“Many voices and stories don’t fit so neatly into the pink box that breast cancer stories often come packaged in.”
Emily MacKenzie, Whyy
Sex, Gender & Breast Cancer.
Anyone can get breast cancer regardless of their sex or gender identity. In the United States, intersex, nonbinary, and transgender persons, who account for approximately 2–3% of American adults, comprise a significant subset of the nation’s sexual and gender minority (SGM) population(1). Among this segment of the SGM population, transgender women undergoing hormone treatment show an increased risk of breast cancer relative to cisgender and transgender men while maintaining a somewhat lower risk of developing breast cancer than cisgender women. These differences are probably due to hormone exposure.
The medical literature on the intersection of gender identity and mastectomy for breast cancer is sparse, and some SGM patients might have questions and concerns that are not addressed by the general literature targeted to the broader mastectomy patient population. SGM patients may (or may not) be interested, for example, in creating a “masculinized” chest wall that includes the appearance of nipples, which may be preserved (wholly or partially) during the mastectomy, restored surgically, and/or aesthetically reconstructed with the aid of tattooing. Or they may be interested in creating an androgynous chest with very small mounds (i.e., that achieved with a Goldilocks procedure). While some aesthetic techniques require a more advanced skill set, “aesthetic gender-affirming” mastectomies have been shown to be oncologically safe (Boyd et. al., 2022). A plastic surgeon on your team might be just what you need.
The bottom line is this: It is your body, your choice. If you feel your surgeon is not hearing your concerns, or that you’re not being presented with all of your surgical options, you have the right to seek a second opinion.
Mastectomy & Gender Identity.
A person’s gender identity can certainly affect what their psychological processing and healing looks like after mastectomy. While a mastectomy is almost always a traumatic event, many SGM patients, including LGBQ+ and other gender-nonconforming persons, feel that they are less attached to a “breasted appearance” than perhaps the average cisgendered patient might be. In some cases, the person may even feel relieved to have their breasts gone because their new body conforms more closely to their gender identity. In these circumstances the risks associated with breast reconstruction are less appealing – or not appealing at all.
“Women — especially those who identify as queer — are rejecting the notion that the breasts make the woman.”Winnie McCroy
“I think it was easier for me, going flat, because I was already presenting as fairly masculine – as a butch lesbian. My pronouns are she, her and homo….The problem fundamentally is that we have to put labels on ourselves.”Lissa Sears, The Gays of Our Lives
“I loved my breasts, so I wanted them or none,” said Jensen. “I think that my queer identity helped make this choice to stay flat easier. As a more androgynous person, I felt much less pressure to conform to hegemonic beauty standards.”Vonn Jensen (formerly Emily), Photo Magazine
“My experience…is at least partly about a close family member who is trans masc nonbinary. I took them down to Florida for their top surgery, and my experience with mastectomy was a part of our bonding on that trip. They are one of my favorite people, and their experience has informed my exploration into my own gender and sexuality… By the time I had my mastectomy I had already had hysterectomy. I had no uterus, cervix, breasts, or ovaries. I thought long and hard about what it meant to be a woman, and came to a screeching halt, having to admit that I didn’t know!”Anonymous
Mastectomy does not usually have any effect on a person’s gender identity, but every person is unique and gender is a spectrum. How your chest looks after mastectomy, after medical and anatomic constraints, is your choice – and how you feel about your body is also up to you.
Choice and diversity are beautiful things!
(1) Percentage inferred from UCLA Williams Institute population studies (June 2016, June 2021), Gallup (February 2022), and Intersex Campaign for Equality (IC4E, 2015). The NIH Office of Equity, Diversity and Inclusion specifies that “the term ‘sexual and gender minority’ (SGM) more broadly references LGBTI and other populations whose sexual orientation and/or gender identity, and reproductive development is considered outside cultural, societal, or physiological norms.”