Dr Louise Newson [00.00.00] Hello. I'm Dr Louise Newson, and welcome to my podcast. I'm a GP menopause specialist and founder of the free balance app. My mission: to break the taboos around women's health and hormones, shining a light on the issues we've been too afraid to talk about, from contraception, sex and testosterone to menopause related addictions and beyond. We're covering it all. I'll also be joined by experts and inspiring guests, sharing insights and real stories, as well as answering your questions and tackling the topics that matter to you the most.  

Dr Louise Newson [00:00:42] On the podcast today, I've got Jean Hannah Edelstein, who's written this book called Breasts. We do talk quite a lot about breasts in the podcast. We also talk about her having a bilateral mastectomy and also a hysterectomy and oophorectomy the most important thing, I think from the podcast is our conversation talking about how to be an advocate for yourself. Choose the right doctor and choose the right treatment for you too. 

Dr Louise Newson [00:01.13] Super excited to have you on the podcast today, Jean. I've got lots of I to talk about, but the first thing is about your book, actually, and it's called Breasts. Like, I have never had a book called ‘Breasts’ before in my hands and a relatively brief relationship, so: I just thought we'd talk a bit about breasts initially because I'm relatively flat chested and I've spent my whole life wishing that I had bigger breasts, but I had lots of patients who are really jealous of me being very flat chested and we're all different, with different shapes with different sizes. And certainly, as a teenager, often we go through lots of body dysmorphia, where we're really wanting to be something different and it's taken me decades to realise, this is me. This is my shape. Like I'm never gonna change the size of my breasts, really. But breasts mean different things to different people, don't they? And different cultures as well, actually. So when we're talking, this is very general. This is just like our opinion. But could you just talk me through, like we’ll come on to your personal story, but like, what have your breasts meant to you from when you were a young age? 

Jean Hannah Edelstein [00:02:19] Yeah. I mean, I think that's a really good question. I grew up in the US, as you can tell from my accent, but my mom is from Scotland so I'm a dual citizen, so I did spend a lot of time in the UK when I was young as well and I grew up in the 90s, which I think was like a particular time for girls where there was a lot of talk about women's bodies, perhaps like, you know, sort of like moving towards a world where there was less modesty. But there was, at least in the US and in the UK, to some extent, as well. But there was also a lot of shame coupled with that, so I would say that I remember as a teenager growing breasts, being interested in them, but also being ashamed of them and being aware that dressing to cover them or conceal them felt important in order to avoid negative attention from them. Boys, but also especially adult men you know, as I went through puberty and and had a visible more visibly like female adult body. Even though as far from being an adult that I started to receive that kind of attention which made me really uncomfortable. But I also felt very responsible for it. I sort of felt like. A little bit, I would say you know that like it was a burden of being in a female body to receive this attention, and I had to do my best to avoid it. But if I didn't avoid it, then I felt often guilt and shame around that. I mean, I think one thing that I, you know, I'm the same age as Britney Spears approximately. And during her heyday as she was emerging as this teen pop star. There was so much conversation specifically around her breasts and whether or not she had implants at, and she was like 15,16. I was both sort of fascinated and horrified by it because it was like this media narrative was telling me that the, my body or the body of someone my age was, sort of up for public consumption and discussion.  

And then at the same time, there was this huge emphasis, certainly within the US and this narrative that she was a virgin, you know, that she had never had sex and that she was saving herself for marriage. So that was very confusing as well. Because it was this presentation of this teenage girl same age as me, as an object, as a sex object, as a body to be analysed and discussed by other people, but also a pure body. And that I think was, you know, just a very kind of strange dichotomy that was just sort of omnipresent in the way that I thought about bodies, and I thought about sex, and I thought about my body and my breasts and my friends, I think to greater or lesser extents. 

Dr Louise Newson [00:04.51] Yeah. 

Jean Hannah Edelstein [00:04:52] So, yeah. 

