In This Episode
All of us live in bodies. But what happens when those bodies change in ways that rob us of critical life experiences? That’s the question that so many people face after mastectomy. Abdul reflects on the idea of embodiment and the role that healthcare plays in shaping it. Then he interviews Dr. Stacy Tessler Lindau, an obstetrician/gynecologist and scientist designing a bionic breast to help people who’ve lost their breast regain some of the critical functions that they too often lose.
TRANSCRIPT
[AD BREAK] [music break]
Dr. Abdul El-Sayed, narrating: Surgeons transplant a genetically modified pig kidney into a human. Catherine, Princess of Wales, is diagnosed with abdominal cancer. A study finds that two in three kids under six in Chicago have been exposed to lead in their water. Gaza is officially facing a famine, according to the United Nations. This is America Dissected. I’m your host, Doctor Abdul El-Sayed. [music break] Friends, before we get started, a big thank you to all of you have already shared your CME needs with us. But I do want to make one last call. If you’re a health care provider who’d like to earn CME credits just by listening to this podcast, we need to hear from you. So head on over to AmericaDissectedCME.com. That’s AmericaDissected, like the show title, CME.com. All right, on to the show. Every year, nearly 100,000 people lose breasts because of breast cancer, either as a result of a diagnosis or trying to avoid one because of genetic predisposition. Olivia Munn, for example, made news because she was one of the most recent stars out of Hollywood to have had a prophylactic bilateral mastectomy, which is a fancy way of saying she had both of her breasts amputated because of a risk for breast cancer. Because of the misogyny that shaped so much of early medical science, we’ve tended to reduce breasts down to appendages that produce milk. But they’re so much more than that. And if you don’t believe me, ask yourself why women’s breasts are still censored on TV. Is it because they produce milk? I think not. Bodies are odd things. They’re both you and not you at the same time. Hear me out on this. There is to this point, no such thing as life that’s not embodied in the physical thing we call a body. And to other people, our bodies are how they most immediately identify us. And it goes beyond a face. Think about this. Do you think you could pretty quickly identify someone you know well a partner, a parent, a friend? If you were to just walk behind them. Or what about the way you can watch someone you’ve never met before and recognize some of their feelings simply by watching the way they move? We humans can recognize a lot about people through their bodies. It’s why we call it body language, after all. So it should go without saying that our bodies are us. But here’s the paradox. I think for most of us, the experience of living in a body is itself disembodying. As I age, for example, the body I’m occupying changes. There are aspects of it I recognize clearly and aspects of it I don’t recognize all that well. There are days when I wake up with random pain for which there is no identifiable cause. It hurts and it’s clearly coming from within. But I don’t think about it as part of me. I think about it as something imposed upon me by, well, my body. That disembodiment becomes so much more acute when you experience more than just a nagging pain. A few weeks ago, we spoke with Elizabeth O’Rourke [correction: Meghan O’Rourke, not Elizabeth] about her book Invisible Kingdom and the experience of living with an undiagnosed chronic illness. What happens when your body starts to do things that you and others can’t explain, but then take it a step further. What happens when your body is threatening to kill you? What happens when your body, that thing you absolutely need to survive, is itself threatening to kill you? What happens when, in order to save that body that holds you, you have to cut a part of it off. How does that change the way you interact with that body? The way people interact with you or the way that you interact with the world? So much of our interaction with the world is mediated by sensations our body sends us, and they account for so many of the most pleasurable things we experience. The things that give life its joy. Smell of a baby or a freshly cooked pizza, the feeling of hugging your kids or seeing and touching their faces. Sound of your favorite song or a bird in the wild. What happens when, in order to save your body, you have to sacrifice some of those most important sensations it gives you. For people with breast cancer, the experience of a mastectomy can be profoundly jarring. For women, it can strike directly at the heart of how they relate with a fundamental identity, their womanhood. But a breast does a lot more than lactate or be seen by others. Take a listen to how women who had had mastectomies described their experience.
[clip of unspecified woman 1] You know, if you sit on your leg for too long and it falls asleep, and then finally when you’re trying to get sensation, it just feels like you get it aches a little bit, but yet you can’t really feel anything. So that’s how it feels.
[clip of unspecified woman 2] So I wear a prostheses and I’ll forget to put my boob in. [laughter]And I’m like, oh man one side’s lopsided.
[clip of unspecified woman 3] I always feel like I have a tight jog bra on. It doesn’t hurt. It’s not uncomfortable. It’s just there. You know it.
