Author: Adela Briansó
In the Global North, breast cancer is often spoken about with a single narrative of loss, heroism and hope. In 1980, Audre Lorde argued against narrowing the disease to a single account. Through ‘pinkification’ with pink ribbons, corporations have ‘branded’ breast cancer in a similar way to shampoo and beauty products, a homogenisation that overlooks the complexity of the illness experience. This article is based on the author’s own ethnographic research, carried out in Spain in July 2016. My informants were twenty white women born and raised in Spain who had had breast cancer. While I believe that gender is a spectrum beyond the man/woman binary, I have used the term ‘women’ here for language simplicity. However, it is important to acknowledge that breast cancer can affect all, regardless of their gender identity.
In Spain, breast treatment is fully covered by the public health system. So is reconstruction, including the nipple and areola, an option that is often considered part of oncological treament. While this is undoubtedly a privilege, it also presents the risk of perpetuating normative ideas of female beauty. Reconstruction is a choice, yet, doctors often assume that having two reconstructed, symmetric breasts is their patients’ desired outcome. This illustrates to what extent constructs about ‘womanhood’ are normalised and reinforced by the health system.
Lucia had one breast removed due to breast cancer. Tired of hospital beds after a lengthy treatment, she took some time to make a decision regarding reconstruction. “My doctor insisted that I should do it, and he kept saying: ‘think about it, I’m sure you’ll end up doing it’. A couple of months later I came to his office and told him I wanted reconstruction, and he seemed very pleased with my decision”. While the insistence of some doctors does not necessarily disempower women, it does play a role in shaping their decision.
Based on Alicia Tinoco-Garcia’s work on cancer in Mexico, I suggest that the decision to undergo reconstruction relies on three pillars: the self, the body and the others, each category entangled with the rest. First, the self, as women look forward to returning to ‘normality’, ‘to being the same again’.
Second, the relationship to the body, as surgery acts as a tool to restore self-image, symmetry and health. Although overwhelmingly determined by aesthetic concerns, reconstruction can sometimes be a health-informed choice, in order to re-balance the weight of the body and prevent back conditions that could lead to chronic pain.
Third, reconstruction is undergone in order to comply to the expectations of others. Maria, who had a double mastectomy and uses external prosthesis, said: “No one comes in my room before knocking now. But it is not about me, it’s to avoid my family suffering. The absence of breasts doesn’t bother me. I just don’t want my family to suffer”.
So, is reconstruction really a choice, considering the complex structures of gender, medicalisation and politics that take part in the process? In breast cancer reconstruction, just like in any other aspect of life, women’s physical appearance is carefully scrutinised and shaped by other actors, whether in the form of silicon implants or public health policy.
Another way of problematising medicalisation is acknowledging that reconstruction is primarily aesthetic. According to Ana Porroche-Escudero and Begoña Arrieta, reconstructed breasts and prostheses fail to restore the ability to perceive sensations: to feel heat, cold, desire. Importantly, this takes place in a patriarchal contexts that undermines female sexuality. While explaining reconstruction, a doctor told Carla bluntly: “Forget about the sensitivity in your nipples and all that”.
Contesting the medicalisation of the body is particularly relevant for global health professionals. In breast cancer, the medicalisation of women’s bodies legitimises surgery and silicon. A way to problematise breast reconstruction is understanding it as a perpetuation of women’s duty to comply to normative beauty at all times. “I have a reconstructed breast, a silicon implant. It looks natural, even if it isn’t natural at all, but it seems like in the head… it works”, said Carla, half astonished, half convinced.
Examining complex structures of gender, medicalisation and politics is crucial to understand breast cancer reconstruction in a patriarchal context. A gender perspective in global health that actively deconstructs the notions of ‘normality’ and ‘womanhood’ would allow for a person-centered, intersectional and feminist approach to illness.
Suggested further reading in English:
Ferguson, Sia (2014) 4 Ways Breast Cancer Awareness Campaigns Can Be Sexist and Oppressive
Hallowell, N. (2000) “Reconstructing the body or reconstructing the woman? Problems of prophylactic mastectomy for hereditary breast cancer risk” in Potts, L. (ed.) Ideologies of breast cancer: Feminist perspectives, Macmillan: St. Martin’s Press, pp.153-180
Manderson, L. and Stirling, L. (2007) ‘The absent breast: Speaking of the Mastectomied body’, Feminism & Psychology, 17(1), pp. 75–92
Porroche‐Escudero, A. (2014). The ‘invisible scars’ of breast cancer treatments (Respond to this article at http://www. therai. org. uk/at/debate). Anthropology Today, 30(3), 18-21.
Porroche-Escudero, A. (2014, November). Perilous equations? Empowerment and the pedagogy of fear in breast cancer awareness campaigns. In Women’s Studies International Forum (Vol. 47, pp. 77-92). Pergamon.