(The Letters from Selves Pas(t)sed series is drawn from writing created over 10 years ago. I’ve decided to include them as they create context for my journey. Keeping in mind where I come from helps me measure where I am and where I’m going.)
I have been lucky in terms of the logistics of a breast reduction. When many medical aids do not cover the R50 000 operation because they view it as cosmetic, rather than medical surgery, I have been in the lucky position of not being able to afford medical aid. In a country where having medical aid is often the difference between life and death, how can I possibly consider myself lucky?
I’m lucky because I’ve never had to explain to some doctor, some pencil-pushing medical aid representative, that a breast reduction would be far from cosmetic for me. I have never had to explain that for me, a breast reduction would free me from a burden under which I haven’t been able to be my true self.
My journey with the logistical side of breast reduction began in 2007. I was referred to the Johannesburg General Hospital (now the Charlotte Maxeke Hospital) by the head psychiatric nurse at Tara. This referral meant that the breast reduction was immediately seen as a medical and psychiatric necessity, rather than a superficial or cosmetic surgery.
The doctors at the Jhb Gen were sensitive to my case, and sympathetic. In fact, their medical opinion that I had completely disproportionate, and chronically large and pendulous breasts, was an unexpected affirmation of something I’d known since puberty. The fact that they had medical terms for the scarring on my shoulders, for the severity of the largeness of the breasts themselves, was a wonderfully affirming experience. Despite my belief that there ‘was something wrong with me’, it took this doctor’s visit to confirm that indeed there was, but that I didn’t have to suffer from it anymore.
It wasn’t that easy, of course. The fact that although a breast reduction is considered a medical procedure, it is still carried out by plastic surgeons, and is thus also a cosmetic procedure. This meant that I would have to lose weight and reach my appropriate body mass index weight. This was due to medical and cosmetic reasons. Medically, the operation is a difficult, long and complicated procedure, and any pre-existing health conditions would complicate it even further. Cosmetically, I had to prove my commitment to the reduction, as many patients pick weight up after the reduction, thus undoing the reduction as most women’s breasts are one of the first areas to be affected by weight loss or gain.
While I was heartened by the fact that the procedure would take place once I had lost the weight, the very notion of having to lose weight was disheartening.
I had gained all of that weight precisely because of my large breasts. I had tried to camouflage their largeness by making my body large. The irony, of course, was that the more weight I gained, the larger my breasts became.
So the fact that my weight-gain was an emotional defence against the trauma and stigma of being large-breasted, made it almost impossible for me to face the idea of losing weight. The weight had become my way of protecting myself against the world and its stares and judgements. How could I suddenly let this protection go? Yes, losing weight would mean that I would lose the breasts through the reduction, but being a fat person with large breasts was who I knew myself to be. I didn’t have an idea of a self without the weight, without the breasts. And although this self was one which I completely and utterly loathed and hated, it was the only self I knew.
I thus left the doctor’s office with a vague sense of optimism which was immediately outweighed and crushed by the enormity of losing a self which I had known for most of my life. And the weight remained, and in fact increased.
A year later, out of complete desperation and an inability to let go of the protective weight, I investigated another route. A route which might allow me to get away with getting the procedure done while being overweight. Overweight women were getting these procedures done every single day, because they could pay the R50 000 that it cost to have it done. So I began searching for ways to pay this fee. I approached a medical loans company who would loan me the money for the operation. I also approached friends, family, and even strangers about loaning me the money. This came to nothing, as my friends and family were not in a position to loan me that amount of money, and the response from strangers (on the website that I created to bring the money in) was one of helpless sympathy on the one side of the scale, and uncomprehending derision on the other.
In retrospect, I am appalled and thankful for this desperate move of asking for help. Appalled, because I had played a helpless victim who was not in control of my own ability to get the reduction done; thankful, because I now realise that that desperation was borne from a place that was not healthy. I’ve since realised that I could not, and can not, get the reduction done until I have lost the weight.
Losing the weight, I have come to realise, is an integral psychological and emotional part of the reduction. I would not be able to deal with a smaller set of breasts emotionally or psychologically until I had said farewell to my fat, large body image. If I had managed to scrape the money together to pay for the operation, I would have had smaller breasts, but I would still think of myself as a large-breasted, large girl.
While I struggled with the idea of the weight loss, and thus the loss of my large self, I went through a very dark period of contemplating a double mastectomy. I figured that having a mastectomy would not require weight loss, and also, a mastectomy would just remove the entire issue of having to come to terms with my breasts at all. This dark period became even darker when I seriously fantasised about performing this mastectomy on my self.
Thankfully I came out of this darkness. A mastectomy would not have been the answer I was looking for. Removing my breasts would have been a denial of my self, my truth, my identity as a woman. And more than that: performing the mastectomy on myself would have killed me.
The crux of the matter was that my identity as a woman, my identity as a large girl and my body image issues and emotional difficulties around weight loss and my large breasts were inextricably linked. I had to deal with each of these issues, separately, and as a whole.
Overcoming my depression was the key to this. Once I emerged from my debilitating and 15-20 year history with depression, I was able to look at these issues soberly and clearly, for the first time in my life.
