A Medical Quest

In Which I Gain a Greater Understanding of Breasts and Ovaries
Health and medicine explained.
June 14 2004 2:32 PM

A Medical Quest

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Illustration by Robert Neubecker

Nancy Etcoff studies the important things in life. She wrote a book called Survival of the Prettiest: The Science of Beauty, and now she is working on a book on happiness. She also teaches at Harvard Medical School and at the college itself, where I am auditing her class on the psychology of happiness. In her book Nancy writes that breasts are one of the things that distinguish humans from other animals: We are the only mammals who, starting at puberty, have rounded breasts all the time, whether or not we are breast-feeding. We are also the only species that views breasts as sexual. American culture, she argues, is as obsessed with breast size as it is with penis size.

No wonder the genetic counselors mention ovarian surgery so much more easily than the preventive-mastectomy option. Plus, having one's breasts removed is a much more difficult surgery than an oophorectomy. The ovaries are small and invisible from the outside, and the surgery is a laporoscopy—an operation in which a tube is lowered into the abdomen through a tiny incision, the ovaries snipped and pulled out through the tube, and all of this takes no more than an hour and leaves only a miniature scar. It may make sense to get rid of both the breasts and the ovaries, but if I have to choose—and at the very least I'd have to choose which pair goes first—I am choosing between the visible expression of femaleness and its invisible essence. "The visible always trumps the invisible," says Nancy—meaning, the visible is harder to lose.

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I ask her what makes a woman—or, rather, a beautiful woman. Breasts, she says. Also, the shape of the torso (narrow waist, wider hips), skin tone (women's skin is less ruddy than men's), lips (fuller than men's), hair (no male-pattern baldness). In other words, it's the ovaries—or more specifically, the estrogen that they produce. Without her ovaries, a woman will often gain weight, especially around the midsection (there goes the torso), her skin will lose elasticity, her lips will lose their fullness and color, and her hair will thin (though not necessarily the same way a man's hair does). Another sexual attribute that goes out with the hormones is the libido. So, the choice may come down to whether I want to feel desire or be desired. I need my ovaries for the former and my breasts for the latter. I've been thinking about it, and I think I'd rather be desirous: I figure I can always find one person to desire me—my actual partner, with any luck—but that won't bring me anything but frustration if I can't feel desire myself. Nancy seems skeptical of this idea: She thinks it could be devastating to feel that there is no one out there who wants you. And worse, to see the reason in the mirror every time you take off your shirt.

I have seen a study of women who opted for preventive mastectomies. Nearly all of them say they've adjusted well. There are two possible problems with the study, though: The women who didn't adjust so well may have been reluctant to participate, and the women who chose the surgery in the first place may have been the determined sort who were more likely to adjust well. But Nancy thinks the study is probably very accurate. All evidence tells us that people are incredibly adaptable: It usually takes us only about six months to get used to the effects of disfiguring accidents or other worst-case outcomes. The only truly intolerable situations are the ones that keep getting worse, or that follow an unpredictable pattern, like multiple sclerosis or other chronic degenerative conditions.

Anyway, she says, "Beauty doesn't correlate with happiness. Beauty gets you a mate. But it doesn't make you happy." Right. But here I get caught up in a trap of circular logic. I am looking for the best way to be both healthy and happy. I have learned in Nancy's class that one needs to be healthy to be happy. One also needs to have sex. But what if the thing that will make me potentially healthier—having my ovaries removed—means I will not want to have sex? Will I become less happy and, consequently, less healthy? What if, on the other hand, I choose to hold on to the body I have, because it makes me happy, but then develop cancer, which will not only make me unhealthy but also unhappy, since, if it doesn't kill me, it can be just the sort of degenerative condition to which it is impossible to adapt?

The utterly absurd nature of the choices makes them more difficult. There is something especially disturbing about cutting off apparently healthy breasts or ovaries. Nancy points out that people generally try to fake youth and beauty, while I am talking about intentionally taking both away.

Still, she tells me that for some women, menopause actually brings a sense of liberation. No more mood swings. No more unwanted sexual attention. "As women get older, they broaden their definition of beauty," she says, "to emphasize aspects of strength, confidence—intangibles."

"What do those look like?" I ask.

Nancy is momentarily stumped. "I think it's more about self-presentation and style—projecting more than meeting signals." I could maybe get into that—as long as premature aging does not turn out to be the sort of chronic degenerative condition we humans can't handle. There is much conflicting information out there, though most experts seem to agree that surgical menopause tends to feel worse than the natural thing. Will I be gray-faced, hairless, and fat? Nancy suggests that genetic counseling ought to include a computer model of how the particular woman will change with age. Will I feel stupid and suffer memory loss? Nancy thinks the cognitive effects don't last, but my physician warns me they do (perhaps women just stop noticing after a while?). Note to self: Contact an expert on women's aging.

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