When I was a little, I used to love puzzles. You could find me with pen in hand, sprawled out on my bedroom floor, nose buried deep in word searches or my Highlights magazine. I wanted to know how things worked. I loved building block sets and making up games with my older brother during summer vacations. Over the years, that curiosity eventually morphed into my current profession as a reconstructive surgeon. I like solving problems — finding an answer, thinking creatively. For me, this still is the perfect blend of art and science. There is something inexplicably beautiful about the human body, and its existence as the ultimate machine.

Yet since reconstructive surgery is a process, I often enter into a long-term relationship with my patients and hear an array of humorous, frustrating, emotional, and fascinating stories of varied experiences. Through these women, I am given a window of understanding of what it means to feel whole and complete. What I consistently see is that this personal sense of well-being is individually defined but vitally important.

When you are 28 years old, cancer is not a word you think of in reference to yourself. For most of us, the big “C” does not become a concern for many years to come. But there are some who are not so lucky. Karen discovered she had breast cancer two days before her 28th birthday, and just two weeks after she got engaged. At that age, the likelihood of breast cancer is low, very low.

Yet one day when she was getting dressed for work, she felt a lump in her right breast. She brought it to the attention of her doctor, and was immediately scheduled for a mammogram, an ultrasound, and ultimately a biopsy — all of which she managed to pull off on an extended lunch break. For her, actually having cancer still felt so remote — so impossible — that she almost forgot about it after the next day once she resumed her active schedule of work, friends, new fiance. But when her doctor called her a week later, her world dropped from below her feet.

• “Karen, so the biopsy shows you have cancer in the right breast. “
• “What?”
• “I’m sorry but you have breast cancer …”

Karen says those words are seared in her brain. At that point all she felt was numbness. She lost the ability to hear anything after “breast cancer” and it took her a while to comprehend, process, understand or feel anything afterwards. Her first thought was, “But I’m only 28 years old!”

With the support of her family, friends, and husband she was able to push herself forward to the surgery to remove her breast (mastectomy), chemotherapy, and then radiation treatment. Yet at the end, ten long months since her diagnosis, she in no way felt complete. In fact, it was quite the opposite.

Karen says she felt empty, drained, lopsided, and scarred — a disfigured and different version of the woman she used to be. She saw herself as physically and emotionally ravaged, like a battleground. Looking at herself in the mirror, the scar across her right breast was a constant reminder of her cancer — a Scarlett letter of a scarier time. She just wanted to be normal, to feel whole again. But what does that mean — to be whole?

Breast cancer showcases how our emotional and mental welfare is so intertwined with our physical well-being. For centuries, women have been defined and judged by their bodies. Breasts are a principal component of femininity. Subconsciously or deliberately, breasts shape a woman’s identity and form her sexuality. We are born with breasts. We do not get to choose our breast size, shape, fullness, or symmetry. Breast cancer, for its part, is a journey that one does not choose to take. For the first time in her life, a woman is asked whether or not she wants her breasts. In this way, breast cancer showcases how our emotional and mental welfare is so intertwined with our physical well-being.

My role in these women’s journey often begins under anxious, distressed circumstances, but ends in much a happier place. There are many options to be considered: remaining flat, undergoing reconstruction with implants, or using her own body tissue. And each has its own resonance. Karen, for her part, chose reconstruction with implants. Undergoing reconstruction after a mastectomy is an elective procedure, but to many women, the physical re-build is a vital part of their mental recovery, making it in fact not so “elective” but rather necessary. Women can finally feel they are over their breast cancer, able to get back to their lives, be with their partners, and no longer feel incomplete. Engaging with women once they’ve carved their new path is like talking to someone who has climbed to the top of a mountain and is able to see the world again, to feel something beautiful — to be alive and liberated.

It’s times like these when I feel especially fortunate for my role in the wholeness puzzle. Just as every woman’s breasts are different, so is every woman’s choice. I have discovered the process and meaning behind wholeness has a broad and very personal interpretation. Simone de Beauvoir once said, “one is not born a woman, but becomes one.” This journey, like few others, reminds me how right she was.

Melissa Poh is a plastic and reconstructive surgeon.  This article originally appeared in the Ritual Journal.

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