And once I overcame the depression, the weight loss issue was no longer an issue. After a lifetime of struggling with weight loss, body issues, dieting, starvation, eating disorders, I spontaneously lost the weight. As I overcame the depression and let go of my depressed identity, my more authentic identity just wasn’t that of a large girl, and thus the weight literally fell off, without any effort on my part.
The truth was that it was my relationship with food that lay at the bottom of all of these issues. I previously ate to fill a hole. And filling this hole created a self that protected itself from the world, and its self, through a layer of fat. Coming out of the depression, I no longer ate to fill this hole. I ate when I was hungry and I stopped eating when I was full. This approach to food, which was completely common-sensical and rational to other people, had eluded me my entire life. But coming out of the depression made this simple and rational approach to food my own approach.
And now that I have lost a large proportion of the weight, I am inhabiting my body more comfortably. It is becoming the body I was always meant to have. The real me is not a fat person. And the real me does not have large breasts.
The fact that this attitude towards my body and my breasts comes from a place of what it means to be authentically me, means that it comes from a much healthier place. I no longer loathe my body; I no longer loathe my breasts. I am more comfortable with them. And this comfort stems from the knowledge that they are not mine, they never were. My breasts are smaller, they always should have been. And now that I know that, now that I can own that and take responsibility for it, now I am ready to have a breast reduction. Now that I know who I am and who I was meant to be, I can make peace with the fact that I am now becoming the thinner and healthier version of myself. And having the reduction, having smaller breasts is just the last piece in the puzzle to becoming my smaller, healthier self, my authentic self.
So the next step is to go to be weighed at the Jhb Gen dietician, to prove my commitment to the procedure through my weight loss, and then to set up a follow-up appointment with the plastic surgeon. Now that I have lost a lot of the weight, now that I have taken responsibility for my own health and body image, I feel a lot more confident and in control of my self and the decisions I make for my self. Continuing on the path of the breast reduction is the path I need to be on. And now that I am in control of that path, I feel a lot more at peace with taking the next step on it.
Post-op – March 2011 #lettersfromselvespas(t)sed
Having lived in a body with my ‘new’ breasts for almost 5 months now, I am filled with many emotions looking at these pictures.
Firstly, there is disbelief. I cannot believe that my breasts were that big. As I had no objective or real sense of what I looked like, avoiding mirrors and photographs, I am actually shocked that I walked around for 20 years with that completely disproportionate and impossible weight. I am saddened and horrified that I allowed myself that burden. In fact, not only allowed myself that burden but that I believed I deserved that burden.
Secondly, there is gratitude and joy. While it is difficult to look at these pictures in the sense of grieving for the time that I lost while my self and my spirit were crushed by that weight, I can look at them with a sense of objectivity, because that girl and the woman I am now are not the same person. I use the words ‘girl’ and ‘woman’ purposefully, as I was then a girl – a teenager in an adult body who was so at odds with herself, her femininity and her body. She could not come to terms with the body she inhabited and was so overcome with self-loathing that there was no self that was inhabitable for her. She loathed her breasts, her body. And because she was imprisoned within that body she loathed her self. She lived within the safe confines of a small, small space in her mind which was self-negating, self-destructive and self-diminishing. She could not accept that this physicality was who she was. She could not accept that this was what other people saw of her; that this is what other people took advantage of and abused. And so she denied her femininity and took every measure possible to cover, hide and mutilate that which made her female.
I remember the first day Tracy started taking photographs. Besides the psychiatric doctors and nurses in psychiatric institutions who have seen me naked when checking for signs of self-mutilation, and my partners, I have not allowed anyone else to see me naked. Sitting in front of Tracy, in my jeans and my bra, with her aiming a camera at me, left me feeling overwhelmingly fragile and vulnerable. I sat there and cried as I saw myself through the eye of the camera, the eye of the other, and as I realised that to the other I was a freak, a sexual object; a thing which was there to be pointed at, laughed about and abused. And in the face of that I was powerless. There was nothing I could do about it. I was trapped in that body with a 1000 eyes staring at me, objectifying me, and the only way I could survive was to remove myself to that corner of my brain where I was safe from them. I had to stay in that corner of my brain where I was safe from them.
But, of course, I wasn’t safe from them. My complete withdrawal from my body left me without a sense of who I was in my body. I had no ownership over it, no sense of or need to protect it. No voice. And so I allowed it to be stared at, made fun of and abused. Over and over again. Especially by myself. The person who did the most damage to me was the Self Loather, that part of me that hated my body and its betrayal of me so much that it not only allowed, but revelled in its ability to cut, burn, pierce, tattoo, starve, overfeed and rape its self.
I see such sadness, such trapped-ness in that girl in those photos. And she was sad. She was trapped.
But I am no longer her. Thinking back to what it felt like to be live in that body, and having had 4 or so months without that burden, I cannot believe how much difference it has made to my every day life and to my sense of self.
The journey back into my body began with the weight-loss leading up to the therapy. And it continues. Since the surgery the journey has picked up incredible speed and I, not to mention those around me, have been amazed at the incredible strides I’ve made.
12 January 2015: MY CURRENT RELATIONSHIP WITH MY BODY AND MY BREASTS: https://germainedelarch.wordpress.com/2015/01/11/breasts-body-issues-gender-identity/