[clip of unspecified woman 4] Driving, putting the seatbelt on sometimes I can’t find a comfortable spot. You don’t feel anything.
Dr. Abdul El-Sayed, narrating: That’s from a video produced by our guest today. She’s been thinking a lot about this challenge for decades. For those who require a mastectomy for breast cancer, it might not be possible to fully replace a breast. But can we leverage science to try to replace some of the most important sensory experiences that breast can provide? Doctor Dr. Stacy Tessler Lindau is a professor of obstetrics and gynecology and geriatrics at the University of Chicago, where she leads the program in Integrative Sexual Medicine and is developing a bionic breast. She joined me to talk more about embodiment, the goals and science behind bionic breasts, and what it means to think holistically about the people she cares for. Here’s my conversation with Doctor Dr. Stacy Tessler Lindau.
Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape?
Dr. Stacy Tessler Lindau: Hi, I’m Doctor Dr. Stacy Tessler Lindau, a professor of obstetrics and gynecology and medicine geriatrics at the University of Chicago. I’m also a scientist.
Dr. Abdul El-Sayed: A scientist and a physician and um and a guest on our show. Just really grateful for you. And also we we were talking before uh we started rolling that we went to the same high school.
Dr. Stacy Tessler Lindau: Go Barons.
Dr. Abdul El-Sayed: Go Barons. This this episode is brought to you by um the now defunct Bloomfield Hills Andover High School. So I want to step back and just, can you give us a, a sense of your work more generally? Um. And how you think about this relationship between, you know, aging and sexual function and the interplay between those two things? And, you know, how it shapes someone’s sense of themselves as they move through life?
Dr. Stacy Tessler Lindau: Yeah. So generally speaking, you know, the the overarching theme of my science for the last 25 years has been to study how social and sexual conditions or factors or functions relate to people’s health across the life course and how people’s health conditions or diseases, or iatrogenesis of the unintended consequences of medical treatment affect people’s social and sexual functioning. So I really had two domains of work. And of course, we can think of sexual relationships as one kind of social relationship or social functioning. My research actually started with the study of sexuality and aging, and I spent the first several years of my career, uh looking at that topic. Believe it or not, when I started this work in 2003, even earlier when I was a medical student, there had never been a national population based study that gave us norms normative data on sexual activities, behaviors, problems function among older adults in the United States. So sort of like the ongoing theme of my career is like scientist of the obvious. Um. You know, we did a large national study with support from the National Institute on Aging, and we established the first normative data on sexual behavior among older adults in the United States. And all of the work in the sexuality domain has really stemmed from there.
Dr. Abdul El-Sayed: I want to ask you, we just had a really great episode with Doctor Emily Nagoski and we were talking just about sex and the way we think about sex in a highly commodified society. And we talked a little bit about um how a relationship uh may change with age, but I want to ask you, how do people’s engagement with and attitudes towards sex and sexuality change as they age? And what might explain some of those trends?
Dr. Stacy Tessler Lindau: I think one of the most important observations from the research and, and my clinical care over the years is that in many ways, older people are just younger people with more years on the planet Earth. You know, even older people who don’t have a partner and maybe even who don’t aspire to sex, and that’s a minority of older people. The even those people would feel that their sexual functioning, the sexual parts of their body are still important to them and part of who they are as a human being. Now, people who are in partnerships as they age are likely to be sexually active. The majority are sexually active. The frequency of sexual activity goes down with age. So it might be, you know, once or twice a week in people younger than 57 in a relationship. And it might be two to three times a month in people 57 and older. Um. Sexual desire can decrease with age in men and women. Men, you know, erectile dysfunction is clearly a condition that increases and in prevalence across age groups. But on the whole, people’s sense of themselves as sexual beings does not change markedly with age.
Dr. Abdul El-Sayed: Hmm. That’s really helpful to understand, because I think about where you sit in your current age, there are two things that are diametrically opposed, but true at the same time, which is you’re as old as you’ve ever been, and you’re as young as you’re ever going to be again. And those two diametrically opposed realities, I think, can play with folks’ mind, because the one nice thing about getting older, as I’ve gotten old enough now to appreciate, is that you you can remember what it was like to be younger, but you will never know what it’s like to be older. And I think that that, you know, from from where a lot of folks listening to this might sit, you have certain assumptions about what it means to age that aren’t necessarily true because they’re entirely assumptions. Whereas when you are um as you get older, you can look back on your life and the contrast, if you’re thoughtful about these things, um gives you a much better sense of like, these are this is how different life stages tend to work. And I say this because I think when we think about older folks, we don’t tend to think about sexuality, and we don’t tend to think about sexual desire as a thing that somebody would want to engage in. And, you know, it’s a really dour way of thinking about your own future if you think about it. Right?
