Time can never restore a breast, but many women find that distance eventually allows them to catch their emotional breath.
"One or two breasts, the shock and sense of loss are devastating," says Rita Calderon, a licensed psychotherapist in New York City who counsels people facing breast cancer. "To view your once feminine breasts and see a prepubescent, flat chest seems like a total obliteration of one's sexual identity."
During the initial unveiling, Calderon says, most women feel shock and terror. Calderon knows because she lost a breast to cancer more than two decades ago. Women fear how their partner will react. They wonder how they will cope. Acute grief may last several months, with most women not truly beginning to feel okay for about a year. For women facing rounds of chemo and radiation or suspicious growths in follow-up exams, the struggle may continue. Having little emotional support and long working hours can also lengthen the road to emotional recovery.
Eventually the intensity of the grieving should start to fade and the clouds begin to part. Feeling better may appear out of the blue, sometimes catching you by surprise. "One morning, maybe a month after surgery, I sat down to breakfast and noticed I smiled and laughed more easily and relished my food," Calderon says. "It can be that simple."
But even when you've moved on, expect to have the grief stop in to say hi now and then. "Seeing a low-cut blouse that I cannot wear or a sexy scene in a book or movie makes me get a visceral pain for the loss, but truly most of the time I am past that," says Ann Fonfa, 58, of Delray Beach, Florida. Fonfa, who runs the Annie Appleseed Project (www.annieappleseedproject.org), which supports people with cancer, had her first mastectomy at 47 and her second a year later. "Time does make it easier."
Friends and family are a vital part of recovery after a mastectomy. "My best advice is to find someone who has gone through the same thing because that is more helpful than any book," says Barbara Rohlik Shekleton, 53, of New Hampton, Iowa. She became close to a woman from New Hampton whom she met on the oncology floor at the Mayo Clinic Cancer Center in Rochester, Minnesota, where both women were being treated. Shekleton went into surgery not knowing if a mastectomy would be necessary, but told her doctor to remove the breast if he felt it was the best move. "There was no hesitation," she recalls. The cancer had spread through much of the breast tissue and a mastectomy was done. Due to the tumor's size, Shekleton had chemotherapy and later had her other breast removed as a preventive measure.
When her hair began to fall out during chemo, Shekleton called her new friend (who knew how to cut hair) and asked her to shave her head. "I remember commenting on how ugly I looked bald and she just whipped off her head scarf to reveal her own bald head," Shekleton says. From that moment on they were fast friends. Let those around you know what you need and how you feel. If someone close to you expects you to bounce back or return to your old self after treatment is complete, be open enough to admit the emotional wounds take longer to heal.
Expect moments when it's difficult to find any semblance of normalcy or peace. Following mastectomy, women often feel their lives spinning out of control, explains Phillis Bennett, a chaplain at the Mayo Clinic Cancer Center. "I remind women that they can still control what they think and feel and how they're going to live the rest of their lives." The future, she reminds patients, is a question mark for everyone. In addition to journaling, which helps patients clear their heads (especially when they're having trouble sleeping), Bennett recommends practicing meditation and guided imagery, a technique in which patients visualize improved health or combating a disease. Studies indicate the technique may have a positive effect on outcome. She likes psychotherapist Belleruth Naparstek's series of guided imagery audiotapes for women dealing with depression, facing surgery, and looking to re-create their sense of well-being.
Although you may not be accustomed to doing so, be open to help. Shekleton recalls a day during chemo treatments when she was down to "just three eyelashes" and feeling at the end of her emotional tether. Her husband, Jim, was trying to be there for her while also taking care of the farm and desperately trying to find time to repair their roof, which was leaking in several places. Fall was approaching and that meant the fields would need to be harvested. It looked like the roof, leaks and all, would not be completed until the following summer.
Shekleton's despair was short lived. "One weekend, friends, neighbors, and relatives all came over and finished repairing the roof and shingling it in one day," she says. Casseroles and trays of desserts were brought over, set up, served, and cleared. Although her family has helped others, they had never been on the receiving end -- until then. "It was overwhelming and I cried with relief," she says. Her emotional tether grew longer by leaps and bounds that day.
Sadness, depressed moods, anxiety, and fear are all normal responses to a mastectomy, but someone who is having more bad days than good, whose sleep or eating patterns are disrupted, should seek help. Your general physician or oncologist should be able to provide a referral.
While some women prefer discussing issues one-on-one with a therapist, many benefit from group sessions, where a trained facilitator leads a group of patients in structured but informal discussions, or group psychotherapy, in which a licensed therapist is at the helm. Some women find both individual and group sessions helpful. "One patient told me that she didn't want to hear strangers' problems," Calderon says, "but many find that sharing induces the healing process and lifetime friendships." Online groups are another possibility for those not ready to reach out in person.
"Some people say 'I don't want to go to a support group because all they do is cry,' but I have been facilitating groups for a long time and I find there is some grieving, but it's not a crying session; there is a lot of laughter and humor," Bennett says.
Often patients find that when one door closes, another door really does open. Two months after her mastectomy, Calderon traveled to Israel and climbed Masada, a huge rock plateau that overlooks the Dead Sea. "It hurt. At the top, I cried with pain but also with joy," she says. Many women find that living through diagnosis and treatment opens doors they would never have approached. Calderon says: "One client rarely ventured out of her neighborhood, now she's an advocate who takes the subway and marches in Washington. Use this horrible disease as an opportunity to enrich your life, from small to big ways: Take your appointment book and schedule a spa treatment, an afternoon at the local library, a yoga class; think of something you've wanted to do but never got around to."
Shekleton recently found out she is positive for HER-2, a protein that promotes growth of cancer cells, but she refuses to let the cancer diminish her optimism. Today she's back to running a daycare business for four little boys. Her three sons and the demands of the farm once again have her full attention. The natural chaos of life has returned, and for that, she's grateful.