in her right breast and had elected for a bilateral mastectomy over a unilateral. When I asked her how she was feeling when she came in for her preoperative visit the next day, her eyes began to well up in tears. Though she felt confident in her decision to have both breasts removed to reduce her risk of recurrence, she explained to me that she felt an unexpected sadness now that the date of her operation was approaching. Though she felt eager to have her cancer removed from her body, she anticipated that she would come out of her operation feeling strange, expressing that, “My boobs have been with me for so long … my whole life. I know they’re of no use to me anymore, and I feel silly for feeling this way about not having them … but I do.”
My attending and I reassured her that her feelings were not silly at all and were in actuality very normal. When my attending gently inquired about whether she would like to speak with a counselor, the patient politely declined and stated that she would have a “Goodbye Tittie” party before her operation instead as a way to cope with her emotions. With much laughter, we subsequently proceeded to officially consenting her for her procedure, and she left to proceed with planning her party.
In line with this patient’s experience, studies have demonstrated that mastectomy has a severe impact on women’s self-image and psychology, necessitating the establishment of intervention programs such as counseling in order to ensure that patients heal not only physically, but also mentally after their procedure. As an undergraduate student who worked in a psychology lab, I focused my research on the phenomenon of objectification — the attribution of object-like qualities to non-objects, including people. Studies have demonstrated that women, more than men, tend to be objectified, particularly in that their sexual characteristics lead them to be dehumanized and viewed as instruments to serve others’ ends. When my patient said that she felt silly because she knew her breasts were of “no use" anymore, she elaborated she felt that way because “I don’t have a man or a baby so I know I don’t need them.” When she said this to me, I felt incredibly sad that she seemed to feel that she was not allowed to experience sadness over the loss of her breasts because they were not being used by another person. I wondered whether this guilt behind her sadness was why she declined the meeting with a counselor, and wondered whether our assurances and her party would be enough to help her mentally heal.
Though society has led many, like her, to internalize that breasts may not be a part of what makes a person human, in reality a mastectomy is not solely the removal of breast tissue, but also the loss of one’s personhood. When explaining the difference between a partial mastectomy and a total mastectomy, my attending would often describe the partial as “taking the cancer and keeping the breast” and the total as “taking the cancer and the breast,” acknowledging that the removal of the breast is significant and distinct from the removal of the cancer. Shortly after my encounter with this patient, I met another patient who told me that she gave names to each of her breasts, and while I laughed, I realized that perhaps that was her way of reclaiming her breasts as human and as a part of her identity. As I continue to care for this specific population of patients, I hope to acknowledge the cognitive dissonance that is experienced by them as they are both excited to remove the cancer that is foreign to them but grieve the loss of their breast(s) that, as my patient put it, have been with them their whole life. I hope that more reassurance can be provided to these women that conflicting feelings are normal and to be expected, because a successful mastectomy can be a celebration and grieving process all at the same time.
Sarah Kim is a third-year medical student at Cooper Medical School of Rowan University in Camden, NJ.
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