直面無胸的人生，她們選擇不要乳房

Before Debbie Bowers had surgery for breast cancer, her doctor promised that insurance would pay for reconstruction, and said she could “even go up a cup size.” But Ms. Bowers did not want a silicone implant or bigger breasts.

在黛比·鮑爾斯(Debbie Bowers)做乳腺癌手術前，她的醫(yī)生保證，醫(yī)療保險會支付乳房再造的費用，還說她“甚至可以增大一個罩杯”。但鮑爾斯不想要硅膠植入物或更大的乳房。

“Having something foreign in my body after a cancer diagnosis is the last thing I wanted,” said Ms. Bowers, 45, of Bethlehem, Pa. “I just wanted to heal.”

“患上癌癥后，我最不想要的就是體內有不屬于我的東西，”賓夕法尼亞州伯利恒市(Bethlehem)45歲的鮑爾斯說，“我只想要康復。”

While plastic surgeons and oncologists aggressively promote breast reconstruction as a way for women to “feel whole again,” some doctors say they are beginning to see resistance to the surgery. Patients like Ms. Bowers are choosing to defy medical advice and social convention and remain breastless after breast cancer. They even have a name for the decision to skip reconstruction: They call it “going flat.”

雖然整形外科醫(yī)生和腫瘤醫(yī)生大力提倡乳房再造，認為它是女性“重新感受健全”的一個方法，但有些醫(yī)生說，他們開始看到對這種外科手術的抗拒。鮑爾斯這樣的病人選擇的就是不接受醫(yī)生的建議和社會傳統(tǒng)，在患上乳腺癌之后保持沒有乳房的狀態(tài)。她們甚至給不進行乳房再造的決定起了個名字，叫“走平胸路線”(going flat)。

“Reconstruction is not a simple process,” said Dr. Deanna J. Attai, a breast surgeon in Burbank, Calif., and a past president of the American Society of Breast Surgeons, adding that more of her patients, especially those with smaller breasts before diagnosis, were opting out of reconstruction. “Some women just feel like it’s too much: It’s too involved, there are too many steps, it’s too long a process.”

“乳房再造不是一個簡單的過程，”加利福尼亞州伯班克市的乳房外科醫(yī)生迪安娜·J·阿塔伊(Deanna J. Attai)說。她是美國乳房外科醫(yī)生協(xié)會(American Society of Breast Surgeons)的前主席。她說，越來越多的病人，尤其是那些在患癌之前乳房偏小的病人，選擇不要乳房再造。“有些女性就是覺得太麻煩：太復雜，太多步驟，過程太長。”

Social media has allowed these women to become more open about their decision to live without breasts, as well as the challenges, both physical and emotional, that have followed. For a recent video created by wisdo.com, a social media platform, and widely shared on Facebook, Ms. Bowers and her friend Marianne DuQuette Cuozzo, 51, removed their shirts to show their scarred, flat chests. And Paulette Leaphart, 50, a New Orleans woman whose clotting disorder prevented her from having reconstruction after a double mastectomy, walked topless from Biloxi, Miss., to Washington this summer to raise awareness about the financial struggles of cancer patients.

社交媒體令這些女性可以更開放地談論不要乳房的決定，以及身體和情緒所面臨的后續(xù)挑戰(zhàn)。社交媒體平臺wisdo.com前不久制作的一段視頻在Facebook上得到廣泛轉發(fā)。在視頻中，鮑爾斯和51歲的朋友瑪麗安娜·杜克特·科佐(Marianne DuQuette Cuozzo)脫去襯衣，露出有疤痕的平坦胸部。50歲的新奧爾良人波萊特·利普哈特(Paulette Leaphart)患有凝血障礙，在雙乳切除后無法進行乳房再造。今年夏天，她裸露上身從密西西比州比洛克西(Biloxi)徒步走到華盛頓特區(qū)，以此激發(fā)人們對癌癥患者經濟困境的關注。

“Breasts aren’t what make us a woman,” Ms. Leaphart said.

“女人不是因為有乳房才是女人，”利普哈特說。

The nascent movement to “go flat” after mastectomies challenges long-held assumptions about femininity and what it means to recover after breast cancer. For years, medical professionals have embraced the idea that breast restoration is an integral part of cancer treatment. Women’s health advocates fought for and won approval of the Women’s Health and Cancer Rights Act of 1998, which requires health plans to cover prosthetics and reconstructive procedures.

