While recuperating from my mastectomy, I read as much as I could, burrowing into rabbit holes on the internet trying to get as much information as possible about HER2-positive breast cancer. I hadn’t read anything about it during the months I thought—everyone thought—my tumor was HER2-negative. Before bed, I went back for deep dives into sections of Dr. Susan Love’s Breast Book or Siddhartha Mukherjee’s The Emperor of All Maladies that I had skipped over. I tried not to feel bleak. HER2-positive breast cancer is more aggressive and lethal. In the months I should have been receiving Herceptin my tumor continued to grow.

I plucked The Emperor of All Maladies off my nightstand. After hearing the author interviewed on NPR, I bought the book and added it to my stack of books to read someday. An idle-curiosity type of someday. Not a learn- everything-I-need-right-now kind of someday. But, that had been a couple of years before my diagnosis. Information had become more precious. Most nights, I read a few pages before my eyelids felt weighed down by my cancer, all cancer, all the lost breast and lives.

If I had been the praying type, I would have made the sign of the cross that I was diagnosed in 2013 and not 1883 or even 1983. William Halsted, a surgeon from New York, developed the radical mastectomy in the late 1880s, which was a small improvement over the other treatment options available at the time: amputation or cauterization—without modern-day anesthesia!—or no treatment whatsoever. Screening didn’t exist. No mammograms. No breast self-exams. Prior to Halsted’s sweeping attempts to rid women of their tumors, surgeons removed the affected breast, but not the lymph nodes in the armpit or the chest wall muscles. ‘Cut more, save more’ was Halsted’s motto. He went to great lengths to get rid of everything and anything a tumor could have touched even if this meant removing the entire breast, all of the lymph nodes, and both pectoralis muscles on whichever side the tumor had been discovered. A radical mastectomy would have destroyed my career as a massage therapist and any vestige of femininity I possessed.

Mukherjee had gathered photographs of trailblazing scientists and doctors who had revolutionized cancer treatment. He included an illustration of Halsted’s radical mastectomy, consisting of two drawings. The upper drawing depicts a young woman, perhaps around thirty, lying on her back with a bored look on her face. A loose sheet drapes her torso and her right arm rests away from her body. An incision curves from her deltoid across her chest and loops around her breast, as if a cul de sac has been drawn on her. A large flap of skin has been peeled toward her armpit, but her breast remains intact other than the teardrop-shaped incision. The artist drew a small lump above the woman’s nipple. If her tumor had begun to protrude, her odds of long-term survival would have been grim.

The bottom illustration is not for the weak-kneed. A photograph would be worse; it would show her blood, fat, and muscles as well as the tumor. The drawing makes the butchery seem tidy, somehow kind. The woman’s breast placed beside her, yet still attached to her body, has unaccountably grown much larger, from half of a grapefruit to most of a honeydew melon. Why is it that the size of tumors in women is described in relation to fruit, while men’s tumors are compared to the size of balls? Her face is covered with a cloth as if the surgeons are sparing themselves her gaze—no longer one of boredom. Maybe she died and they decided to continue with the mastectomy as a teachable moment. The gaping wound is devoid of blood. Two pairs of surgical scissors are suspended midair as if held by an invisible surgeon who is removing bundles of lymph nodes from the woman’s armpit.

Halsted’s radical mastectomy didn’t save as many lives as he thought it would; however, it irrevocably disfigured his patients. He must not have given much thought to the pec major and its purpose. Not only does it move the arm, it also provides a platform and support for breast tissue and insulates the chest. Visualize removing a swath of skin and tissue along with a fan-shaped muscle stretching from the sternum to the collarbone and a point on the humerus. Now imagine not being able to do much of anything with your upper arm and chest. Try to remember how a harsh winter wind feels; even a heavy coat can’t keep you warm enough. Without the pec major and breast tissue, it feels like the wind has blown straight through your skin into your lungs. Granted, most women in the late nineteenth century and early twentieth century were not doing yoga or lifting weights, but not having this muscle had a severe impact on a woman’s day-to-day life, with no machines to lighten the domestic load.

For almost one hundred years, the Halsted mastectomy was standard. A few doctors took the radical mastectomy to new heights—the super radical mastectomy—by removing the latissimus dorsi or even completely amputating the woman’s arm. What kind of misogyny led to these extreme methods? It took nearly one hundred years for doctors to figure out that radical mastectomies were overkill.

Doctors didn’t fully understand the lymphatic system and nobody knew anything about HER2 status. Some women died. Some women were cured. Nobody knew why. Of course, the surgeons had thought more drastic surgery could solve everything.

I see a lot of scars at the spa. Before each massage, I ask clients about any health conditions, skin sensitivities, or recent surgeries. If they mention cancer, I’ll run through quick questions about surgeries, radiation, chemotherapy, lymph nodes—everything I know from firsthand experience. I never see mastectomy scars unless a small ribbon of white or pink (depending on how recent the surgery is) meanders into the woman’s armpit. Sometimes, older ladies will tell me not to worry about the scars on their backs, saying they had had a mastectomy long ago. I’ll ask if they had the lat flap surgery and they’ll look surprised that I know. The lat flap is rarely used anymore; it entails cutting the latissimus dorsi muscle and pulling it forward to construct a breast from the flap of muscle. More disfigurement. Less range of motion.

In junior high art classes, my teacher played cassettes about Jack the Ripper and his bloodthirsty crime spree. She had played the Tommy soundtrack for nearly a month so her obsession with Jack the Ripper seemed like a natural segue. It meant all the seventh and eighth grade students listened to whatever dark story fascinated her. Did anyone complain or tell their parents, or did we think it was normal to listen to gruesome stories of a series of women who had been murdered nearly a century before? I went to school long before trigger warnings and coddling children became the norm. Every once in a while, a particularly brutal detail caught my attention, making my stomach flip. How much worse could the details get? The matter-of-fact descriptions of the victims’ mutilations seemed clinical, almost like Marlin Perkins in Wild Kingdom narrating how various lions and hyenas hunted their prey on peaceful African savannahs.

