by Sarah Sutro and Judith Cohen
Sarah Sutro is an artist and writer whose work has been shown and collected in the U.S. and internationally. Judith Cohen is a writer with numerous publications and a college professor who teaches in an adult education program. They are close friends; both had been diagnosed with breast cancer.
A longer version of this article appeared in The Intima-A Journal of Narrative Medicine, Fall, 2014 (Columbia University Narrative Medicine Program).
We are two friends, an artist and a writer, both who have recovered from breast cancer, who remain fit and healthy as we enter our seventh decade. Meeting over thirty years ago at an artist’s colony, neither thought about breast cancer as we hiked, talked and became close friends. Sarah, whose artist books reside in the Museum of Modern Art and Art Institute of Chicago libraries, as well as many other collections, had recently married, and was deeply involved in her art work. Judith was divorced and single then; her first novel (Seasons, 1984) had just been published. We have talked about our breast cancer experiences and treatment choices over the years, concluding that age affected how we felt about our bodies and self-image and hence our decisions about reconstruction.
Sarah’s Story
Sarah’s diagnosis of cancer, in 1998, showed a tumor confined to her breast with no lymph node involvement, thus early stage. After a lumpectomy, the margins surrounding the removed tissue showed extensive ‘in situ’ (Latin for “in place”) cells. Though classified as a non-invasive cancer (i.e., one that does not grow into normal tissues within or beyond the breast), she was advised to have a mastectomy, with the possibility of breast reconstruction.
At age 47, reconstruction felt like a positive new opportunity. She felt like she had her life ahead of her. She wanted to feel and appear as normal as possible, and to have an active life. Yet, having a major surgery was still a really difficult decision. Finally, after a friend showed Sarah her mastectomy scar, a gesture that was meant to be reassuring, she decided to have the reconstruction. The more she thought about mastectomy, the more she dreaded seeing a scarred chest for the rest of her life and feeling a loss of symmetry and balance in her body. Since many younger women were treated at this cancer center, Sarah felt confident about the outcome of her plastic surgery.
The type of reconstructive surgery used at that time was called a TRAM (Transverse Rectus Abdominis Myocutaneous) flap. In this procedure, which is no longer recommended or performed at many major cancer centers, muscle is drawn up from the abdomen 
beneath the skin to fill the breast cavity. Slender and lithe, for Sarah it wasn’t an issue of wanting to get a “tummy tuck” to get rid of belly fat at the same time as her breast surgery. She agonized about the decision for about a month after her initial lumpectomy, finally settling in on the TRAM flap. When she was in recovery after the surgery, Sarah remembers that her surgeon’s 8-month pregnant belly pushing against the bed seemed like a sign of reassurance, that her own choice for reconstruction was one of hope, a positive expression of the future to come.
“Raintree Series #11,” 2006, natural color on paper, 31”x21”. Natural color paintings reflect the wet, tropical environment of South Asia, its organic growth, movement and change, where Sarah lived for several years.
Right after the surgery Sarah’s chest wall felt like “wood,” but after six months her body felt marvelously healthy and new. Mammogram technicians told her reconstruction looked natural. Curiously, the surgery was much less painful and disruptive than the CMF (Cyclophosphamide, Methotrexate, and Fluorouracil) chemotherapy that came later, a six month regime of pills and infusions that dragged on and on. Since the tumor was the infiltrating kind, and she was pre-menopausal, she had the most aggressive treatment. Sarah’s only regret about the surgery was that the scarring of her stomach muscles compromised her yoga practice: she had to do yoga on her own, at her own pace, and no longer in led classes.
Sarah later wrote a book about her experiences in Asia as an artist discovering natural colors, and touching on her experience recovering from cancer (COLORS Passages through Art, Asia and Nature, 2011).
“Palm Lines,” 2007, watercolor, 8”x11”. The growth outside Sarah’s windows in Thailand, huge palms, tropic weather and lush nature, inspired exuberant paintings as well as more minimal abstraction. Nearly ten years out from the experience of illness and treatment, life was good and to be lived.
Judith’s Story
Whereas Sarah felt youthful and wanted her body to reflect this after she was diagnosed with breast cancer, Judith was diagnosed with the disease later in life. Based on her family history of breast cancer, she considered having both breasts removed but decided against this when the results of genetic testing proved negative for BRCA mutations. Judith also could have chosen lumpectomy, with more surgery if needed, but she knew immediately that her preference was for the single mastectomy. “At that point in my life, I didn’t need my breast to feel whole. I was 63 and my husband was very supportive.” In other words, Judith believed that her self-image eclipsed others’ perceptions of her body. As a feminist, she was also wary of the plastic surgery industry, breast enhancement and reconstruction. “Keeping the breast,” she said, “gets far more attention than the cancer itself.”
Despite her initial preferences, the decision making process wasn’t easy. Judith talked to three other women who had had reconstructive surgeries, including one with compromised muscles, another who found it more painful than any of her other cancer treatments, and a third for whom the reconstruction failed. At the suggestion of her doctor she agreed to a consultation with a plastic surgeon, but she cancelled the appointment. One of her stiff-lipped New England students, whose mother had breast cancer, made an offhand remark that still resonates: “I think you should wear your scars proudly,” she said. Some mastectomy patients have artistic tattoos drawn on their bare chests. Judith chose a single mastectomy but opted out of the tattoos. Still wanting a way to gain acceptance of her new, different body, Judith instead took pictures of herself before and after surgery.
Judith holds a mask over the breast that will be removed, anticipating its absence.
Though Judith normally didn’t make visual art, she created a collage using pictures from different parts of her life, including pre- and post-surgery images. It continues to hang in her study.
Not only did Judith question the fetishizing of the reconstructed breast and the pink adornments that seem to accompany them, she was tired of all the books with affirmations about breast cancer being such a good thing. She came up with her own proposal. Reminiscent of Jonathan Swift’s ironic solution to the “Irish problem” (his dead pan argument that all Irish children should be roasted or boiled to increase the food supply), she said: “If ALL postmenopausal women elected to have their breasts removed and it became as routine as getting a tonsillectomy or an appendectomy, wouldn’t the breast cancer death rate decline dramatically?”
Judith’s rebellious questioning of common assumptions remains intact. Despite years spent dreading breast cancer, her most powerful post-cancer realization is that millions of women face this disease, many emerging to have rich and interesting lives. She hopes we come to see breast cancer as a collective problem, like global warming. “It’s a steep bump in the road, one deep enough to cause damage, but not a wall. For women with productive work and decent lives, having cancer need not push them off course.”
Since Judith was diagnosed years after Sarah, she was grateful for her friend’s support. Today they spend more time discussing art than they do cancer, but they are each helpful to the many friends and acquaintances who have also gotten a breast cancer diagnosis.
“Demystifying Breast Cancer” is formatted as a PDF for you to print easily and share. Click here to download.
