After breast cancer and failed reconstruction, this mom found beauty by going flat

Joanna Rankin, a 40-year-old Calgary woman, is not only a survivor of breast cancer, but of breast reconstruction that went wrong.

Joanna Rankin says implant ordeal was worst part of her cancer journey

Joanna Rankin and her son Ben, shortly after she finished her first round of chemotherapy. (Submitted by Alexandra Zabjek)
Listen to the full episode26:28

This radio documentary, which you can listen to above, was produced by Alexandra Zabjek as part of CBC's The Doc Project. Zabjek is a journalist based out of Edmonton and is a long-time friend of Joanna Rankin, who is profiled in this piece.

Joanna Rankin was 32 years old, a PhD student and a new mom when she was diagnosed with breast cancer. 

She was, and is, my friend. We've known each other since junior high school. When she was diagnosed, we were living on different sides of the country, building our lives, families, and careers.

Joanna Rankin and her son, Ben, near the time she first received her cancer diagnosis. (Submitted by Joanna Rankin)

My friend — with her infectious laugh and keen sense for a good party — was suddenly thrown into a new world of medical terms and trauma: chemotherapy, radiation, mastectomy, and reconstructive surgery.

It was that last part of her treatment plan, the breast reconstruction, that caused her terrible pain and mental anguish through her cancer journey.

"Everyone just kept telling me that I would have a psychological breakdown if I woke up from surgery and didn't have breasts," she recalled. "I certainly had a lot of reservations about it, but all of the medical teams told me repeatedly how hard it would be for me."

"They would just always tell me that, you'll have chemo and radiation and surgery and reconstructive surgery as well."

Joanna underwent a double mastectomy in 2011. During the same surgery, doctors inserted "expanders" into her chest. The expanders are later inflated to help stretch out the skin and tissue so they can eventually hold up an implant.

'My stitches opened up right away'

Joanna's expanders became infected almost right away.

"Some of my stitches opened right up, and there was just a gross ooze coming right out of them all the time," she remembers. "At the end of the worst part of my infection, I was having pus coming right out of my skin all over my breasts."

At the time, Joanna was living in Toronto with her husband and young son, while most of her friends and family were living out west. She dealt with the trauma of a double mastectomy, chemotherapy, and a pending course of radiation, largely on her own.
Joanna Rankin poses for the camera with a wig, and without, during her cancer treatment. (Submitted by Joanna Rankin)

Sick and weak, she felt unable to stand up to her plastic surgeon, who was convinced that proceeding with the breast implant operation was the best course of action. 

After the implants were in place, Joanna had more infections and complications. Six months after the surgery, she ended up in the ER and underwent immediate surgery to remove one of her implants because it was so infected. Two weeks later, the second implant was removed.

At that point, Joanna wanted nothing to do with implants again; she made the decision to go flat.

She would eventually go on to celebrate and accept her chest, joining a "flat positive" movement that advocates for women who don't want to undergo reconstruction after a mastectomy.

Now, Joanna wonders why she felt so pushed into agreeing to breast reconstruction. She knows her doctors had good intentions but wonders if her young age affected how they approached her case.

In Canada, only about 16 per cent of women who undergo a mastectomy get breast reconstruction surgery, according to the Canadian Cancer Society.

For years, access to the procedure was limited, especially to those living in rural areas, by a lack of access to plastic surgeons.

Over the past decade, there has been a concerted effort by patient advocates and others to change that. 
Dr. Angel Arnaout, a breast cancer surgeon and Ottawa regional director of breast surgical oncology, says that for years women weren't given the opportunity for breast reconstruction following a mastectomy, pushing many women to advocate for that. (Submitted by Angel Arnaout)

"Now, with every patient who is offered a mastectomy, it's mandated that they need to be offered the option of immediate reconstruction," Dr. Angel Arnaout, a breast cancer surgeon and Ottawa region director of breast surgical oncology, told White Coat, Black Art's Dr. Brian Goldman.

The ability to immediately offer reconstruction is now one of several quality metrics used to evaluate cancer care. There is also the pressure to make decisions quickly so that the initial breast reconstruction surgery can take place at the same time as the cancer is removed. That means less overall surgery for a patient who chooses reconstruction.

"Sometimes we've overshot it....We sometimes want to do all of those things for patients without realizing it's not for everybody."

At the same time, Arnaout said, patients need to recognize that just because something is offered, it doesn't mean it is recommended.

"I think they need to understand there are risks to everything."

Arnaout says what happened to Joanna is rare. Less than five per cent of patients who undergo reconstructive surgery end up losing their implant, but she added that infection is a very real risk for all patients.

Feeling flat and fabulous

These days, Joanna teaches in the Department of Community Rehabilitation and Disability Studies at the University of Calgary. She wants to talk about her experience to raise awareness for other women who might be going through something similar.
Joanna Rankin with her sons Ben (standing) and Charlie, after her cancer treatment was finished and she had her implants removed. (Submitted by Joanna Rankin)

Joanna is part of a growing "flat positive" movement, which includes groups like Flat & Fabulous and Flat Closure Now. On its website, Flat Closure Now says they advocate to ensure "breast cancer patients and providers understand that 'going flat' is a valid, beautiful and healthy surgical option after mastectomy."

Like many communities of survivors, these women meet online. That's where Joanna first discovered a photograph of an older woman, a breast cancer survivor, standing in the ocean. A huge octopus is tattooed across her flat chest and over her shoulder. 
Joanna Rankin shows her tattooed chest. She has a swallow tattooed on either side of her chest; they're traditional sailor tattoos that mark the safe return from a journey. (Submitted by Joanna Rankin)

"She just looks so happy and sort of proudly displaying her scarred and flat body. I was really inspired by that."

When I see my friend now, I often see the top edges of her own chest tattoos that poke up under the neckline of her shirt. There are two swallows tattooed on either side of her chest. They are traditional sailor tattoos that mark the safe return from a journey. 

The experience of showing her scarred chest to a stranger was both painful and liberating to Joanna.

"To have that experience of pain that I chose rather than having that medically forced on me was really empowering. And then to create something that I think is beautiful over top of a space that I just felt was so ugly and fraught with emotion — it was empowering to me," she said.

"And now I'm good with that. I feel I reclaimed that space from medical authority. It's my body again. It's part of me." 

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