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: Which is like, yeah, when I get older, I’m probably not going to want to do that anymore, which is like, that’s kind of sad. [laughter] Um. It does leave us, I think, um failing to pay attention to the needs of people who I think youth bias, a tremendous youth bias in our society tends um to have a stereotyping in a pretty uh painful and uh unfair way. And your work is really about trying to peel that back and–
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: –ask what the real implications are. But obviously bodies change. And you talked a little bit about that with the erectile dysfunction circumstance. And then certainly there can be more episodic, um circumstances that people face.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: I want to, um ask you the word embodiment comes up a lot in your work, and we’re going to get a further on down to some of the pioneering your work you’re doing around breast prosthetics. But I want to ask you, how do you think about embodiment and why do you feel like it comes up so often uh in your work?
Dr. Stacy Tessler Lindau: Wow, you just said so many things I would love to comment on, and and I do just want to quickly say that I love the way you described um, you know, sort of being young and old at the same time. And we’re always living as long as we’re alive we’re always living, and we’re also always dying, you know. And it the optimist focuses on the living part. You’re also like today, you’re as young as you’re ever going to be. And you’re I always say, well, I’m older than some, but younger than others. And that’s almost always true. My grandma lived to 102. Even she was still younger than some others. Um. The concept of embodiment is one that really has become part of my my lexicon, my daily vocabulary since a patient said to me, really asked me the question what was I going to do about the loss of sensation or the numbness in her breasts after her mastectomy? You know, so if I can just tell the quick story.
Dr. Abdul El-Sayed: Please.
Dr. Stacy Tessler Lindau: I I’m a gynecologist. Uh. For the last 15 years, my practice has been focused exclusively on seeing women and others who who feel gynecologic approach is right for them, but mostly women with cancer who are looking to recover their sexual function after cancer treatment. And if you think about it, the vast majority of cancers that people survive directly affect the sexual organs. So breast cancer would be the most common in women, prostate cancer the most common in men. And then we have the gynecologic cancers. We have the colorectal cancers, we have head and neck cancers, all of these cancer types. And then there are all the cancers that don’t directly affect the sexual organs, but the treatments do. And so, you know, my grandma asked me, can you please explain what cancer and sex have to do with each other? And, you know, this is one way to help people understand that cancer is a is a scary diagnosis. And it oftentimes gets really focused on a single body part. But ultimately the cancer and the cancer treatment can really affect, you know, obviously, our whole body and our feelings about our body, our connectedness to our body. And in the case of breast cancer, where the treatment oftentimes involves one or two mastectomies, with reconstruction to the breast, many women have the experience after reconstruction that their breasts, while they look good in a sweater as one of my patients said, do nothing for them. Now, what’s really interesting and and really a call to action for me is to hear a woman describe, you know, my partner, my husband loves my new breast, my reconstructed breast, and he still engages with them sexually. And my breasts turn him on, but I can’t feel him touch my breasts at all. Can you imagine how strange it would be for another person to draw pleasure from a part of your body that you cannot feel, and from a part of your body you might even feel mad at, you know, or sad about. So this really helped me understand what is embodiment. Embodiment is both the physical and psychological belief that a part of one’s body belongs to them. And and there are many circumstances in which people may may feel disconnected from their body. But the most obvious cases would be, you know, the amputation of a limb and and replacement with a prosthetic. Does that prosthetic belong to you? What can we do to make it feel that it belongs to you? Or, as many women will call mastectomy, the amputation of the breasts and either reconstruction of the breast or the wearing of prosthetics. You know, we can really understand what embodiment means when we talk about amputation and prosthetics. [music break]
[AD BREAK]
Dr. Abdul El-Sayed: And you know it’s interesting because it connects back to that idea of of aging. And I, that’s sort of the other um experience you come to understand. It’s as you get older, you have an implicit contrast with what your body used to be. And I think because there’s a contrast and the thing changes, but the you that you are certain is you independent of your body, doesn’t feel like anything’s changed.
Dr. Stacy Tessler Lindau: Right.
