After a Mastectomy, Moving Between Gratitude and Grief

I lay on my back and opened my robe, just as I’d done for every other appointment. But when the doctor prodded my new breasts with her fingertips, I felt naked for the first time. Thin, sloping scars were exposed on my chest, where a surgeon had removed my nipples, but left a smaller version of my areolas.

“If you ever want tattoos, I know a guy named Vinnie in Baltimore. He’s good,” my gynecologic oncologist said as she helped me sit up on the exam table.

“Thanks, but I think I’m good,” I said. My answer was a reflex. I’d had a preventive double mastectomy with reconstruction — two surgeries five months apart — during a pandemic, with three kids at home. I couldn’t fathom driving to Baltimore for 3-D nipple tattoos.

My middle child, Tophs, had helped us discover the BRCA mutation. His puzzling medical symptoms, including dangerously low blood sugar and growth failure, led doctors to order a genetic test of more than 20,000 of his genes. I never expected that my 4-year-old son carried a BRCA2 mutation, and, as it turned out, so did I.

I was 32, and the diagnosis — an increased lifetime risk of developing breast cancer (up to 85 percent) and ovarian cancer (up to 27 percent) — was devastating. Because the cancers associated with BRCA mutations develop in adulthood, my son’s care didn’t change, but my medical team expanded overnight.

I immediately entered a high-risk program at the University of Virginia’s Emily Couric Clinical Cancer Center, and met my gynecologic oncologist, breast surgeon and plastic surgeon. They showed me photographs of women’s torsos before and after surgery. We discussed my family tree, which was marked by a variety of cancers on one side. Having a BRCA mutation doesn’t mean you’ll get cancer. It just means you have to weigh whether you want to spend the rest of your life under surveillance (alternating breast M.R.I.s and mammograms every six months) or take things into your own hands with a major preventive surgery.