“I don’t take any bullshit from anybody. This was different. I hadn’t experienced this before. Whatever I said was brushed aside.”
The healthcare system didn’t always have a place for Richelle. Sometimes, that was made clear on a medical form.
Richelle (she/they) is a non-binary, queer femme living in Queensland who works as a clinical sexologist and diversity and inclusion advisor. Richelle is used to helping organisations understand identity, inclusion and safety. But when they were diagnosed with breast cancer in 2022, they found themselves navigating a system that didn’t always listen to them, recognise their identity or provide a safe space for the LGBTQIA+ community.
When there’s no box for you to tick
Richelle was diagnosed with DCIS (ductal carcinoma in situ) in their right breast after a routine mammogram, with a second tumour detected during an MRI. As they began navigating their care, one medical form gave only two options to tick: male or female. Richelle didn’t identify with either.
“So I drew a box on it,” they said.
When forms don’t give people in the LGBTQIA+ community a way to identify themselves, it can immediately signal, "This is not a safe place for me. I’m not seen, I’m not recognised," says Richelle.
That feeling didn’t stop at the paperwork. During an examination, Richelle heard the surgeon tell another doctor that they would need a single mastectomy, rather than the lumpectomy and radiation originally planned. The surgeon explained that their breasts were "too perky" and there wasn’t enough skin to close after a lumpectomy. Richelle knew straight away that a single mastectomy wasn’t right for them.
“I said, ‘You take one, you take both. I identify as non-binary, so my breasts do not define me.’ That was the first time the surgeon rolled their eyes at me.”
An eye roll speaks volumes
Richelle knew they wanted both breasts removed with an aesthetic flat closure.
“Don’t get me wrong, I loved my boobs. And I rocked a corset. But they’d done their job. They’d fed my three children. And it was just this gut thing that I knew that, for me, I could still be feminine without breasts.”
“I just kept saying to my surgeon, ‘I want an aesthetic flat closure,’ and they’d look at me and go, ‘We don’t call it that.’”
Richelle pushed back.
“I said, ‘I don’t care, that’s what I want.’”
The term made it clear that Richelle wanted a flat chest with a good surgical result.
“The dismissal by my surgeon was the thing that bothered me the most. It was the eye roll. It was so passive aggressive. That was a shock.”
“I’m educated. I’m strong. I’m independent. And I just felt invalidated and unheard.”
Richelle asked a social worker and breast care nurse to help advocate for what they wanted and took their partner to appointments.
“My body, my choice became my mantra,” they said.
Richelle’s decision to have a double mastectomy also sat within their broader family history. Their grandmother was one of 13 siblings, with breast, uterine, cervical and prostate cancers across that generation. Despite this, Richelle wasn’t eligible for genetic testing because cancer seemed to have "skipped" their mother’s generation.
When the outcome feels right for you
Pathology from their surgery showed LCIS (lobular carcinoma in situ) in their left breast. For Richelle, that reinforced that having both breasts removed had been the right decision.
What Richelle hadn’t expected was how they would feel in their body afterwards.
“I didn’t realise how comfortable I would be in my skin after.”
Richelle knows this won’t be everyone’s experience. Their breasts hadn’t been central to their identity, but they understood how breasts can be closely connected to sexuality, arousal and identity for other people. Reconstruction or prosthetics may be important for some, while others may choose to stay flat.
Making care safer for the wider community
Richelle says things are starting to change, with more cancer information now available for the LGBTQIA+ community, but gaps remain. Resources, screening and healthcare services often assume patients are cisgender, heterosexual or comfortable with gendered language.
They believe screening messages should focus on the body parts a person has.
“If you have a cervix, you need a cervical screen, and if you have breasts, you need a breast screen, no matter how you identify.”
Visible signs of inclusion must also reflect how people are treated.
“They can stick a rainbow sticker up, but it doesn’t mean that they’re inclusive and it doesn’t mean that they’re safe,” says Richelle. “Just accessing medical services can be a real nightmare.”
People may need to decide whether it is safe to disclose their identity, whether their partner will be recognised, and whether staff will use the correct name and pronouns.
Ask and listen
Richelle’s professional background helped them advocate for themselves, but they also needed support. Not everyone will feel able to speak up during diagnosis and treatment. They encourage people to take someone to important appointments and find peer support.
“When you can talk to someone who’s had a similar experience, whether that’s a lived experience of an identity or a medical condition, there’s a whole heap of stuff you don’t have to explain.”
Inclusive care needs to be built into forms, information and conversations, rather than left to patients to ask for it. Richelle’s message to healthcare professionals and services is simple: if you’re unsure, ask and listen.