At 25, I discovered that my breasts could be a ticking time bomb.
A member of my family tested positive for the BRCA1 genetic mutation, which is associated with an increased risk of breast cancer. He alerted all the women in our family to get tested at the earliest. I got tested and a month later got the confirmation: I was also positive, meaning I had a 72% chance of developing breast cancer at some point in my life. Lifelong,
Until then, I still thought only of sickness and death Other Had to deal with people. I was young and fortunately healthy. The BRCA1 diagnosis pushed my mortality to the present and meant painful decisions had to be made.
I could choose to do nothing and hope for the best, but the circumstances were clearly against me. I may choose to have more frequent mammograms, sonograms, and breast MRIs to try to catch cancer early if it emerges. But for the best possible protection, I would have to have prophylactic surgery.
For a long time, I could not bring myself to do anything. Even when more family members were tested and found out they were carriers, I avoided the topic at family gatherings. It wasn’t until two years after my diagnosis that I felt strong enough to reach out to a genetic counselor, who referred me to a surgical oncologist.
Within minutes of my first meeting with the surgeon, he told me matter-of-factly that the safest course of action would be to have a double mastectomy, ideally by age 35. I was stunned by the short timeline, and everyone inside me rejected the idea of surgery. In the first months after that appointment, I remember thinking more than once that I’d rather die than lose my breasts.
But at 33, I welcomed my son into the world, and I found that the changes of pregnancy and breastfeeding made the prospect of further physical changes less daunting. Above all, being a mother made survival a clear priority. By choosing to have surgery, I will reduce my risk of breast cancer to less than 1%. In my career as a surgical oncologist, he had never seen a single case of breast cancer in any of the hundreds of patients he had performed the same surgery on.
After another clear mammogram in April, I decided I didn’t want to continue living under the threat of breast cancer and consulted a plastic surgeon.
The first thing the plastic surgeon asked me wasn’t, “What do you want to do?” It was, “How are you feeling?”
He opened the door for me to talk about everything I’d been thinking about for a long time: fear, sadness, anxiety, and the anticipation of grief and loss after surgery. She and her nurse practitioner addressed my feelings before saying anything about my body or how they might work on it. In an era of tedious 15-minute therapy encounters, that unnecessary hour-long conversation—with time left open for silence, tears, and questions—felt like a small miracle.
When the conversation turned to my surgical options, we discussed whether I wanted to opt for breast reconstruction surgery, or forgo implants and “go flat,” as they call it. I was surprised to find how intensely I felt.
Breasts are not necessary to be a woman, but My Breasts are an integral part of how I understand and experience my gender identity. I associated them not only with beauty, but they were the most tangible expression of my early motherhood, as I connected with my son through breastfeeding. I couldn’t even imagine feeling really comfortable and confident in my body without them.
I’ve been fortunate to have always felt at home in the gender I was assigned at birth, but I had no idea how deeply attached I was to my gender identity, and how uncomfortable I would feel if my body didn’t align with my perception of that identity. That’s how I realized that the term “gender-affirming care” applies to me as a cis woman.
Gender-affirming care generally refers to health care services that confirm a person’s gender identity when it conflicts with the sex they were assigned at birth. But cis people also routinely benefit from medical intervention to affirm their gender identity.
America alone tops the number of annual breast augmentations 300,000, And it’s just one of countless aesthetic surgeries and procedures designed to help cis women enhance or create “femininity” qualities. Some cis men get hair transplants, take steroids to help them become more muscular, or take Viagra to maintain their “masculine” virility. Trans people are not alone in seeking their gender-affirming medical care, but they also Are They are treated differently when it comes to receiving it.
Implants do nothing to reduce the risk of cancer, and actually carry potential dangers of their own in the form of infection and other complications. Yet breast reconstruction is considered a “medical necessity” for cis women, allowing insurance companies to cover the procedure for thousands of dollars. If the litmus test of medical necessity was simply the prevention of disease and death, then transplants would not be eligible. But of course, living doesn’t just mean dying.
When my surgeries were submitted for pre-authorization, they were successful. Acceptance letters were simply delivered to my doorstep – I never had a conversation where I was expected to justify my decision, and I certainly never faced the shock of being denied.
Trans people seeking gender-affirming surgery may face significant institutional barriers to access care. Some insurance companies have explicitly accepted this Science This reflects the health benefits of gender-affirmation surgery, but not all. Even when insurers explicitly cover gender-affirming care, there can be Byzantine red tape or rebuttal against which an appeal has to be made. Sometimes third parties such as psychologists have to verify that a trans person is of sound mind and should be given the care they seek.
All of this is happening under a cloud of opposition to gender-affirming health care for trans Americans. nationwide, statewide Legislators Actively stripping people of their right to make their own medical decisions, putting lives at risk because of their own fear, ignorance and bigotry. At the federal level, the House of Representatives recently passed a military spending bill that explicitly included provisions Deny gender-affirmation to service members and their families surgeryS, just last week, Louisiana’s legislature voted Prohibiting anyone under the age of 18 from receiving gender-affirming surgery, puberty-blocking drugs, or hormone treatments.
These disparities can have profound effects on the health of trans people. Research consistently shows that trans people have higher rates of depression, anxiety, and suicide, and gender-affirming surgery suggests remarkable success Improving health outcomes for those who receive them. The notion that my mastectomy and elective breast implants are lauded as “brave,” while trans people seeking gender-affirming care are questioned, shamed, and even criminalized is not only illogical, but unethical.
I am not happy about having surgery. I dread the pain and discomfort, and I’m sad to say goodbye to the version of my body I’ve grown to love and love. But I know that my community will be there for me and help me get through this, something that should be true for everyone.
In April, when I told my oncologist I was ready to move on after nearly 10 years in her care, she beamed with a big, beaming smile. A little confused, I asked her what made her so happy.
“Now I don’t have to worry about you!” He replied. She really valued my life and was happy that she would have a role to play in preserving it. All patients of all gender identities deserve to know what it feels like.
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