Dr. Abdul El-Sayed: It just the body that you’re in can’t do a lot of the things that it used to be able to do. And, you know, if you are privileged enough to be pretty healthy, that shows up in ways that are like, not as fast, not as strong, not as flexible, more likely to be injured. But if you’ve had an experience like cancer, it’s like, man, that that part of my body almost killed me. And then I had to cut it off. And then now a lot of the things that I used to enjoy about that part of my body aren’t, aren’t really there anymore. And I, I really, actually can’t imagine the experience of disembodiment that that can come from something like that. Uh. Or, you know, if you’ve lost a limb to an amputation, that that sense of like, okay, so my body used to be a certain way, and now it’s missing a pretty important function of itself. And it’s I kind of feel the same, but like, now it just can’t do the same things that it used to be able to do. And I, you know, I can imagine, you know, you take that to its logical conclusion, this experience of dying. Right. Um.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: Which by definition, none of us have had. But you can imagine, like, this is this is me leaving this thing that will ultimately end me on this earth. But, like, here we are. Um. You know, this thing’s dying. But if you’re again privileged enough to keep your cognitive capacities through the end of your life, that’s got to be a crazy experience. But I really appreciate the point that that you made in the connection, you know, to to answer your grandma’s question between sex and cancer, which is that cancer takes away a lot of aspects of what used to make your body what it was or what you got used to.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: And particularly when you think about the experience of, of sex, that is, that is a, a deeply embodied thing. Right? Um.
Dr. Stacy Tessler Lindau: Yes.
Dr. Abdul El-Sayed: That is a very physical expression of a certain set of emotions. And, you know, you can imagine the context here. I want to ask you, you know, you guys got to working on this idea of a, of a bionic breast. I want to understand it both from its object oriented capacity. What do you what are you trying to get out of this? Like what is it that this is going to accomplish for somebody and how does it do that? And then the technical question of like, all right, so how do you actually build something like this that can offer that kind of sensation, which is, you know, if you think about a sort of a, a sexual sensation, it’s it’s not an on off thing. It’s a very um sensitive piece which, which implies a whole lot of very complex, you know, neuronal entanglement. So um.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: Give us the goal. And then and then how you guys are achieving that goal.
Dr. Stacy Tessler Lindau: Yeah. The goal of the bionic breast project in the long run would be to fully restore all the functions of the breast after mastectomy. If we read medical textbooks, the breasts have one function and that is lactation. Very little is written about the other 72 verbs women would use to describe the functions of their breast. But after lactation, one that most women could describe would be the sexual functioning of the breast, especially the nipple-areolar complex. Now, while the nipple-areolar complex and the nipple itself for most women is an erogenous zone, a point of sexual pleasure. Some women will experience nipple erection, other women won’t. And it doesn’t seem there’s any correlation between the erection ability of the nipple and women’s pleasurable sensation from the breast. But scant little is written or known or talked about. I mean, when’s the last time you said the phrase nipple erection? You know, it just doesn’t happen very often. Even surgeons, you know, operating on women’s breasts and reconstructing women’s breasts, best we can tell from studies with women and and reading studies with surgeons is that this phrase doesn’t even get uttered. So our goal ultimately is to restore the full functioning of women’s breasts. And we draw our inspiration from penile scrotal transplant procedures. So did you know that worldwide there have been four or five at my last count, complete penile scrotum transplants?
Dr. Abdul El-Sayed: I did not know this.
Dr. Stacy Tessler Lindau: Right. So unless you go digging, you might not know.
Dr. Abdul El-Sayed: Wait, when you say transplant, you mean literally.
Dr. Stacy Tessler Lindau: From one person to another. Yeah.
Dr. Abdul El-Sayed: Wow. Okay.
