PITTSBURGH, Pa -In 2011, Dawn Critelli and her date moved in close to one another. Things were starting to heat up, but before they could continue she needed to give him fair warning.
“I kind of have something to tell you,” she said.
She told him that she was like Barbie, that she had a cross between implants, muscle and lumps of fat instead of breasts. She showed him the scar lining the length of her torso. It told the story of a back muscle repurposed across her chest.
Critelli, a 43-year-old mother of two from Pittsburgh, Pa., was dating after breast cancer. She was first diagnosed at 29.
The American Cancer Society reports that across the nation, a woman is diagnosed with breast cancer every 2.3 minutes. About 227,000 will be diagnosed next year. One in every 220 of those women will be ages 15 to 40. Many of them, like Critelli, will still be on the dating scene.
Breast cancer adds a unique set of obstacles to dating.
“It can be pretty complicated,” said Jennifer Kehm, co-founder of Young Women’s Breast Cancer Awareness Foundation. “You’re watching television and you can’t stop seeing cleavages. ”
Kehm had one of her breasts removed when she was 36. She started her organization to try to help support young women with breast cancer. She tells women that when they look at themselves in the mirror not to focus on what’s missing, but rather on what’s still there.
“I still have my life,” said Kehm. “But for some, breasts are a big deal. They’re beautiful. It’s a part of womanhood.”
She said there are many implications of dating with breast cancer.
“Physically you’re different, and health-wise you’re different,” she said. “Some people back away because they worry about your health. You want to put your best foot forward, and you want that other person to like you but what do you tell them? ‘Hi, I’m Jen, and I just went through chemo’. It takes a lot of courage just to give that information and then you have to figure out when, when is a good time to offer it up?”
Megan McCann, Senior Manager of National Programs at Young Survivors Coalition, an organization that advocates more research and diagnostic tools for women under 40, said that the obstacles of dating with breast cancer are physical and psychosocial.
“There are physical side effects from treatment that may impact a young women’s sex life,” said McMann. “For example vaginal dryness can cause painful intercourse; she may also experience fatigue and decreased libido. Emotionally, though, there are other factors like body image concerns resulting from mastectomy and breast reconstruction, as well as treatment side effects like hair loss and early menopause.”
Critelli, a two time breast cancer survivor, worried that no one would ever want her.
“I was bald,” she said. “I felt deformed. While on treatment I couldn’t taste the salt in my food and sweets were so bland. Not to mention, if a date took me to dinner I was afraid the chemo would make me throw up.”
Married with Cancer
Critelli dated, married and divorced twice since being diagnosed. She was only 29 when she was first diagnosed. Her story begins with an itch that woke her out of her sleep and found under the itch was a lump.
“It was so small,” said Critelli. “You could only feel it if I were laying a particular kind of way.”
Critelli tested negative for BRCA-1 and BRCA-2, two genetic mutations that signal a risk for breast cancer. Both of Critelli’s grandmothers had breast cancer, her aunts had breast and ovarian cancers, and a great uncle had esophageal cancer.
Critelli demanded to have her breasts removed. Doctors turned her down and told her to rethink her decision. They also told her to wait until she was older to get a mammogram. At 29, she was considered too young to get one.
“Younger women have denser breast tissue and this makes mammograms difficult to detect a suspicious mass on the breast,” said McCann. “Currently, there are no effective screening methods for this population.”
“If I would have waited, I may not have been here,” said Critelli. “Because I was young, getting my breasts removed was out of the question. A mammogram wasn’t even entertained. But you have to know how to get what you want in this world. I got my mammogram.”
Critelli got the mammogram, but nothing showed up so she pushed for an ultrasound where they did find a malignant tumor. Critelli’s thoughts raced: her marriage was still new, she had a five-year-old and she was trying to get pregnant again. She said the struggle for women dating or trying to salvage a marriage with breast cancer isn’t about racing the clock to have a baby.
“It’s about telling someone you need to hurry up and have kids, or that you can’t have any more,” she said.
A 2007 study by Demographic Research found that debt, emotional fatigue and possibility of survival were major factors leading to divorce in couples facing cancer. Infertility is on that list. After her tumor was removed, 36 radiation treatments, and the new baby girl she wanted, Critelli got a hysterectomy. She also got divorced.
“He was staying for the kids,” said Critelli. “And then I had cancer so it was like he was stuck. How could he get out then?”
Dating with Cancer
Ten years later, Critelli was four months into a new relationship. One night her new boyfriend felt a large lump near her nipple.
“I told my boyfriend then that this would be a long road,” she said. “I told him my hair would fall out and I would gain weight. I tried to give him an out, but he said he didn’t want one. He just said to get a biopsy.”
Critelli’s biopsy came back saying she had stage-two cancer classified as “triple negative”: that meant her hormones would feed the cancer. But the night before she found out, her boyfriend proposed to her.
“Planning our wedding kept me focused on something positive,” said Critelli. “Thinking about losing hair, and what I would look like after the surgery didn’t matter as much. He even shaved my head and he always told me I was beautiful.”
While making wedding plans, Critelli had her breasts removed. Concerned about her image, she chose to undergo a procedure that would push the fat up from her stomach to form a lump of fat in place of her breasts. The radiation made her skin too tight so she had to take more drastic measures to form breast. The procedure took her Latissimus dorsi, the muscle that wraps from the side to the back, and strapped it across her chest along with two deflated balloon-like sacs. Each week she would get the sacs filled to help expand her skin.
“I was going for at least a B cup,” said Critelli. But the sacs expanded in the wrong direction, expanding inward and cracking her ribs rather than stretching her skin. She would have to settle for an A cup.
“I was completely flat,” she said. “But I had small breast to begin with anyway. Image wasn’t important to me anymore, my kids were.”
Being a new bride, albeit in a wig, also kept her hopes up.
After six months of chemo, 36 more radiation treatments, a mastectomy and a second marriage, she discovered her new husband was addicted to cocaine.
“I don’t think the cancer caused it but I don’t think it helped,” said Critelli. “Addiction is a sickness and he stood by me through mine, so I stood by him through his.”
After two years they got divorced.
Dating after Cancer
A year after her second divorce, Critelli was back on the dating scene, peeling herself away from a moment of intimacy to explain her scars and implants to her newest boyfriend, Rick Macfarlane of Pittsburgh, Pa.
He responded that he didn’t care so Critelli braced him for more.
“I don’t have nipples,” she said.
She explained that to get nipples she would have to take some of her vaginal lining to recreate them. She wouldn’t get the benefit of any sensation so she opted not to get nipples.
“I knew her history,” said Macfarlane. “But I didn’t know about the removal of her breasts before she put it out there, but I’m glad she did do it that way.”
He said it wasn’t awkward and his feelings for her did not change.
A year later they are still dating. Critelli said that with or without breast cancer, dating is about whether or not people see one another for who they are, not their wig.