Others admitted their bias leaning in the other direction, noting complications and mixed results of reconstruction surgery, or mentioning fashion alternatives – "flowing tops or layered tops on top of one another ... interesting scarves and fashionable shawls" that de-emphasize the shape of breasts for women who require mastectomy but choose not to have reconstruction or to use prostheses.
Wanting to further explore the issue of breasts, sexuality, and breast cancer, I spoke with a beautiful young cancer survivor who expressed her tremendous gratitude to an ob.gyn. who openly and in a matter-of-fact way discussed her breasts, sexual relationship, and yes, sexual function in a way her oncologists never had, since she had felt caught unprepared for the catastrophic hit that her sexual relationship, as well as her body, had taken during her cancer battle.
I spoke to another survivor – this one middle-aged – who was stunned into silence when a physician casually noted that she needn’t worry about ever replacing the breast implants she would receive during reconstruction, as is periodically necessary. When that day came she would be in her 70s, he mused, and the implants would simply be removed, since she "wouldn’t be needing" her breasts anymore.
It was against this backdrop that I read the study "Pink Ribbon Pin-Ups: photographing femininity after breast cancer" in the journal Culture, Health & Sexuality (2012;14:753-66).
Author Kaitlyn Regehr described her controversial project, which raised money for the Canadian Breast Cancer Foundation, as a reaction to gallery portraits and coffee table books depicting "haunting" visages of women’s scarred, postmastectomy chests, bald heads, and gauntly disfigured bodies.
A self-described "burlesque expert and television personality," Ms. Regehr recalls her encounter with a breast cancer survivor who had been asked to participate in a "rather provocative photo shoot in which she would be photographed without her wig."
The woman, she said, mentioned feeling like a "victim on display," leading Ms. Regehr to contemplate that "voyeurs of ... cancer" objectify women in a manner no less objectionable than the male-centered cheesecake photography and pin-up photography popularized from 1915 through World War II.
Today’s version of pin-up art is created according to the healthy whims and fantasies of women themselves "for the purposes of personal empowerment and sexual exploration," according to Ms. Regehr.
She invited survivors to apply to be calendar models and set about creating the first in a series of "Pink Ribbon Pin-Ups" in which women would choose how they would be seen, sexually, post-cancer.
Among the first 14 participants, none chose to highlight the scars of their cancer by posing without a wig or prosthetic breasts. Some said frankly that that they had decided to participate as a gift to a significant other, or as a means of reclaiming sexual self-confidence. One young woman described her marriage post-cancer as "predominantly nonsexual" and said she wanted to give her husband the pin-up photo for Christmas. Another survivor, dying of her cancer, was thrilled by the idea that she would be "Miss March" – her husband’s birthday month.
Were the images self-objectifying, or "subscribing to the feminine ideal as defined by the male gaze"? Ms. Regehr asks.
Later in the article she provides her own answer, drawn from the definition of individualized sexual empowerment: "Each woman has the right, and should have the opportunities, to explore and express her post-cancer body."
I’ve encountered women whose empowerment came from saying "no" to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.
In other words, it’s complicated.
And we’ll never understand how it is for a particular woman until we frankly discuss breasts in the context of breast cancer – not just how they appear, clothed or unclothed, but what meaning they hold for her sexuality and sense of self.
Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist. Visit the Views section at www.oncologyreport.com to see what is new in Vitality Signs.