Dr. Stacy Tessler Lindau: And in all cases, I mean, one can imagine, you might think, oh, maybe this is some kind of gender affirmation procedure or something, but no, these were all cases of trauma. I think one of the cases may have involved a penile cancer, which is an extremely rare condition that’s less than 1% less than 0.1% compared to breast cancer, which is a very common condition. And um hundreds, you know, I don’t know how many millions of dollars. I’ve actually tried to figure it out, but let’s call it at least tens of billions of dollars have been invested in the technology, the procedures, the science to enable penile scrotum transplant in men. And what are the measures of success of that procedure? Well, cosmetic appearance is one. And in fact, one man had his transplant removed after the procedure when he and his partner could not cope with the appearance of it. Okay, so a cosmetic or esthetic outcome is important, but it didn’t stop there. The other measures of success of the procedure were restoration of sensation, sexual function, erectile function, urinary function, and embodiment. That was one of the scientific outcomes of these procedures, that the men felt that this transplanted organ belonged to their body. So we’re talking about a condition that happens in less than 0.1%, probably of an order of magnitude lower than that men a year worldwide. And we’re doing procedures to restore function of this organ, not just its cosmetic appearance, holistically. So we draw our inspiration from that. And we said, well, 100,000 women a year in the United States alone have one or both breasts removed. Millions of women, tens of millions of women worldwide, are living with amputation of one or both breasts. And most of those women have lost all or most of the sensation in their breast. They’ve lost all of their sexual function of their breasts. And many, many other functions have been disrupted. So could we invest some resources in iterating the mastectomy and reconstruction procedures with an eye toward restoring not just the form, but also the function of the breasts? That only seems fair, doesn’t it, when you when you compare it.
Dr. Abdul El-Sayed: I mean, one of the as we were preparing for our conversation today, one of the things that I was thinking a lot about was, you know, increasingly we’re understanding that for folks with certain genetic um predispositions, you actually have prophylactic mastectomy.
Dr. Stacy Tessler Lindau: Right.
Dr. Abdul El-Sayed: And that tends to happen a lot earlier than uh surgical mastectomy for treatment of a cancer or simply because at this point, you know, once you know your risk of cancer is high, there’s there’s a lot of incentive to remove the breast early.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: And you can imagine, you know, you just sort of think of a life and a life without a certain thing. How much more per life loss of that function exists now in folks who didn’t even get cancer, but just had such a high probability of getting it that–
Dr. Stacy Tessler Lindau: Right.
Dr. Abdul El-Sayed: A mastectomy made sense. And so, you know, it does make, a whole lot of sense. And also, you know, the complexity of the organ should suggest that if, you know, if you can have a, a full penile scrotal surgery to, you know, to, to transplant from one person to another, we could do a lot better with breasts. Right?
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: And certainly, you know, thinking about about how far we’ve come in terms of understanding and mapping sensation. That technical piece, though, is one that that I find really interesting. You know, I say it’s not as complex, but, you know, it’s pretty complex. So walk me through what it takes to, to be able to actually return sensation and, you know, not just, you know, touched or not touched, but the kind of sensitivity that is implied in sexual sensation to a breast?
Dr. Stacy Tessler Lindau: Yeah. So we took the inspiration, at least the argument for why we ought to invest in this uh from the male penile scrotum experience, we took the technological inspiration from really incredible science that has enabled restoration of the sense of touch to the prosthetic hand. So my colleague, my late colleague sadly, uh Sliman Bensmaia, a brilliant neuroscientist who passed away at the age of 49 in August last year, ten days after our award came from the National Cancer Institute. So uh–
Dr. Abdul El-Sayed: Mm. That’s awful, I’m sorry.
Dr. Stacy Tessler Lindau: May he rest in peace. Sliman Bensmaia just um worked as part of a team, of brilliant scientists who have come to understand not only how to restore, to provide or endow motor function to prosthetic hands, but to endow that prosthetic limb with um sensory function. Now, that’s a complex problem, because, of course, the hand is is distal from the central nervous system, and the hand which experiences both sort of functional, you know um directive mechanical touch, but also hedonic touch, pleasurable touch. Think about how important the hand is as an intimate organ. The hand also has dexterity, which the breast does not. So as I was, you know, really deeply thinking about my patient who said to me, what are you going to do about the numb breast? Because my loss of sexual function, I can’t get aroused, I don’t have interest, I can’t have an orgasm. And that’s because I cannot feel my breast. What are you going to do about it? And as I’m thinking about what I’m going to do about it, and I’m looking at the literature on nerve graft procedures, on flap procedures, which, you know, there’s been a tremendous amount of work there. And I, I think it’s very, very important. We should have multiple options for how we try to preserve