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Russian Roulette. When a woman enters the hospital for a biopsy, her surgeon usually asks her permission to perform a mastectomy if the biopsy should be positive. Thus most women go under anaesthesia without knowing whether they will wake up breastless or not. Surgeons defend this practice on the ground that it reduces both the risk and the expense of two operations. Even so, some women would rather know beforehand what they face, and some surgeons agree that there is no harm in waiting a few days between a biopsy and a mastectomy. "A cancer isn't going to grow that much in a day or two," says Robbins. "But if a woman decides to go surgeon shopping and delays a couple of weeks, she's taking her life in her hands. You can't play Russian roulette with breast cancer."
Most women agree, and in all but a handful of cases, they courageously go along with their doctor's recommendation. "Do whatever has to be done to help me live," said Mrs. Ruby Flynn, 41, of Atlanta, when she entered Piedmont Hospital for a biopsy andultimatelya mastectomy two weeks ago. But no woman can really anticipate the shocking reality of awakening to discover that one of her breasts is gone. Her husband's tears told Gina Thompson, 36, of Malibu, Calif., the result of her operation. "Because everyone was so upset, at first I was more aware that I had lost my breast," she said. "It was only a week or so later that it fully dawned on me that I had had cancer."
"Losing a breast, part of her femininity, is a pretty devastating thing to a woman," says Ruth Roseland, a Quincy, Mass., psychologist who counsels mastectomy patients. "Women feel that they have done something wrong, that mastectomy is a form of punishment." Some become bitter and angry. Others become withdrawn and depressed, particularly as they begin to undergo the frequently debilitating X-ray or drug treatments usually necessary to control any residual cancers.
Fear of Rejection. How a woman copes with her ordeal and moves ahead depends in great part on her own self-image. Betty Ford has an open and natural attitude: "I told Jerry the other day, 'You've got a better figure than I have.' He's trying to lose weight, but all I need is a little padding." Alice Roosevelt Longworth, 90, the daughter of Theodore Roosevelt, jokes about her two mastectomies and refers to herself as Washington's only "topless nonagenarian." Julia Child, television's "French Chef has a no-nonsense attitude about her operation, which she revealed publicly for the first time last week. Says she: "I would certainly not pussyfoot around about having a radical because it's not worth it." Both Shirley Temple Black and Marvella Bayh, wife of Indiana Senator Birch Bayh, have made it equally clear that a mastectomy is less tragic than some believe.