At 25 years old, I discovered that my breasts could pose a serious threat to my health. A family member tested positive for the BRCA1 gene mutation, which is linked to a higher risk of breast cancer. This prompted our family to undergo testing as well. Unfortunately, my test results came back positive, meaning I had a significant chance of developing breast cancer in my lifetime, up to 72%.
Before this diagnosis, I never really considered illness and mortality as something that affected me. I was young and healthy. However, the BRCA1 diagnosis forced me to confront my own mortality and make difficult decisions. I could choose to do nothing and hope for the best, but the odds were not in my favor. Alternatively, I could opt for regular screenings to catch any potential cancer early, or I could opt for a prophylactic surgery for the best possible protection.
For a long time, I avoided addressing the issue, even as more family members tested positive. It took me two years after my diagnosis to seek help from a genetic counselor, who referred me to a surgical oncologist. During my first meeting with the surgeon, she straightforwardly informed me that the safest course of action would be a double mastectomy before the age of 35. The short timeline and the idea of surgery shocked me. In the months following that appointment, I wrestled with the thought of losing my breasts and even considered that I would rather die than undergo the surgery.
However, when I had my son at 33 years old, the transformations my body went through during pregnancy and breastfeeding made the idea of further physical change seem less daunting. Above all, becoming a mother made it clear to me that staying alive was my top priority. By choosing to have the surgery, my risk of breast cancer would be reduced to less than 1%. In the surgeon’s career, she had never seen a case of breast cancer in any patient who had undergone the same surgery. After receiving another clear mammogram in April, I decided I no longer wanted to live under the constant threat of breast cancer and sought the opinion of a plastic surgeon.
The plastic surgeon didn’t immediately focus on my surgical options, but rather on how I was feeling. This allowed me to open up about the emotions I had been carrying for so long, such as fear, sadness, anxiety, and the anticipation of grieving and losing a part of myself post-surgery. The surgeon and his nurse practitioner addressed my emotional well-being before discussing my physical body or the surgical procedure. In a medical environment where appointments are often rushed and last no more than 15 minutes, this hour-long, unhurried conversation felt like a miracle, allowing for silence, tears, and questions.
When we did eventually discuss my surgical options, we explored whether I wanted to undergo breast reconstruction surgery or choose to go without implants, also known as going “flat.” I was surprised by the intensity of my emotions. While breasts are not necessary for womanhood, they play a significant role in how I understand and experience my gender identity. They signify beauty to me and hold a deep connection to my early motherhood experiences through breastfeeding. I couldn’t envision feeling truly comfortable and confident in my body without my breasts. Although I have always identified with the gender I was assigned at birth, I didn’t realize how attached I was to my gender identity until then. This made me realize that the term “gender-affirming care” encompassed my experience as a cisgender woman. Gender-affirming care typically refers to medical services that align with a person’s gender identity when it conflicts with their assigned gender at birth. However, cisgender individuals also benefit from medical interventions that affirm their gender identity, such as breast augmentations, hair transplants, and hormone treatments.
Implants do not reduce the risk of cancer and may even pose their own potential complications and infections. Yet breast reconstruction for cisgender women is considered a “medical necessity,” allowing insurance companies to cover a procedure that can cost tens of thousands of dollars. If the criteria for medical necessity were solely preventing illness and death, implants would not qualify. However, living is about more than just staying alive.
When my surgeries were submitted for pre-authorization, they were quickly approved without any conversations or justifications necessary. I never had to face the traumatic experience of denial. In contrast, transgender individuals seeking gender-affirming surgeries often encounter significant obstacles in accessing care. Some insurance companies acknowledge the proven health benefits of gender-affirming surgeries, but many do not. Even when coverage is provided, navigating through the red tape and potential denials can be overwhelming. Sometimes, additional validation from psychologists or other third parties is required to justify the care a transgender person seeks. All of this occurs amidst a hostile climate towards gender-affirming healthcare for transgender individuals. State legislators across the country are actively attacking individuals’ rights to make their own medical decisions, putting lives at risk due to fear, ignorance, and bigotry. Recently, the House of Representatives passed a military spending bill that explicitly denies gender-affirming surgeries to service members and their families. Additionally, Louisiana’s legislature voted to prohibit individuals under the age of 18 from receiving gender-affirming surgeries or medication.
These disparities in access to care can have severe consequences for the health of transgender individuals. Studies consistently show higher rates of depression, anxiety, and suicidality among trans individuals. Gender-affirming surgeries have been proven effective in improving health outcomes for those who receive them. The fact that my mastectomy and elective breast implants are praised as “brave” while trans individuals seeking gender-affirming care face skepticism, shame, and even criminalization is not just illogical, it is immoral.
Undergoing surgery is not something I am excited about. I am fearful of the pain and discomfort, and I mourn saying goodbye to a version of my body that has been cherished and loved. However, I am grateful to be a part of a community that will support me through this process. This support should be available to everyone.
When I informed my oncologist in April that I was ready to proceed after almost 10 years under her care, a huge smile came across her face. Confused, I asked her why she was so happy. She replied that she would no longer have to worry about me. She genuinely valued my life and was delighted to play a role in preserving it. Every patient, regardless of gender identity, should experience that level of care and concern.
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