and restore sensation to the breast. But my surgical colleagues will agree that those procedures are a long, long way from restoring the kind of sensation that that women want to experience. And they’re only a subset of people who are eligible for those kinds of procedures. So I was looking around for a bionic man, and I found Sliman Bensmaia, literally, you know, down a few halls or a block away on the campus at the University of Chicago. A colleague in my lab actually saw an article where President Obama fist bumped one of his his robotic um prosthetic limbs. And I called him up and I said, I’m a I’m a gynecologist down the hall. You know, I saw the work you’re doing with hands. I have a breast problem. And I think it’s a lot simpler solution. I think the technology you’re developing could help solve the sensation problem in the breast. And it’s a lot closer to the central nervous system. And it doesn’t need dexterity. And he sort of paused and he said, you know, well how many breasts a year and, you know, 100,000 women, one or two breasts a year in the United States alone compared to, say, maybe 4000, you know, below the elbow amputations a year worldwide. So he said, I agree with you. And I think this is a tremendous way to increase the impact of the work we’ve been doing with people who’ve had limb amputation. So where we are now is we received that funding from the National Cancer Institute in August last year. We are planning a phase zero clinical trial, which means we’ll be implanting uh a device similar to what’s used, an adapted version of what’s used in limb amputees into the chest wall at the time of mastectomy. This device literally has leads on it and a little cuff that’ll wrap around the intercostal nerves where they’re transected or cut at the time of the mastectomy. And then little, very, very thin, almost. Remember the old fashioned phone cord that had a coil, very hair like thin coils will come out through the skin, and women will come in to the laboratory twice a week following their mastectomy, will deliver energy through these leads to communicate to the intercostal nerves. And we will discover what degree, what kind of current, to what frequency, what patterns needs to be delivered into the nerve in order for the woman to feel a pleasurable sensation. Now, this will not likely be sexual sensation. I would be surprised if delivering energy to the the intercostal nerves in the experiments we’re going to be doing now actually give women the sensation of arousal. But it’s not impossible. I mean, it is nerves that branch off the intercostal nerves that ultimately supply the nipple-areolar complex. So we just don’t know I mean mapping of the nerves even in the female breast is uncharted territory. We could be doing just basic anatomy and physiology, and for the first time ever, describe the women’s breast as if it were the Wild West, you know in like the 1800s. So that’s where we’re starting. And once we understand, can delivering electricity into the remaining nerves give a sense of sensation? Can it mitigate pain? That’s one of our other hypotheses that by delivering electricity, we might be able to tamp down post-operative and not even post-operative but nerve related pain, we’re also interested in what it could do for the itching problem that a lot of women have after mastectomy. So that’s the first thing we’re going to do. And then we’ll have to move from there toward, more holistically, restoring not only the sensations, but I want to be able to restore the nipple erection function of the breast. And we should be able to figure that out.
Dr. Abdul El-Sayed: Yeah.
Dr. Stacy Tessler Lindau: Given our discoveries uh and our, our ability to restore function in the penis and, and in other body parts.
Dr. Abdul El-Sayed: Yeah. Well, it’s, you know, it’s a really interesting question because, you know, on the one hand, as I, as I’m hearing you talk about it, the complexity of the innovation of breast tissue, you know, may in some ways actually be more complex than just, you know, penis function. Right? Because the penis is just a, a large blood bag. Right? And once there is a certain sensation, it doesn’t even have to be physical sensation. Right? Then a number of things happen and the bag fills with blood to the point where you have, you know, immense pressure and that’s what causes an erection. Whereas here you’re talking about trying to suss out very, very nuanced feelings from a single nerve and the way that it’s mapped and I’m, you know, even just thinking about, like, to go back to this where you started, where in our medical textbooks, we reduce breasts down to a lactation unit.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: Even that, though, you know, from a hormonal standpoint, is actually also really complex.
Dr. Stacy Tessler Lindau: Yeah.
Dr. Abdul El-Sayed: Right? It’s this sort of oxytocin that drives this milk let down that actually, you know, allows for, the release. You know, there’s so much about what happens when uh an infant will latch on to a nipple and all of the hormonal um cascades that follow on through that. It’s a really, really complex thing. And I have to ask. Right. You know, it’s 2024, people have been getting mastectomies now for um more than half a century. And we are just now getting to this point where leaders like you are forcing us to think a little bit about what it actually means to reproduce uh a lot of the anatomic and physiological function of this part of people’s bodies we’ve been cutting off for a very long time. And I got to ask, like, how much of that is about the implicit misogyny of how we think about women’s bodies and who gets to have sexual pleasure as they age or after an iatrogenic event and who doesn’t?
