Breast cancer – a non-binary perspective

Content note: cancer, surgery

It’s weird, getting breast cancer when you have an ambiguous relationship to your breasts – suddenly you’re thinking about them constantly when you’d managed to largely ignore their existence. I mean, cancer sucks regardless, no doubt about it. But breast cancer is one of those really gendered cancers, and if you’re a person with gender issues anyway, the whole process is very odd. And disconcerting, and very very cisnormative, not to say cissexist.

When my breast surgeon told me I had breast cancer, the clear assumption was that I would want (or at least consider) having breast reconstruction surgery. But I didn’t – I have never liked having breasts. From my point of view, my breasts were these annoying, large lumps which had sprouted on me at the age of 11, without my consent, and which had now proceeded to horribly betray me. Why the hell would I want to keep them?

But breast reconstruction was the only option discussed with me – risk reducing mastectomy of the other side was never mentioned, or even just choosing not to reconstruct. Instead, I got a booklet and a chat about breast reconstruction. I should have said then that I didn’t want it, but I was in shock – I had sort of known, deep down, since I found the lump, that it was cancer, but I had been hoping for some other result – any other result. I did not, of course, get it. So it took me months to even mention that what I really wanted was to have the other breast removed, and then I was brushed off with a “let’s finish chemo first”. Which, yeah, of course I needed to finish my treatment, but it seemed unfair that I couldn’t even raise the question.

When I came round after my mastectomy (or the removal of Evil!Boob as I called it to myself), I thought for a (horrible, horrible) moment that they hadn’t done anything – the combination of a large remaining breast and the lovely hospital gown I was wearing gave me the illusion (for a few moments) that I still had Evil!Boob. I had to touch it to be sure it was gone. It didn’t help that it didn’t hurt – my only previous surgical experience had been with a broken leg and that did hurt, so I had thought that this would too. I expected pain, at that point, but it wasn’t there – in fact, I actually felt pretty good: all my normal aches and pains seemed to have been wiped out by the anaesthetic.

There were a lot of assumptions about the things that would concern me: hair loss (didn’t particularly bother me), loss of fertility (definitely didn’t bother me – although there was a clear expectation that it would). And I get that these things do bother a lot of people, but not everyone.

And during all of this, I would (continue to) reassess my gender, the culmination of a long, slow process that had started with being a tomboy as a child and then become a general “female, more or less” for the last 10 years or so – largely due to my lack of knowledge of alternatives. A process which would have been much faster and less complicated if I had come across the concept of “non-binary” earlier – instead my first introduction to other genders had been “genderfluid” and that term didn’t speak to me at all. Thinking about it now, that is probably because I separate my gender identity and my gender presentation quite strongly – I’m always and only non-binary in identity, but my presentation might vary according to how I feel at any given point in time. To be clear, this is my view on what non-binary means, and I know other people think of it differently.

So there’s a couple of assumptions that seem to be going on during breast cancer diagnosis and treatment: firstly, that you are/identify as female (apart from the subset of men who get breast cancer); secondly, that you are concerned about your femininity, including your fertility and your appearance.

This makes it tricky if you don’t fit this mould. So much of the information you’re given assumes that these things matter to you, which was definitely not true for me. I just wanted to get my treatment done and get on with my life.

To be fair, I don’t know exactly what I would change, or how, except perhaps to ask for more things to be phrased as questions. It’s not that I felt it was wrong to offer options if I had been concerned about hair loss, or fertility, or loss of femininity, but I would have preferred for that to be an explicit question.

Towards the end of my active treatment, I felt like a bit of a fraud, allowing my clinicians and fellow patients to continue assuming I was female, but I frankly did not have the energy to deal with being out as non-binary *and* go through chemo and radiotherapy. I don’t feel as bad about this as I could, given that during this period I also got harassed by someone while trying to use the female toilets in a library. I was prioritising my physical survival, in the form of getting through my treatment, and my mental health, in terms of finally realising my gender, and coming out to strangers was way down on my list.

I’d probably do the same thing again, which I guess is the best indication that it was the right decision for me.

© bardofupton 2018

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