(story submitted by Wendy Colbert, a Chestist)
I miss my nipples. Sure, there are benefits to being a 44-year-old nipple-free woman. I can wear skimpy tops now without a bra. No matter how cold the breeze is, my chest remains smooth and unstimulated. And of course, those pesky cancer cells that had nested just behind my right nipple are gone, along with all the tissue that made up my breasts.
I miss my breast tissue, and the sensation of my chest skin. I'm mostly numb now. But I miss my nipples the most. I wish I heard more women value and grieve their loss of sexual sensation after mastectomy and breast reconstruction, so that I would have had a better understanding before diving into the process myself.
Before breast cancer, I never thought much about my nipples. You could say I took them for granted.
Now, I wonder, where did my nipples end up? Were they chucked into some hospital waste dumpster, along with other spare parts – tumors, cysts, and cellulite? My nipples were special. Shouldn't they have been properly grieved for and more ceremoniously disposed of?
My nipples represented sensation, practicality, privacy and intimacy. I used my nipples to breastfeed my son 10 years ago. They played a significant role in my process of sexual arousal. Two of my most sensitive, private parts are now gone, relegated to a dumpster. My ease of arousal has been crippled, dulled. I liked that invisible, nervous system connection that linked my nipples with my crotch. That's been severed. The nerves have been cut, the tissue gutted, the nipples themselves jettisoned. One of my tools of arousal has been lost.
Not all women who undergo mastectomies have their nipples removed. Because my cancer was so close to the nipple, I wasn't comfortable risking keeping any tissue in that area. Even women who choose to keep their nipples following a mastectomy most likely will lose sensation. They also risk the nipples dying, becoming blackened and lifeless, necessitating another surgery to remove them.
My nipples will be replaced later – the last steps in the reconstruction process – with nubs gathered from my remaining breast tissue and circular pink tattoos that simulate areolas. Those steps are a few months down the road, after the expanders have done their job and saline implants take their place. Appearance-wise, I was sure the breast reconstruction results would exceed my expectations. I'd seen the anonymous before-and-after digital photos of other patients in my doctor's office. But the surgeon can't give back sensitivity of feeling in body parts I've opted to remove. I'd like to think that women's sexual arousal holds the same premium as that of men, but the replacement nipples will be purely cosmetic in nature – designed more to please my partner than myself.
My oncology surgeon had warned my husband and me when I told her of my choice to have a mastectomy: "You realize your sex life won't be the same. Other patients have told me they wish they would've known."
I nodded my head, thinking, sure, it'll change. I'll be numb. But the detailed reality of what she was telling me wouldn't fully hit until after I'd had the mastectomy. She was right. My sex life was more than satisfying after the surgery, but it was different.
In the weeks following the mastectomy, after eliminating the breast cancer, I felt a strong urge to affirm life, and sex was one way to express this. I felt self-conscious about my lack of breasts and nipples in the bedroom at first, and wore a sports bra with puffed cotton falsies until one night my husband said, "Can I take this off? I want to feel your skin." His hands gently explored my back and then the marred tabletop of my chest. Twin pink, horizontal scars crossed the centers where my breasts and nipples used to be. As we lay with my flat chest against his in the dark, tears formed in my eyes. The urgency of his kisses told me I was desirable because of who I was, not because of any body parts I possessed. A sense of confidence filled me, and with it my libido rose, as I realized I'd conquered the hardest part. If I could feel sexy without breasts and without nipples, I felt sure I could feel sexy throughout the reconstruction process. It felt liberating to have breast- and nipple-free sex – to shrug off men's or society's expectations for a woman's appearance, if only temporarily. It made my partner and I appreciate the rest of my body more. Gradually, I became comfortable with my appearance even with my clothes off.
Over the coming weeks, my husband and I adapted sexually to my changed body. We countered with more intense kissing, more fondling of my remaining parts, and as the reconstruction process progressed, eventually appreciating my partner's appreciation of my new parts. But I had a constant awareness of what was missing, what I used to have that could never be retrieved.
I found myself more focused on my husband's chest during sex than ever before. I would rub my fingers across his pec's and the valley between them, wanting him to feel a sensation I no longer could. I touched his nipples more than before, missing and compensating for the lack of my own. I longed to feel my own chest and made up for it by giving his chest extra attention.
When he touched my chest, I could sense it, but it didn't give me a pleasurable sensation. It was more like he was touching my elbow. When he grazed where my nipples used to be, I felt it at a deeper, almost muscular level rather than at skin level. I sometimes had to glance down to confirm the sensation. It was like wearing a heavy down parka even when you were naked. Strangely, I felt more womanly than ever – there was an excitement generated by the closeness that came from exposing my most vulnerable parts.
Removing my nipples was the right choice for me, because of the peace of mind and confidence it brings on a daily basis that the cancer can't return there because those parts are gone. I will have no more malignant cells behind my nipple.
As I move through the surgeries, I'm learning to welcome the little losses that are part of life. Losing my nipples is a reminder as sharp as a scalpel – wake up, start living, a small piece of you is gone, but the rest of you is still here.
(Wendy Staley Colbert's essay 'Choosing Mastectomy' is featured in Theo Pauline Nestor's anthology We Came to Say.)