Dr. Stacy Tessler Lindau: Well. My field, obstetrics and gynecology, is deeply rooted in both misogyny and racism. Many of the technologies that are still relevant in Ob-Gyn practice today were developed by white men, doctors, and enslaved women under terribly painful and disrespectful, to say the very least, conditions. And this this is something I have, I’ve written a little bit about. And really, every ObGyn and everybody who even train does their, you know, their medical student rotation on ObGyn should know. Having said that, I think there are probably multiple forces in society that conspire to a world where actually it’s been, I think more than 300 years since, since mastectomies have been performed, at least as we know them today. And I think there are a number of societal forces that have conspired to result in a situation where our priority has been to restore the form of the breast. Now, why is the form of the breast important? And who is it important to? Yes–
Dr. Abdul El-Sayed: Right.
Dr. Stacy Tessler Lindau: Women care about the appearance of their breast, both clothed and not clothed. But men care too. And I think there’s been because surgeons who’ve done these procedures, you know, over the course of time, the vast majority of people who did these mastectomy procedures and innovated the reconstructions were men, because that’s who populated the the field of surgery. It’s very possible that the best meaning surgeons couldn’t conceive of the importance or even conceive of the functions of the breast. When we ask women, what do your breasts do? First of all, women who’ve had one or both breasts removed can give a long list of words to describe what their breasts do. Because in what many say is, I never appreciated all the things my breasts do until I didn’t have them, you know? And by the way, anyone listening, if you have breasts or you have someone with your in your life with breasts, appreciate your breasts. You know, we spend so much time thinking they’re not perfect. They’re not even, they should be perkier, they should be lovelier, you know, but my patients who’ve had one or both breasts removed would say, appreciate your breasts, whatever they are. I want to share a quote that comes from Vogel and Wainwright, 1969. These were zoologists. I think they were at Duke. And what they said is structure without function is a corpse.
Dr. Abdul El-Sayed: Hmm.
Dr. Stacy Tessler Lindau: Function without structure is a ghost.
Dr. Abdul El-Sayed: Hmm.
Dr. Stacy Tessler Lindau: And I keep that in mind as I think about not just the the pursuit to restore the functions of the breast, but as we think you know, I mentioned at the beginning and you talked about aging. I have a dual appointment, it’s very unusual to have an Ob-Gyn and geriatrics appointment. When I think about my people as whole people, my patients as whole people, they don’t want to be a corpse and they don’t want to be a ghost. We need structure and function. We need form and function. And if people are given the choice, by the way, now that social media enables women who go through mastectomy to talk to each other without the doctor in the room, you know a growing number of women are opting to not reconstruct their breasts after mastectomy. Going flat is what a lot of people would call it, and they’re making that decision in part because the word on the street is they’ll have more sensation in their chest wall than they would if they reconstructed. Now, that’s not the only reason, but that’s one factor that that people consider. So here we have people choosing function over form, you know.
Dr. Abdul El-Sayed: Yeah.
Dr. Stacy Tessler Lindau: I I think it’s um as doctors taking care of people. And I’m sure there are plenty of women surgeons over the years who also haven’t given a lot of thought to this. You know, I just don’t want to make it about hatred of women that we ended up where we are. I think there are a number of factors. But um, if we stop and think about our person as a whole person, the need for both the form and function becomes obvious. And, you know, the White House has just put out a huge call for innovations related to women’s health. It’s a good time to be thinking about how can bionic technology serve the well-being and health of women, not just in the context of cancer, but overall, it’s an exciting time.
Dr. Abdul El-Sayed: Yeah, and it’s about time. We really appreciate you being one of the pioneers in this space. And and joining us to share a bit more about your work, the ideals that drive it and, you know, the really, really cool science underneath it. And we really do hope that uh that you find great success because I know that um there are going to be hundreds of thousands of, of folks who are really going to benefit from it. Our guest today was Doctor Stacy Tessler Lindau. She uh is an obstetrician gynecologist, um and also a geriatrician and a scientist. And uh is leading the work on, developing a bionic breast. Doctor Tessler Lindau, thank you so much for your time. I really, really appreciate you.
Dr. Stacy Tessler Lindau: Thank you so much for having me. It was a great pleasure. [music break]
Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now.
[clip of unspecified news reporter] Doctors in Boston are celebrating after the world’s first successful transplant of a pig kidney to a living person.
