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Totally Radical, Dude

AlyssaCotlerby Alyssa Cotler, Living with Cancer.

Save the ta-tas.

Save 2nd base.

No bra day.

Have you noticed how the messaging around breast cancer awareness is centered on, well… breasts? Of course you have.


But you don’t see messages like “Save the Prostates!”


I suppose it’s not surprising since so much about what defines a woman and makes her feminine is how she looks, with particular emphasis below her neck.


And as much as I always prided myself on being above such superficiality, the idea of choosing to remove my breasts seemed radical.


My breast cancer diagnosis wasn’t a shock. In fact, I’m surprised it didn’t happen earlier. My mom died of breast cancer when she was 40. Since I was 19, and felt my first lump, I knew it was a matter of time. I had many more scares along the way. One of the scariest was when I was in my mid-twenties, and as I waited for the phone to ring with my biopsy results, I imagined what it would be like to lose my breasts. I wondered if my new husband would still find me attractive. Then the call came that the suspicious mass was nothing more than a benign fibroadenoma and I put my worries aside for the moment.


A few years later, another biopsy showed no cancer but did show atypical hyperplasia, raising my risk even higher. Now, I was less worried about my vanity and more concerned about the children I hoped to have one day. Weren’t breasts somehow integral to childbearing? How could I breastfeed them without breasts?


More years passed. I gave birth to (and nursed) two crazy little girls. Once the younger graduated from breastfeeding, I sought genetic testing for the BRCA mutations. I was negative. I was still considered high risk, but the negative test justified my continued decision to hold on to my breasts. I started taking tamoxifen as a prevention. For the first time in 24 years, I thought that perhaps breast cancer wasn’t my destiny. I was finally doing something proactive… but not radical.


Eighteen short months after starting tamoxifen, the cancer was found. Needless to say, I was pissed. But in a very strange way, I was also relieved. The other shoe had finally dropped and now I could deal with it. The first decision I made, even before getting all the histology, was that I would have a bilateral mastectomy with immediate reconstruction. Notice how I automatically included reconstruction into that treatment decision. Living without breasts, even fake ones, still seemed too radical to me.


I chose my plastic surgeon in part because he and my breast surgeon had a lot of experience working well together. As the breast surgeon completed her work, he was able to come behind her and place tissue expanders. I was lucky (can someone with cancer be lucky?) that the cancer was far enough away from my nipple that I was a candidate for nipple-sparing surgery.


The expanders were the worst part. I remember waking my husband the first night I was home and telling him, “I have to get up to pee, but it seems there’s an elephant on my chest.” No lie, those damn things under my pectoral muscles could be used as some kind of enhanced interrogation devices. It took several days, many opiates, and some gentle yoga, to start feeling sort of okay. Having the expanders filled every couple of weeks would set me back a couple of days, but again, yoga helped so much. Living with them was akin to having small bowling balls in my chest. There was no give, so forget about sleeping on my stomach or even wearing a tight sports bra. After 2 ½ months, I was able to exchange those puppies for silicone implants, and the relief was immediate. Now, 6 months later, I’m looking forward to having fat transfer done to round out and make them look a little more natural (plus the added benefit of belly liposuction where they will harvest the fat).


Now, I look down at my reconstructed breasts, and they look so similar to what was there before. I mean, they’re perkier. But since I was able to have a nipple-sparing procedure, and the scars are on the underside and out of my line of sight, it’s really no big visual change.


And now I feel a little silly for thinking this would be such a radical procedure. I try not to second guess decisions made in the past, but I do wish I had included the idea of prophylactic mastectomy as a real option to reduce my risk of developing cancer.


At the moment, I’m waiting for test results to learn if I am positive for a genetic mutation (CHEK2, to be exact) which could explain my family and personal history. One of my great fears is that my daughters also will be genetically disposed. With that in mind, I’m doing my best to normalize my mastectomy and reconstruction. The recovery was truly hell, but in hindsight, there’s no comparison to the anxiety of living at risk and now living with the fear of recurrence.


I don’t hide my reconstructed breasts from my girls. They were very curious to see the scars immediately after surgery, so I showed them with no hesitation or modesty. If they walk into my bedroom while I’m getting dressed, they get to see the whole shebang. I took them bathing suit shopping recently, and purchased a skimpy little number from which my scars peak from the sides. It’s me. It’s who I am, and how I’ve chosen to look. I’m no less that same person than when breast tissue resided where I now have silicone implants.  There’s nothing radical about it.



I am a health communicator, wife, and mother of two girls. I was diagnosed with early-stage invasive lobular cancer in June 2015 at the age of 43. Thirty years earlier, I lost my mother to breast cancer (long before it was acceptable to even say “breast”). I’ve been a vocal breast cancer advocate ever since. Stop by my blog at or visit me on twitter at @AlyssaJoy71.


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