Dr Louise Newson [00:04.53] It's really interesting, isn't it? I've got three daughters, and I think I'm more protective because of them, really. And some of the things that they've had to endure or comments that people have made to them, it was one thing people making comments to me when I was growing up. But somehow it's a whole new level when it's my children. That people have commented on them. And it’s really maybe because I'm a doctor, but some people are like anatomical bodies in my mind, you know, it's, it's really, I don't judge people by the size of shape what they are, but actually people do and it there's a lot of pressure on society. I think sometimes if you haven't got the right breast size or whatever, and I know just recently trying to buy a bra, but I'm realising that there's so much bigger than they were when I was younger. And people are bigger breasted than they used to be, whether that's a good thing or a bad thing or why it is it's a whole different conversation. But it's how people feel and I know my children have gone from ridiculous wearing push up bras with the most padding to try and get the biggest cleavage and now they don't actually wear bras. It’s gone in the completely opposite directions actually and I don't know whether that's just because they feel freer with their bodies. You know, lots of their friends don't wear bras. It's we're not, we're not changing the shape of our breasts for other people to comment or trying to be something or not. I don't know what it's like in the US? 

Jean Hannah Edelstein [00:06:16] You know in the US when you have a Victoria's Secret, I remember, you know, as a teenager, going towards my late teens, starting to shop in Victoria's Secret with friends. Sort of. You know, it was very clearly, in retrospect, clearly being marketed to teenage girls like they knew what they were doing. But I think it's because when you're born, you don't like….obviously you have the, you know, the anatomical configuration that will cause you to grow breasts, but you don't have the breasts and they're the only body part that kind of emerge like that and change your body dramatically.  

And so I understand why both people feel we, you know, a certain level of detachment from them that they don't from an arm or a leg. And also, the way that society views them as kind of malleable in a way that other body parts are not, and I mean I remember thinking as I got into like my, university years and then into my early 20s, then I did have quite large breasts. Which I got, you know, both positive and negative attention for and thinking like, oh, I wish I could just kind of like swap them occasionally for a smaller set so that when I go to the gym or don't want this attention, then I can do that. And then because that was kind of how like the cultural discourse of the fashion discourse talked about for us. But the reality was of course, I couldn't trade them in, or I could, but then it would have, you know, required a lot of plastic surgery. And then I think what was interesting, I moved to London in 2003 to go to Graduate School, and that was very much the heyday of a particular kind of media narrative around plastic surgery. Glamour models like Jordan and Jodie Marsh were very prominent and there was constant discussion about the breast size of various celebrities, magazines trying to remember like Closer, they would run paparazzi photos of female celebrities and like circle, what size their breasts were. Did they look bigger this week? Did they have a boob job? Lots of, you know, just tabloid journalism around, you know, specifically focused around the size of women's breasts.  

Dr Louise Newson [00:08:13] It's really interesting and so moving forwards, obviously you've written your book called Breasts. It's not just about you and your breast size and how you had various experiences. Tell me what happened. 

Jean Hannah Edelstein [00:08:26] So when I was 41, so a couple years ago, I was diagnosed with early breast cancer. Stage 0. DCIS, Ductal Carcinoma in Situ…you can correct me if I’m….

Dr Louise Newson [00:08:38] Yeah, that's exactly right. 

Jean Hannah Edelstein [00:08:40] And that is that the early stage of detectable breast cancer. I live in, so I was in London for nine years and then I live in the United States now and so here because I work for a large corporation, I do have very good health insurance and because of that I was getting regular screening for breast cancer. Because I was considered high risk because I have a genetic syndrome called Lynch syndrome, which increases the risk of a lot of different types of cancer.  

So I went for my normal mammogram. As I said when I was 41, really just expecting it to be the usual and that was when they diagnosed me with this early breast cancer. And then I was quite quickly told that the solution to that would be to have a mastectomy, and so the book is called Breasts, A Relatively Brief Relationship, because in the end I only had breasts for about 30 years and then I had mastectomy in February of 2023.  

Dr Louise Newson [00:09:35] So you had both your breast removed? 

