Breasts, real and otherwise

Waiting two weeks to update the blog is a bad idea! There is now too much to write, so I plan to break it down into a series of theme-based posts. I may also need to institute a regular publication day: the ultimate inspiration is the deadline.

Today’s topic is breasts: real, fake, cancerous, cadaverous and gone. I’ve been ruminating on what to do with the space left by my soon-to-be-missing right breast. In June when I went back east for a consultation, I was told I would foreclose the possibility of reconstruction if I did not get a tissue expander[i] at the time of my mastectomy. After radiation—which begins about a month after surgery and consists of six-and-a-half weeks of daily zaps with some kind of atomic energy to the affected area—the skin will be too taut too stretch. So I was told.

I said I really didn’t know yet about reconstruction; I am constitutionally inclined toward less medical intervention and my breasts are pretty small anyway.

“But you’re still young!” came the response. (Translation: “But think of your match.com profile! ‘Bald, unemployed, cancerous widow with two kids and one breast seeks life partner.’ Good luck with that.”)

There is tacit pressure to replace missing breast(s), and 75-80 percent of women opt for reconstruction. The docs are quick to assure you that insurance will cover it. A 1998 federal law mandates that insurance companies that cover mastectomies must also cover breast reconstruction, along with surgery on the unaffected side, if desired, to make the breasts symmetrical.[ii] While the legislation is generally hailed as a victory for women’s and cancer rights’ groups, I can’t help thinking the plastic surgeons’ lobby is probably the one that actually outsmarted the insurance lobby.  

The plastic surgeons, for their part, are unrestrained in their enthusiasm. The American Society of Plastic Surgeons’ pamphlet Breast Reconstruction Following Mastectomy opens with this salvo: “Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other disease.”

Really? Is? The editor in me is appalled by the flagrant overstatement. Use of the transitive verb implies a statement of fact, when in reality there are many women who loathe their reconstructed breast(s) and/or the process that created it. Wouldn’t it be more responsible for a group of scientifically trained physicians to hedge a bit—to say, for example, “Breast reconstruction can be a rewarding procedure”? or Is often? Or Is generally? I don’t think I’ve ever seen legitimate medical literature use such definitive language about a procedure that, like any procedure, has potential risks as well as potential rewards.

Needless to say, that was just one more irritant that spurred to do my own research and thinking about reconstruction. A friend had a breast fashioned from her own tissue after mastectomy. Like me, she was too thin to use excess tissue from her abdominal area (i.e., belly fat), but the plastic surgeons convinced her they could steal from her buttocks. The resulting ass-boob, as she calls it, looks like a flesh-colored steak was appended to her chest. When she later got the second breast removed, she opted for a silicone implant.

I stumbled onto a self-described rant on a breast cancer discussion board by a “flat” woman. This is not hyperbole: a non-reconstructed double-mastectomy chest is quite a flat chest, and this flat-chested woman was looking for kinship. The replies were amusing and apolitical, so I posted a query, asking for suggestions on how to approach what I thought was an impending decision point.

The responses were lovely. Several women had had explantation, or removal of their implanted breasts, and lamented all that they didn’t know when they got implants—namely, that they have a high rupture rate and can cause discomfort and reduced function. “My pec muscles thank me every day,” one woman wrote.

One woman said a hug feels more intimate with ribcages touching.  

Another waxed philosophical:

“Do you think we are all just sort of who we are underneath our breasts, and if we happen to get cancer and need them removed, who we are just sort of surfaces after a while? As an athlete, I am very happy with how my body floats and glides in the water now. Running is also so much easier!”

One woman recounted a conversation with a plastic surgeon who could not grasp that there is more to consider with breast reconstruction than aesthetics. When asked if women experience pain with the micrografting techniques he does, he said, “The result is really natural looking.” Again she asked about pain and discomfort, and again he boasted about the look of his creations.  

There’s no right decision for everyone. For women with large breasts, being a “uniboober” would probably feel uncomfortable and unbalanced. For many women, losing a breast (or two) adds further insult to the injury of cancer, and the downsides of reconstruction are worth the benefits of restoring some sense of normalcy to their self-image.

Thankfully, I don’t need to make any decisions yet. I met with a plastic surgeon yesterday who told me he doesn’t put tissue expanders in at the time of mastectomy. He prefers to wait at least four to six months following radiation before beginning the process of reconstruction. He told me there is no time limit; he recently did reconstruction on a woman in her 60s who had a mastectomy in her 40s.  

In trying to convince me (unnecessarily) that it’s not a great idea to put in a tissue expander at the time of mastectomy, the plastic surgeon told me implants tend to shift down and outward when they’re done that way. One way to counter this, he said, is to use skin from cadavers. My mind suddenly wandered[iii] and I left my trusty notebook in the good surgeon’s office so I can’t explain exactly how the cadaver skin plays into things.  

As for me, he said I would need both an implant and a latissimus dorsi “flap.” The latter is where they steal tissue from your back if you don’t have enough meat on your belly or butt. At this point, the thought of cannibalizing my back muscles and enduring umpteen more months of surgeries and procedures to make one little insensate lump on my chest sounds about as appealing as liver and Vegemite on toast.

But you never know. I’m looking forward to a “show-and-tell” session in October where women with various types of reconstructed and non-reconstructed breasts will, well, show and tell us newbies what it's really about. Of course I’ve also done some voyeuristic online sleuthing. Hint: my favorite are the flat chests with cool tattoos over their scars. I’ll let y’all do your own google searches.  

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[i] A tissue expander is basically a fancy plastic bag that is placed under the skin of the missing breast and gradually filled with saline solution to stretch the skin; once sufficiently stretched, the saline is usually replaced with a silicone implant.

[ii] More info on the Women’s Health and Cancer Rights Act: http://www.insure.com/articles/healthinsurance/mastectomy.html

[iii]  Here’s where my mind went: Is John’s skin, which we donated along with any other tissue and organs that could be used, now a breast? Fascinating.  

Skyping with Rosie

With Willem and Joy at Fort Flagler State Park

First taxol infusion! I chilled my fingers and toes in hopes of warding off nailbed damage and, more importantly, neuropathy.

Nicki was my taxol companion and ice assistant. She's also Been There. It was a treat to catch up.

Brian and Alder on our evening constitutional. Yes, the weather is always like this. Seattlites are whiners.