乳房切除后“走平胸路線”的新運動是對女性特質和乳腺癌康復固有觀念的挑戰(zhàn)。多年來，醫(yī)學專業(yè)人士認為，乳房再造是乳腺癌治療必不可少的一部分。女性健康倡議者爭取并最終促使《婦女健康與癌癥權利法案》(Women’s Health and Cancer Rights Act)于1998年獲得批準，該法案要求醫(yī)療保險計劃涵蓋修復和再造手術。

Since then, breast reconstruction has become standard care. More than 106,000 reconstructive procedures were done last year, a 35 percent increase since 2000, according to the American Society of Plastic Surgeons. While it is not known exactly what percentage of women opt for breast reconstruction after a mastectomy, one study found that in 2011, 63 percent of women who were candidates for the procedure chose to have it. In some parts of the United States, the number is closer to 80 percent today.

從那以后，乳房再造成為標準護理。據美國整形外科醫(yī)生協(xié)會(American Society of Plastic Surgeons)稱，去年共進行了10.6萬多例再造手術，比2000年增加了35%。雖然女性在切除乳房后選擇再造的確切比例尚不可知，但一項研究發(fā)現，2011年，在準備做乳房切除手術的女性當中，有63%的人選擇再造。如今，在美國的某些地區(qū)，這個數字接近80%。

In promoting the surgery, doctors cite studies that suggest breast reconstruction improves a woman’s quality of life after cancer. But some women say that doctors focus too much on physical appearance, and not enough on the toll prolonged reconstructive procedures take on their bodies and their psyches. Up to one-third of women who undergo reconstruction experience complications. A systematic review of 28 studies found that women who went without reconstruction fared no worse, and sometimes did better, in terms of body image, quality of life and sexual outcomes.

有研究顯示，女性在治療癌癥之后進行乳房再造有助于提高生活質量。推介再造手術時，醫(yī)生會援引這類研究。但一些女性認為，醫(yī)生過于注重體貌特征，對她們的身體和心靈在漫長再造過程中所經受的痛苦卻關注得遠遠不夠。做再造手術的女性有多達三分之一會出現并發(fā)癥。對28項研究的系統(tǒng)性匯總顯示，就身體形象、生活質量和性表現而言，沒做乳房再造的那些女性的狀況不會更糟，有時還會更好一些。

“That’s the dirty little secret of breast reconstruction: The risk of a major complication is higher than for the average elective surgery,” said Dr. Clara Lee, an associate professor of plastic surgery at Ohio State University who performs the procedure.

“乳房再造術有個可怕的小秘密：術后出現重大并發(fā)癥的風險要高于普通的選擇性手術，”會為患者做再造乳房手術的俄亥俄州立大學(Ohio State University)整形外科副教授克拉拉·李(Clara Lee)說。

Ms. Cuozzo, who appeared in the Facebook video with Ms. Bowers, spent a year having her breasts rebuilt after a double mastectomy, but after four infections in five months, she had the implants removed. The reconstruction, she said, “was getting worse than the cancer.”

和鮑爾斯一起在Facebook上的那個視頻中出現的科佐，在做了雙側乳房切除手術以后，用了一年時間來再造乳房，但卻在五個月內出現了四次感染，于是她把植入物移除了。她說，進行乳房再造“比患癌癥還要糟糕”。

While some states, including New York, now require physicians to tell women about the availability of breast reconstruction, women say they often are not informed of the option to remain flat. “I was never told there was a choice,” Ms. Cuozzo said. “I went from the breast surgeon to the plastic surgeon, and they said, ‘This is what you’re going to do.’” Dr. David H. Song, chief of plastic surgery at the University of Chicago and immediate past president of the American Society of Plastic Surgeons, said that the risk of complications was real, but that focusing on them was like focusing on plane crashes when “millions of flights land safely.”

目前，包括紐約州在內的一些州要求醫(yī)生告知女性可以進行乳房再造。但女性們表示，自己通常不會被告知還可以選擇讓胸部保持平坦。“我從未被告知還有其他選擇，”科佐說。“我從乳房外科醫(yī)生到了整形外科醫(yī)生那里，他們說，‘這就是你接下來要做的’。”芝加哥大學(University of Chicago)的整形外科主任、美國整形外科醫(yī)師學會(American Society of Plastic Surgeons)上一任會長大衛(wèi)·H·宋(David H. Song)說，并發(fā)癥的風險真實存在，但過度關注并發(fā)癥就像是在“成百上千萬航班安全著陸”之際將注意力集中在墜機上。

Given advancements in surgical techniques, “the aesthetic result can be better than the native breast,” Dr. Song said. “Patients can come out the other end looking more youthful, with a better aesthetic in her breast than before.”