Jean Hannah Edelstein [00:09:37] That's correct. So I had the cancer was found  on the right side and it was quite widespread, so a lumpectomy, was not an option. Because it was just throughout the breast. I had the option of keeping the left breast, but because of my elevated risk, my surgeon was sort of inclined towards me having it, having it removed as a preventative measure also because I did by then this was post breastfeeding two children. I had very large breasts, I think I was a 30F or G at that point and so I can't remember, maybe 32. Anyway, in order to have a single mastectomy and then a reconstruction. I was going to have to have significant surgery to the left side anyway because reconstructing a breast of that size was just not feasible, so I thought about it and it seemed very clear to me. I didn't want to have, you know, I didn't want to go through any more of this. I didn't want to have this concern again and also a relative of mine had had only one side done and was pretty unhappy with the results, so that also influenced by decision.

Dr Louise Newson [00:10:41]  So you have subsequently had reconstruction, but that wasn't initially, was it? So initially you went from having breasts to no breasts. 

Jean Hannah Edelstein [00:10:50] That's correct. So yeah, it all felt, you know very swift. I had the diagnosis at the end of December, I had the surgery in mid-February, so it was about 7 weeks. I think 7 or 8 weeks between diagnosis and surgery, and you know, and I'm sure there will be folks listening to this who have gone through mastectomy as well. It's very shocking. It's an amputation. And of course, I also know that I was fortunate compared to many breast cancer patients and that the surgery was sufficient. I didn't have to go through further treatment, but nonetheless, it's just very shocking to have this part of your body cut off. And I think particularly because I had had this kind of complex relationship with my breasts and it has been interesting since publishing the book. I have, of course you know, had the privilege of speaking to a lot of women about their breasts  

Dr Louise Newson [00:11:40] I’m sure. 

Jean Hannah Edelstein [00:11:39] And how they feel about them, and there's a hugely diverse range of opinions and experiences, but for me I think I had spent this time feeling sometimes tortured by them because of the negative attention I received. But I had come to terms with them over the years and I was in an, you know, I was in a good place with my body and my breasts. I had breast fed my children. That was in itself sometimes a difficult experience. But ultimately, when I was glad that I had, and yeah, and I had this, like feeling of, like, ease and happiness in my body. And so it was it, I felt very angry to be told. That I now had to have them removed.  

I went and had the mastectomy and partially because they wanted to, you know, though they didn't believe that the cancer had spread. They wanted to be absolutely sure of that from the pathology, from the surgery, before doing reconstruction also because my breasts were so large. I think doing reconstruction in one surgery with mastectomy wasn't really sort of technically that's feasible. So yeah, so I had expanders which are placed in the area where the where the reconstruction is happening, which are essential temporary implants that are kind of like a balloon where they start out very small and then overtime you go back to your surgeon's office and they inject saline into them so you can make them slightly larger and it's a very strange it's so strange. You know, I'm sure you're familiar with this, but like or someone I'm, you know, not a physician. 

I don't work in the healthcare industry, so you go in and they literally inflate you and then they say, well, how does that look? And then at some point you say okay that seems fine and then you go for a second surgery where they replace the temporary expander with a permanent implant. 

So it's kind of like having a dress made, I guess. But I mean, that's the closest thing I would describe it to. Like going to a tailor and be like, can you hem that a little bit more, but it's just such a strange and kind of just disembodying experience. 

Dr Louise Newson [00:11:31] And did you feel well supported throughout that process? 

Jean Hannah Edelstein [00:13:34] Yeah, I mean, I would say a mixture. I was very well supported by my family and my friends, um my husband, lost his mother to breast cancer before I met him. And that was a very traumatic episode in his life, and so, I think the impact on him of hearing my diagnosis was very hard, but he was incredibly stalwart and supportive throughout the whole process. I mean, I think I don't really like to talk about my sex life, but obviously like, that was something that came into it. Thats how that would affect that part of our lives? And should I be concerned about should my thoughts around reconstruction or mastectomy concern like how he would feel and you know, his quickly he just was going to support whatever choices that I made and has never made me feel any different in that way. So that was really important. 