One day, the narrator’s disembodied voice described how the last victim’s womb had been removed and she had been skinned, gutted, and her breasts removed then placed under her body. I lifted my head from my painting and gazed at my classmates; none of them seemed to notice. They chatted and laughed as they painted their versions of hobgoblins. It seemed as if they had a different tape playing in their heads and I was the only one able to hear the Jack the Ripper story. I bent my head down and glanced at my flat chest, not a glimmer of a pointy nipple or rounded mound like most girls in my class. I couldn’t imagine having them grow only to be hacked off. I hoped his victims had died before he mutilated them. Did he kill them first, or would he have enjoyed their panicked screams? What kind of a boy would he have been? Would he have torn the wings from butterflies? Would he have terrorized stray cats and dogs?

The narrator suggested possible perpetrators, including a medical student, Prince Albert, a butcher, and others. The police considered the med student theory because the murderer knew anatomy. The murders occurred a few years before Halsted published a paper describing his surgery. I wonder if he had read any of the newspaper accounts about Jack the Ripper, and if he had, did he see parallels between their methods. If the med student theory was true, could the med student have been in Germany during one of Halsted’s trips to the continent to learn from famous surgeons?

Even though Halsted’s radical mastectomy seemed savage, it also made me grateful. Grateful to be born in the early sixties. Grateful that surgeons who eventually challenged Halsted’s methods were listened to. Grateful there had been so much research into the science of cancer and how it metastasizes. Grateful that breast cancer research receives significant funding. Grateful the internet enabled me to research and know which questions to ask. In Halsted’s time, patients were more or less guinea pigs anytime they had surgery.

Surgery in the late 1800s was most likely not for the poor; mastectomies were probably reserved for women of means. I wonder if doctors practiced on the poor or institutionalized. Maybe they had learned some procedures on battlefields. The scene in Dances with Wolves when Kevin Costner’s character, John Dunbar, is about to have his leg amputated illustrates how terrifying surgery was for the people about to be operated upon. Dunbar knew he stood to die if he lost his leg, let alone not being able to stand anymore. He heaved himself off the operating table, pulled himself onto a horse, and rode off into the Wild West where he lived an inexplicably limp-free life. I doubt many women could push themselves off the table Kevin Costner-style prior to having a breast removed. Once the doctor administered ether, or whatever anesthesia he chose, the patient had no choice. What had doctors said to their patients prior to surgery?

In a desperate attempt to become cool or at least not embarrass myself on a daily basis, I read Glamour magazine during high school. I loved the Dos and Don’ts and the advice column from a man named Jake, who, in reality, was probably a series of underpaid women. The last several pages contained classified advertisements of magic potions and lotions guaranteeing flawless skin, shinier hair, and larger breasts. The breast ads intrigued me; I spent months analyzing the ads for breast enlargement shakes, creams, and developers before settling on a bust developer. I doubted the efficacy of creams and shakes, fairly certain they would enlarge anything and everything, but an exercise device would target the muscles under my breasts.

I used my babysitting money to send away for the bust developer; it landed in our mail slot cloaked in a plain brown box as if it contained unmentionable secrets. I opened it and held two white plastic tubes connected by a thick rubber hose snaking through them. It was basically a resistance band before resistance bands were cool. A little leaflet illustrated a variety of exercises designed to tone my pectoral muscles. No matter how often or how long I did the exercises, my cup size didn’t swell beyond a double-A. Inevitably, my brothers would walk in on me while I stood in front of my mirror grappling with the tubes, wishing and waiting for one or both of my breasts to break free of my training bra. One of them would grab my bust developer and chant, ‘I must, I must, I must increase my bust,’ with an exaggerated show of doing the exercises. I would sit on my bed, feigning boredom. One day, their friend, Todd cycled to our house with my brothers, and the three of them all shirtless and sun-burned from an afternoon at the swimming hole discovered me in the throes of exercising. Todd grabbed my bust developer and stretched the tubes apart as if drawing a bow. The hose snapped and thwacked him on his chest, raising an immediate welt. They fell all over themselves, laughing about how well it worked. My brothers tried to put it back together, but couldn’t. My dream of a B-cup and my babysitting money vanished.

Language and its use with respect to the body always intrigued me. The first time I read the word amputation used instead of mastectomy, it made me pause. It sounded so violent. So masculine. So traumatic. Not that I didn’t think a mastectomy would be traumatic, but amputation conjured people who had lost limbs due to bombs, diabetes, or industrial accidents.

Like many English words, amputate has Latin roots; am-, around, and putare, to prune: to prune around or lop off. After three surgeries, it certainly felt as if my breast had been pruned bit by bit before it was finally lopped off. I imagined a conscientious gardener deliberately snipping chaotic overgrowth to create order. In medical dictionaries, amputate is defined as removal of all or part of a body part enclosed by skin. That definitely applies to a mastectomy, but mastectomy is more specific than amputation. Mast-, breast, and -ectomy, removal of: removal of the breast. Mastectomy sounds more benign than amputate. A tumor is chaotic overgrowth, one cell gone rogue, marshalling a blood supply to feed its growth frenzy. Maybe a logician or mathematician would say that mastectomy is to amputate as square is to rectangle; but, I’m not a mathematician, and now I have more angles than curves.

The months between my diagnosis and eventual mastectomy had given me plenty of time to think about the utter futility of puberty and the irony of agonizing over being small-breasted— just to have my breast removed, lopped off, amputated.