鑒于手術技術的發(fā)展，“再造的乳房就美感而言會比原來的乳房更勝一籌，”宋醫(yī)生說。“這一切結束后，患者會顯得更年輕，胸部比以前更具美感。”

But it is that kind of talk — suggesting that a reconstructed breast is an improvement on a woman’s natural breast — that enrages many women who have undergone mastectomies. For starters, a reconstructed breast is often numb and can no longer play a role in sexual arousal. It often lacks a nipple, since the nipple is usually removed in a mastectomy.

但他的話暗示著再造的乳房是女性天然乳房的升級版，這類說法會惹惱許多切除了乳房的女性。首先，再造的乳房通常是麻木的，再也無法在性喚起過程中發(fā)揮作用。它通常沒有乳頭，因為乳頭在乳房切除手術中一般會被摒棄。

After looking at photos of reconstructed breasts, “I was slightly horrified,” said Charlie Scheel, 48, of Brooklyn, who decided against implants after a double mastectomy. “You don’t have nipples and you have scars everywhere.”

看過一些再造的乳房的照片以后，“我有點兒恐懼，”現年48歲、來自布魯克林，在切除雙側乳房后決定不做植入手術的查理·謝爾(Charlie Scheel)說。“你沒有乳頭，而且到處都是傷疤。”

Rebecca Pine, a cancer survivor from Long Island who co-founded a photography and writing project called “The Breast and the Sea,” said, “It’s a tremendous amount to put your body through, and it’s not like we’re going to get our breasts back.”

來自長島的癌癥幸存者麗貝卡·派因(Rebecca Pine)是一個名為“乳房與海”(Breast and the Sea)的攝影和寫作項目的聯(lián)合創(chuàng)始人，她說，“你的身體要經受極多的苦痛，而且也不是說我們能找回自己的乳房。”

Some women say physicians pressured them to get implants. When Catherine Stapleton, of Florida, woke up after her mastectomy, she discovered that her breast surgeon, a woman, had left unsightly flaps of skin and tissue that could be used for breast reconstruction later, in case she changed her mind.

一些女性表示，醫(yī)生曾敦促她們接受植入手術。佛羅里達州的凱瑟琳·斯特普爾頓(Catherine Stapleton)在做了乳房切除手術以后清醒過來時，發(fā)現她的乳房外科女醫(yī)生留下了以后進行乳房再造時用得上的一塊塊難看的皮膚和組織，以防她改變主意。

“When I woke up from anesthesia, I was in shock,” said Ms. Stapleton, 58, who is now facing additional major surgery to correct the first procedure.

“當我從麻醉中醒過來的時候，感到很震驚，”現年58歲的斯特普爾頓說。她現在的處境是，要接受額外的大手術來修正第一次手術。

Geri Barish, president of the Long Island advocacy group 1 in 9, said a doctor had chided her when she opted against reconstruction. “One doctor said to me: ‘How can you walk around like that? You look deformed,’” she recalled.

長島倡導團體九分之一(1 in 9)的主席杰里·巴里什(Geri Barish)說，當她選擇不做乳房再造手術的時候，遭到了醫(yī)生的責問。“一位醫(yī)生對我說，‘你怎么能就這樣走來走去?你看起來有些畸形，’”她回憶道。

Support groups and social media have allowed women to share stories about the realities of reconstruction. “A lot of the women in my support group had infections, and they were surprised at how many surgeries were involved,” said Alicia Staley, 45, who stayed flat after a double mastectomy. “As I compared notes, I wondered, ‘Why are all these women doing this to themselves?’”

互助團體和社交媒體的存在讓女性得以分享與乳房再造的現實有關的故事。“我那個互助組里的很多女性都出現了感染，此外，其間涉及的手術數量之多讓她們很驚訝，”現年45歲、在切除雙側乳房后選擇讓胸部保持平坦的阿莉西亞·斯特利(Alicia Staley)說。“跟她們交流時，我很疑惑，‘這些女性為什么要這樣對待自己?’”

Coming to terms with a flat chest after breast cancer can be difficult. While some women wear a prosthesis in their bra, it is not uncommon for them to stop using it. “They’re heavy, they’re uncomfortable, and they’re in a sensitive area where you have scars,” Ms. Pine said.

讓乳腺癌患者接受變成平胸的事實會很困難。一些女性會在胸罩內戴假體，不過也有很多人不再這樣做了。“它們很重，感覺不太舒服，而且它們接觸的是留有傷疤的敏感部位，”派因說。