Um my family was also very helpful in terms of, you know, coming in and helping with the kids. When I was going through surgery and so forth and in terms of the healthcare providers I worked with, I would say it was somewhat mixed. The surgeon who diagnosed me was amazing, when you have a mastectomy with reconstruction, at least here in the US, you work with both a breast surgeon and a plastic surgeon. They work as a team. After I met with the breast surgeon, I then went on what I would describe as kind of like a Goldilocks, like shopping trip for a plastic surgeon. To find the one that felt right for me and what I wanted, and the first one I met with, I found terrible. His approach seemed to be very he was just very negative about what I could expect and also just kind of, I just felt very dismissed by him. 

Sort of like no acknowledgement of like what I was actually. No acknowledgement. He was clear that he had a cosmetic practise in his surgery as well. But like no acknowledgement, that was not why I was there. I was not there with, you know, a sense of excitement about having the surgery. I was, like, very unhappy about it. And so he was definitely not the right person. He also had me watch a video, which is one of the craziest things I've ever seen, which was, you know, before he even came in. His assistant was like, oh, watch this video. And the video was just felt very a very sort of, like, preachy video. Two women about like now, you're going to have a breast reconstruction, and you should just be accepting of what happens and you'll be happy at the end and there was like a scene of a woman being spoken to by a male doctor and she was just, you know just nodding and he, you know. And then the final scene was a woman who I would estimate was in her late 60s, early 70s, washing a dog in a garden with the hose. 

Dr Louise Newson [00:16:08] Oh god... 

Jean Hannah Edelstein [00:16:09] With a voiceover about like, you know, your life will return to normal, and you'll be so happy. And I was just kind of like what? Whose idea was this?

Dr Louise Newson [00:16:17] That’s very hard isn’t it… 

Jean Hannah Edelstein [00:16:21] And I think a lot of healthcare providers, especially surgeons, to an extent, they're so technically excellent, but they don't necessarily have a lot of space in their brains to also think about the people who they're performing the surgery on. And ultimately, you know, I thought about it a lot. And I was like, I would rather the person doing the surgery be great at surgery, they'd be someone I want to hang out with. That's OK. We don't have to be best friends, but I just do need them to see me, like as a person. 

Dr Louise Newson [00:16:47] Yeah. 

Jean Hannah Edelstein [00:16:48] The second plastic surgeon so I rejected that one. The second one I went to see, then that was kind of funny because he was much warmer and friendlier, but then he started telling me that he would give me some free liposuction while I had the procedure done  

Dr Louise Newson [00:17:01] No way. 

Jean Hannah Edelstein [00:17:02] And that was very funny because he was.. So with reconstruction you have that implant put in and then many women have a fat transfer, which is when they do some liposuction on another part of your body to get some fat, which they then place sort of above the implants and fill it out and make it look more natural because you don't because you no longer have breast tissue. You can finally see the outlines of the implant, so that itself is very normal and I expected it. But he was sort of describing he was like and you know, I can take some extra and just like throw it away. And I remember. And my husband and I were just kind of like starring at him? Like what? What? And he said it like two or three times and he's like, you know, I'll charge it to your insurance because you know, because this is a cancer surgery, insurance would pay for it but a cosmetic surgery? They wouldn't pay for. And I was just like totally bewildered. And then I thought, oh, he's trying to cheer me up with by offering some free cosmetic surgery. But he doesn't know anything about me. Like I don't want cosmetic, I would not choose to do this, I am not interested in this.  

Dr Louise Newson [00:17:57] Gosh, it's very judgmental, isn't it? 

Jean Hannah Edelstein [00:17:59] It was very judgmental and it just felt quite sort of, you know, just making the assumption. Well, women, all women, want to be thinner. So this woman will also want to have liposuction.

