Forget ‘crowd-pleasing’ breasts – for more joy, focus on feeling: a surgeon’s view
A doctor contemplates what is, she believes, the most exploited – and serially underestimated – female body part of all.
By Gabriel Weston
With surgical enhancement to breasts – a powerful erogenous zone – “a woman may gain the power to elicit male desire, but in so doing she relegates herself to the erotic sidelines.”Credit: Sonja Lekovic / Stocksy United
Much is made of the common ground between surgeons and artists. But, while any portraitist’s gift resides in their ability to engage profoundly with a subject’s identity, this humane concern is still sadly lacking in many of our operating theatres.
For the archetypal surgeon-villain, one need look no further than Ian Paterson, who must have started his training around the same time as I did and, in 2017, received a 20-year jail sentence for performing unnecessary breast surgery on hundreds of women. But the small-town examples chill me, too, the ones whose failings go under the radar so that they are able to keep working. The most cack-handed, insensitive and dangerous surgeon I ever trained under was a breast surgeon. Sure, he was motivated to save lives, but he lacked even the most cursory regard for a woman’s feelings.
I assisted in many of his mastectomies. I won’t forget his habit of lobbing the breast he’d just sliced off across the operating table and into a kidney dish, like a baller shooting a basket. Nor how it felt to go with him afterwards to see a patient on the ward, the curtain bulging with all of us gathered round the bed, the rosiness of this consultant’s triumph, the second smile of his mask-line still bisecting his handsome jowls, the tremulousness of whichever woman it happened to be that day, sitting in bed as he stood, looking up at him like a girl, flat-chested beneath her bandages, trying to meet her saviour in gratitude, no place to acknowledge that though he had given her something, he had taken something too and it wasn’t just any lump of tissue, not the same as a stretch of bowel or a bit of spleen.
People say they’re happy to forsake bedside manner for a surgeon with great hands. But we shouldn’t set our sights so low. Everyone knows about the rocky history of cosmetic breast surgery, the earliest attempts often resulting in death, and modern implants beset with complications, leakage of carcinogens, scarring and rupture to name but a few. But there is a bigger truth. Problems will occur in any operating theatre where the person in charge doesn’t give a shit about the individual lying on the table. And one of the commonest casualties of cavalier surgery is damage to a patient’s nerve supply.
Breasts are a powerful erogenous zone. Their skin is served by anterior and cutaneous branches of the fourth to sixth intercostal nerves, the former doing most of the saucy work. I like to imagine it literally humming with sensory information. The areola is the most sensitive part and those of us who have small breasts are thought to get the most sexual pleasure from them. What a compensation prize! Curvy women might have the most crowd-pleasing breasts, but not the hottest ones. A functional MRI study done by the American psychologist Barry Komisaruk in 2011 showed that the three separate areas of the parietal cortex that light up when a woman’s genitals are stimulated also flash when her breasts are touched. I don’t just hate boob jobs because they’re dangerous and foolish. I object to the fact that they put sexiness, appearance and performance in front of sexuality, sensation and experience. With surgical breast enhancement, a woman may gain the power to elicit male desire, but in so doing she relegates herself to the erotic sidelines.
Our breasts are treated like public property. Let’s stop colluding in the obsession with how these organs look and start to focus on how they really feel.
But it’s not all doom and gloom. At the Royal Marsden Hospital, Sutton, in a gleaming operating theatre, two young women consultants stand side by side at the table. They are part of the clinical army who treat the one in eight women in the UK who develops breast cancer, though what’s happening in this room isn’t the regular cut and thrust. Two weeks ago, using a needle, they planted a tiny magnetic seed in the centre of their patient’s tumour. They want what cancer surgeons have always wanted, to cut out disease. But these women are focused on something else besides, the person who surrounds the tumour. They are determined to preserve as much of her normal breast as possible.
The gowned women wait, gloved hands crossed over their chest. The patient is wheeled in. One steps forwards silently and applies her probe to the woman lying beneath her, to her breast, watches the red digital numbers on her monitor, listens out for the tone whose frequency rises as she gets nearer to the epicentre of the tumour. She follows her signal with the blade, dissecting down with virtually no loss of blood to where the cancer is, cutting around it, lifting it out, smaller than a plum. The breast is still itself, a small incision in the side, barely any fullness lost, no noticeable change in its contour. The person with breast cancer never seemed to matter when I was training, but they do now. The surgeon works quietly and without bravura. Her hands are quick and neat.
But it’s not just these young heroines with a job to do. Getting the breast out of the anatomical doldrums will take more than surgery, plus me banging my drum. It’s time to challenge the fact that – regardless of whether we’re being ogled, or disapproved of – our breasts are treated like public property. Let’s stop colluding in the obsession with how these organs look, and start to focus more on, and maybe even celebrate, how they really feel.
Girlhood. I don’t need science to tell me my breasts are linked to my genitals. All summer, a boy’s hands come to rest there in the sunlight. Through my closed eyes, it’s orange in the sun and wind, and there is no fear in me at all and nothing I want more than his hands on this part of me. We should announce the breast as the emblem of our own pleasure. We should be teaching our girls in school that their desire matters too and the breasts offer a simple route to sexual joy that won’t harm them.
Early motherhood. I am a new milk-cow, encased in a scaffolding bra. Cabbage wilts on my scorching chest. My baby does nothing but cry to be fed, then feeds and vomits, before the whole cycle starts again. It is always night-time with no one else around. Then again: I arrive from a gum-tree Australian summer into snowy Heathrow, alone with my baby. Home is cold so we go straight to bed. Over the edge of the podgy duvet, the room is blue-quiet, the window framing a three-dimensional puzzle of snow. She feeds quietly, her hand like a star against my heart and I know I won’t forget this happiness as long as I live.
Older motherhood. Wise as a fox, I am wheeled down the corridor to the ward, while a nurse on either side of me crams a twin’s tiny face into each breast. Their little mouths bang against me comically, but I am not a bit concerned because I am too happy that they have been born safely and are well. Later, my nipples will bleed and my toes curl, but it is excellent to be an old mother. I know that, though I am starting again, it will all be over soon enough. Fireworks crackle in the November sky and I hold my last two babies close. It is a beginning and an end.
Now. The children are noisy in the garden, but they are far enough away, and it is quiet up here. I take my top off and unclip my bra. I place my clothes on top of the toilet and stand head-on in front of the mirror. My heyday is over, these breasts have no more amazing and feeding to do, but they still matter to me. I inspect them one by one, the nipples and areolae then the rest, raising my arms up and putting them down again to check for skin puckering. I step into the bath, lower myself holding onto the sides, lean back and watch the shiny heat encase my goose-bumped bareness. Pressing my spine into the bottom of the bath to get my chest under the surface, I begin with my left breast. Soft as marshmallow in the water, I start to feel it with my right hand, just as I was taught. Three fingers together, starting at the nipple and exploring the flesh in circles, ever wider and firmer. Trying to find anything odd, heart ready at any moment to thump in underwater alarm. There isn’t much ground to cover and I finish by putting my left arm down, making a warm wet hollow of my armpit which I push my fingers into, searching for lymph nodes, before moving to the other side of my body.
Then I am done and there is still time. I let in more hot water from the tap and lie back, pondering the strange, unbridgeable gap that exists between the body science describes and the one each of us is living inside right this moment. I look along the length of my body in the steam. Feet and legs and pubes and stomach and breasts. I’m middle-aged but still happy naked. I press down into the warmth and, feeling the water close above me, I settle into the absolute silence of myself.
This is an edited extract from Alive: An Alternative Anatomy, by Gabriel Weston (Penguin Random House; $37).
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