Can you get your groove back after a mastectomy?

You step down from the hospital bed, glad to be alive and – as the doctors have confirmed – in good health. After a week of tests, treatments, surgery and observation, you are now ready to go home.

It is only as you drop the hospital gown and reach for your bra that you freeze. What was that they said about how to get dressed again?

Then it hits you: The mastectomy you have just had has taken off a breast.

While you are grateful to be well, you are reckoning with all the things you may have to live without; no more v-neck tees, no more deep, plunging evening gowns, no more sexy bikinis, no more dates, no more intimacy.

But really, does the removal of one or both breasts after cancer mean that life is over? This is a poignant question in Kenya, given that statistics from the Kenya Cancer Association indicate that younger women, in their late 20s and 30s, are more at risk of contracting the disease compared to the Western world where women in their 50s and 60s are more likely to suffer.

'MY BODY WAS LOPSIDED'

Katheke Mbithi came head to head with this question in 2005 when she had a mastectomy at the age of 34. “It hit me when I got home. My body was lopsided, I couldn’t wear a bra.

I had given birth the same year and was on chemotherapy, and I couldn’t breastfeed. That first year was very traumatising. I couldn’t wear many of my regular clothes and was just trying to adjust to this different thing."

Catherine Ngaracu-Mutua, a mother of one, felt the same. “It is a life-changing process. Having the mastectomy makes you feel totally different. I remember going into hospital with two breasts and coming out with one. And then you get home and start wondering how you are going to be dressing and things like that. I even remember not wanting to show my husband the scar but he insisted so that he could come to terms with it in his own way.”

The horror of the ramifications a mastectomy would have on her life also hit Lucky Ndanu when diagnosed in 2008 while only 22 years of age.

“It was the worst thing that I could ever have thought of. After the operation, I woke up to a body that had only one breast; it was not the best of sights. That’s when it hit me that this would be me for the rest of my life.”

David Makumi, vice chairman of the Kenya Cancer Association, has been managing cancer programmes in East Africa for the past 10 years and has seen women struggle through this issue.

“Self-image is a big issue because our women get breast cancer early, in their 30s and 40s, at prime of their (life). The operation has its own psychological impact on them. I know patients who take a long time before they can be able to look at themselves in the mirror.”

NO LONGER ATTRACTIVE

The fear of being no longer attractive, and even being odd, is not just a part of the vivid imagination of a breast cancer survivor.

Some of the awkwardness is inflicted from outside. “I hear women asking how to stop their colleagues from peeping at them,” says Makumi. “We, as a society, have not fully made peace with it. We are not supportive of women who have had their breasts removed. (But) a woman is not just her breasts; the woman is in the woman, the very being.”

Shilabukha Khamati, an anthropology lecturer at the University of Nairobi, puts the question of women’s breasts and femininity into context.

“The body is not just a physical and biological organism; it’s also a political, social and symbolic thing. In traditional African cultures, women’s breasts didn’t have the sexual, erotic association that they have today.

Then they symbolised nurturing, fertility and the continuing of the community.”

It is a fact that contemporary Kenyan culture views breasts as sexual symbols of sorts, if the excitement at the breast enlargement surgeries done by popular entertainers in the country is anything to go by.

So how does a woman get her feminine groove back if she has lost a breast? Katheke Mbithi says, “I thought about getting reconstructive surgery but then decided to stick to wearing a prosthetic.

The good thing about prosthetics is that no one can notice the difference. Sure, it has its drawbacks, like you can’t wear certain evening dresses and strapless tops, but I think these are just physical features. It has worked… and it has been nine years.”

Catherine Ngaracu-Mutua is, right now, the picture of feminine elegance, in a stylish suit in deep saffron, perfectly manicured nails, acres of bangles on her hand. She decided to take a more permanent solution and sought reconstructive surgery in 2005, a year after her surgery in 2004. She explains: “I got tired of the prosthetic. It was hard to wear certain blouses; you had to button them all the way up to the top.

The bra wasn’t fitting properly, and many times the prosthetic would just fall off when I bent down.”

For Lucky Ndanu, the habit of wearing a prosthetic has become second nature.

“The prosthetic is something I put on and forget about. It’s one that you can stick on; I bought it for Sh14, 000 at Woolworths at Yaya Centre in Nairobi, and that means that I can use a normal bra.”

Even beyond her physical appearance, she realised that having had the cancer did not stand in her way of getting a baby of her own as she had feared.

Her daughter Koki is now one year and four months old. “I thought that no man would accept me, that I would never get a baby. But those were fears and I faced them. I was able to breastfeed her on one breast for six months.”

While Catherine and Katheke have been married for many years, facing the ordeal while with their husbands, Lucky admits that her conception of womanhood has been challenged over the years as a singleton.

“From my experience, the first thing would be opening up to the guy about the fact that I’ve had cancer and had a mastectomy.

A DISEASE OF THE GENES?

A lot of people have the perception that cancer is a disease of the genes and that it can automatically be passed down to children.

Because of this, it has been a bit hard, in terms of thinking about whether I should tell a guy, how to, and when to. I’ve met guys and opened up to them, and gotten different reactions. Some are nasty but many take it well. But when you find the ones that are willing to stay, you know for sure that those ones are genuine.”

Lucky has advice for any younger women facing the same ordeal, on how they can still feel feminine.

“First of all don’t feel shy about yourself; you have done nothing wrong. It’s not as if you asked to be given the disease. You need to be strong, you need to dress up like a woman and feel confident about yourself. Look into your mirror regularly and tell yourself that you are beautiful. I walk out there and do not remember I don’t have a breast. A huge part of it really is about confidence.”

And Katheke, married for 14 years, emphasises the need to consider one’s partner’s feelings when dealing with the aftermath of a mastectomy.

“A lot of the husbands of women who go through this are terrified, they are scared,” she says. “When their wives have been discharged from hospital, they don’t know what to do. People don’t know it but men get affected when their wives go through life-threatening illnesses. I think they even get sicker than us. They too need counselling.”

Back to femininity though, Shilabukha Khamati points to the fact that its definitions and classifications are often fluid and changing.

“In the question of what is femininity, there’s the utilitarian and the aesthetic, but more important than these is how a person views themself.

A woman may have lost one breast or both, but the key question is, how does she feel that other people feel about it? That is what will determine how other people will react.

If you have a girl who’s had one breast removed and she feels beautiful, and on the other hand another one who has both breasts but thinks she’s ugly, the first will have a more productive and happy life.

So if you accept and confront it, then your life will be very positive.”