00:21:35 Dr Louise Newson [00:18:08] That's terrible. 

Jean Hannah Edelstein [00:18:09] Yeah. And I'm a very, let's say average size person, but like no, I didn't. And there wasn't, you know, so again, I just felt like this person does not see me as a person. 

Dr Louise Newson [00:18:18] As a complete person.  

Jean Hannah Edelstein [00:18:20] So the third surgeon who I found, you know both did excellent work and I felt he was at least making an effort to get to know me. So, I felt comfortable working with him.

Dr Louise Newson [00:18:29] And that is really important. You know, as a doctor, I really keen for patients to feel that their whole person, their mind and their body and all their organs are looked after. There’s so much in medicine, that becomes very siloed. And that’s very difficult for that person, because you do want to be treated as an individual. And that’s crucially important, anything we do, whether it’s a surgery, medicine we are giving, or making a diagnosis. Or what have you. But since you've had the mastectomy, you've also had two other big surgeries as well, haven't you? 

Jean Hannah Edelstein [00:19:01] Yeah that’s true. So, a few days before the book came out, I had a hysterectomy, including, and I can never pronounce this, oophorectomy 

Dr Louise Newson [00:19:09] Oophorectomy, so your ovaries… 

Jean Hannah Edelstein [00:19:11] Yes! Had my ovaries removed as well. So, Lynch Syndrome is interesting because it's first of all, not that well known even though it's actually very common. I think it’s about 1 in 300 people have one form of Lynch Syndrome. It's primarily associated with colon cancer. So having this surgery was something that I was told when I was first diagnosed with Lynch in 2014. That I should have. And I was 33 at the time and I remember you know going in for this, meeting with this geneticist and it just feeling like it accelerated from zero to 100 KM an hour. From ‘oh you have Lynch Syndrome’, to ‘you should have a hysterectomy’. And I was completely overwhelmed, couldn’t believe it. I pushed back and I was able to for many years get some testing done to see if I had any signs of early cancer. But was frequently reminded that the tests done for ovarian and uterine cancer are not that effective and especially ovarian cancer is usually only detected when it's very far along, and so, because of that, this surgery was recommended whenever I completed my family. So yeah, so this in April, late March was when I finally decided to do it. 

Dr Louise Newson [00:20:19] Yeah, which is a big decision, especially when people have preventative surgery. It's almost harder sometimes to make that decision and it and it is very individual, but obviously having your ovaries removed at a younger age also means that many of your hormones have been removed as well. So you are taking some hormones, aren't you? 

Jean Hannah Edelstein [00:20:40] Yeah and I mean I will say, I was very scared of the ovarian removal. You know, I think it was presented to me originally all those years ago, just kinda like a quick and easy solution to this risk. And it really weighed very heavily on me because I knew, what the actual implications of early menopause would be. Then when I had the breast cancer there was some concern whether I would be able to go HRT, but fortunately I was able to connected with an excellent doctor, who, for people with the kind of early stage breast cancer I had, the risk of, increased risk of a recurrence is not significantly increased by hormones and, as she said, she was more concerned about the implications for my cardiac health, my bone health. Then she would be for recurrence of the breast cancer, so she was happy to write a prescription.

Dr Louise Newson [00:21:30] And it's so important to have that conversation really, especially as you're young as well and certainly in many countries, US and the UK, we know that a lot of young women who have their ovaries removed, are not offered HRT. They’re not offered oestrogen, they’re not offered testosterone, they’re not offered progesterone, yet we’ve known for decades, that there are benefits to health but also to wellbeing and symptom control as well. Especially for young women. So it's really important. There's a lot of women even now, have their ovaries removed, and don’t realise that they will be menopausal. I mean, it's obvious when you know it, but if you don't know it. People don't always join the dots. 