Dr. Abdul El-Sayed, narrating: That’s right. Surgeons transplanted a Crispr modified porcine, which is a fancy way of saying pig kidney into a human being for the first time. Richard Slayman, 62 and suffering from end stage renal disease, said he saw it as an opportunity to both get a new kidney and potentially open up an opportunity for thousands of others in his situation. Beyond being an interspecies transplant, part of what makes this so novel is the use of Crispr to modify the genetics of the kidney ahead of transplant. The pig, whose kidney now sits in Mr. Slayman, was bred specifically with 69 different genetic modifications, including deletions of pig genes, additions of human genes, and modifications of genes that prevent the kidney from transmitting certain viruses that pigs can carry into humans. This breakthrough could transform organ transplantation, creating more options for the over 100,000 people currently on the list for a new kidney. 17 of whom die every single day for lack of one. In other news.
[clip of Kate Middleton] In January I underwent major abdominal surgery in London. The surgery was successful, however, tests after the operation and cancer had been present.
Dr. Abdul El-Sayed, narrating: That was the voice of Catherine, Princess of Wales, announcing her cancer diagnosis. Her absence since an abdominal surgery in January, and the subsequent release of a photoshopped image of her with her kids, created quite a controversy over the past several weeks. She appeared in the video to explain her absence, revealing the diagnosis of an unspecified abdominal cancer. This is the second cancer diagnosis announcement in the British royal family in just two months, and has explained much of the speculation that preceded it. Princess Kate is only 42, and her diagnosis highlights a trend we’ve discussed a couple of times previously on the show. The fact that cancer rates among young people are increasing, particularly colorectal cancer, which would statistically be the most likely form of abdominal cancer, though nothing’s been confirmed in Princess Kate’s case. We wish Princess Kate and King Charles and all those in treatment for cancer a safe, speedy recovery. A new study published by Johns Hopkins and Stanford found evidence that upwards of two thirds of Chicago’s children under six, nearly 130,000 kids, are exposed to lead in their drinking water. Those kids are disproportionately likely to be children of color. The researchers used data to assess the proportion of household lead water tests that tested positive for lead, and found that nearly 75% of city blocks had positive tests, possibly exposing nearly two thirds of children under six. That is astounding, considering all we know about the impact of lead and the experience in Flint, Michigan. But it’s also a reminder of how critical infrastructure is for public health. These children are exposed to lead because of piping that, in some circumstances, was installed over a century ago. Chicago, with its 400,000 lead service lines, has more of these than any other city. The city is working to replace them, but given just how many there are, even under the EPA’s proposed rule requiring replacement in ten years, Chicago would get up to 40 years to replace them. 40 years, how many children would be exposed in that time? Meanwhile, it’s Ramadan. During this holy month, Muslims fast without food or water from dawn to sunset. Ramadan is usually a time of reflection. The fasting meant to both remind you of the blessings you normally take for granted, and the suffering of people around the world who don’t have them. I know I speak for myself when I say that this has been the most spiritually straining Ramadan I and most of the people I know have ever experienced, and that’s because the suffering is so vivid. It’s hard to break fast knowing that millions of people in Gaza don’t get to break theirs. Last week, the UN ruled that Gaza is officially on the brink of famine. The UN uses a grading system called the Integrated Food Security Classification with five levels, the worst of them being fullout famine, defined as the circumstance when at least 20% of households face an extreme lack of food. At least 30% of children suffer acute malnutrition, and two adults or four children per every 10,000 people die each day due to quote, “outright starvation or the interaction between malnutrition and disease.” The UN estimates that parts of Gaza could already be in famine, and that it’ll set in in other parts within the next few months. But there’s something about these definitions I always find grotesque. It’s like, are enough kids starving yet? Can we officially call it a famine? It sterilizes the human toll of the devastation. See, famine isn’t a natural situation. In today’s world that has to be inflicted on people through brutal violence, direct or economic. In this case, both. And when it sets in, it consumes people in the most vicious ways. For the past 172 days, Israel’s continuous bombardment has killed 32,000 people, more than 12,000 of them kids. 20,000 more kids have been orphaned. At least 1000 have lost one or more limbs, kids limbs. And now they’re being starved to death as aid trucks await arbitrary entry decisions on the border, and the US constructs a bridge to deliver it while continuing to supply the bombs that created this hell in the first place. We’ve needed a cease fire. Kids are literally starving. That’s it for today. America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emma Illick-Frank. Charlotte Landes mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sara Geismer, and me, Doctor Abdul El-Sayed, your host. Thanks for listening. This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice, and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human, and Veteran Services.