Jean Hannah Edelstein [00:22:12] I’ve had exactly that conversation, actually, cause I have some friends who are physicians, girls who I grew up with, who are now women who have been doctors for many years, and I mention that to them, and they said yes absolutely. And I have to say I was frustrated because I had to initiate the conversation about HRT and I'd really had to make several phone calls, send messages, before I was able to get this consultation with this doctor, who works within this world leading hospital where I received my treatment. It's amazing. And you know I’m very lucky to receive care from them. But I was kind of shocked to be honest that I felt like it should have just been part of the pathway there, that if someone is having their ovaries removed, then of course they need to have this consultation. But I really had to get a lot of back and forth, including me saying OK. I just won't do the ovaries and the surgery I’ll delay that for four more years before they were able to sort of like connect the dots and say, oh OK, you can speak to this doctor. 

I would describe myself as someone who, as I said, I have these friends were physicians, I would say I’m more sort of comfortable in a hospital environment, than a lot of people are. I’m well educated in my condition. And still I had to fight for it that much. And so it makes me feel really concerned about other women, to your point who don't even know that they’re about to go into menopause. You don’t know what to ask for. And I'm so glad that you use your platform to talk about it, because I think we just need to talk about it more. 

Dr Louise Newson [00:23:41] You you're absolutely right. And I think you know, we learn from others and that's why it's so important to share experiences. And I'm really grateful for you to being so open about many experiences that you've had, but also you did say about choosing the right doctor for you and I think that is also really important, because a lot of women that I consult with have often been really let down by the medical system and they’ve been given wrong information or information that’s just not right for them. Or treatment choices that they don’t want.  

So I think this is really important, is as we move forwards, that people feel comfortable, with the decisions that they are making. And that it’s done at the right time, because I think that’s important. Everyone thinks, that a treatment offered to them, that they have to either take it now or not. Of course so they can delay treatment choices, it’s great you being so open.  

But just before I end, I'd really like three tips and one of the things that comes through a lot from the book is you are a real advocate for yourself and you're doing what’s right for you and not for others. How do you think, you know, three tips do you think would be really useful for people to learn from. Three messages so that we can all be advocates for ourselves, for our health? 

Jean Hannah Edelstein [00:24:50] Oh that’s such a good question. Number one is take the tests that are offered to you. A lot of women are very afraid of mammograms, which I completely understand. They’re uncomfortable, they’re unpleasant. They can feel violating. But none the less if you are offered a mammogram, do take it. And also if you are diagnosed with dense breasts, then ask for an ultrasound in addition to a mammogram. That’s really important. And if you’re not offered one, but you understand you are of high risk because of your family history, or genetic history, like mine, then ask for it. Ask for what you need. So, I think that’s number one. And if people/hospitals say no to you, then keep asking, because actually I’ve often found, as I said with the example of HRT, repeated asking does get you what you want. You just have to pursue and not be told no.  

The second thing I would say, is get a second opinion, I think we can feel very intimidated by healthcare providers or physicians who tell us things that are upsetting or frightening. You don't have to do anything that just one provider tells you to do. For me, with my diagnosis, of course, mastectomy felt very dramatic. So I went and got a second opinion, encouraged by the surgeon who diagnosed me initially and the second opinion was basically identical to the first opinion which made me feel much better about the course of treatment, and I know some people feel like they're going to insult their doctors by asking, you know, going out and getting a second opinion. And I think a good physician will never take it personally if you want to double check their views with you know one of their colleagues essentially. 

And then I think my third tip would be pay attention to how you feel emotionally and pay attention to your intuition. Actually, a friend of mine recently wrote a really excellent book on intuition. And you know, one of the points that she makes in that is that women are often sort of, through our lives told to doubt ourselves, told that we're being hysterical. Told that we're being too sensitive. And so forth and I think through this whole process, by learning more to listen to my intuition about how I feel, I haven't been able to control the process, but I have felt like more of an active participant in it rather than rather than an object in the process. 

Dr Louise Newson [00:27:09] So important, an active participant, I like that. Thank you ever so much, Jean. It's been really informative. So, thanks for joining me today. 

Jean Hannah Edelstein [00:27:16] Thank you so much, Louise, this is great.