To Have And Have Not

Breasts evoke a lot of complicated thoughts and feelings, especially when they’re yours. They identify us as female mammals, as the bearers and nurturers of life, allowing us to develop a deep and primal bond with our babies. They also identify us as sexual beings, and back up that identity with some of the most sensitive nerve endings and softest skin on our bodies. When they are caressed, they give a great deal of pleasure to both caresser and caressee. So it is no small thing when a doctor tells you that you have cancer in your breast, and that in order to save your life, she has to hack off part or all of one or both breasts. It’s a good thing my breast surgeon is such a sweetie, because I most definitely have a love/hate regard for her. On the one hand, she saved my life. On the other, she mutilated me. But I’m 54, not 24, and that makes a difference in how I feel about the whole ugly adventure.

This is a picture of me at about age 11. I was a serious student of le ballet in those days. When puberty set in, I didn’t change all that much. My teeny starter-boobs didn’t really get a whole heckuva lot bigger. I never developed an hourglass figure or “womanly” curves. I was always taller than everyone. I was evidently built for speed and agility and not va-va-voom.

In high school, I hated my height and lack of curvaceousness, but in college, I began to learn that my body type was actually perhaps the best kind to have in order to grow older gracefully. Honest to god, my body today doesn’t really look all that much different from the way it looked when I was a pre-pubescent ballerina. My breasts are still “perky” and I still don’t really have what you’d call hips. The only thing that was ever in abundance on this body was leg. To a ‘leg man,’ I’m a dream-come-true, and I still look good in high heels and a short skirt. In the last few years, menopause has put an extra 15 pounds on me, but that has only ended up giving me a few of the curves I’ve never had but always wanted. And see those big mitts?? My hands look exactly the same now as they did then, just bigger. Believe me, I give a great massage with those puppies.

‘Course the big difference now is that one of my breasts is half gone. Ever since all the swelling went down after surgery, it has looked sorta like a collapsed souffle. It’s lopsided, it’s flat along the bottom, and it has a big divet on one side. Since radiation, it has shrunk even more, and the pectoralis muscles along my armpit, where I had myself a nice, red radiation burn, have shortened so that it hurts to stretch my arm all the way above my head. Radiation continues to affect your tissue up to two years after you have it, so I have another year and a half of shrinkage and tightness to look forward to.

Plastic Surgery — Or, Dr. Frankenstein Meets ‘Sixty-Minute Makeover’

I don’t like the way my hacked-up breast looks, I admit. And I really don’t like the way it feels. The incision was made along the edge of the aureola, the idea being that once it healed, the scar would be hardly noticeable. Well, that’s mostly true, once you get past the asymmetry and the divet and the lumpiness. But it was incredibly unpleasant having a healing scar in one of the most sensitive square inches of my body. Not to mention the lump of hard scar tissue directly underneath, which is about the size, shape and consistency of a frozen string bean. And I’m lucky to have this much breast at all. When you have a full mastectomy, they remove your nipple altogether, and with it, a lot of skin and normal sensation. So even if you get immediate reconstruction, you end up with an insensate mound of flesh that’s really only good for show anyway. It certainly doesn’t provide the pleasure it once did to the caressee because it is no longer an erogenous zone. However, my nipple is so oversensitive and my breast is so sore and lumpy now, I cannot bear to let anyone caress it anymore, so mine is no longer an erogenous zone either. So, pretty much no matter what option you choose, neurologically and sensually, most breast surgery turns you into yet another accidental amazon.

Miraculously, legislation in this country guarantees a woman’s right to lifelong breast reconstruction after she’s been diagnosed with breast cancer. Sounds good on the face of it, but in reality, the options for plastic surgery are all quite unsavory, in my opinion. If it’s safe to keep any of your breast in the first place, and thus avoid a full mastectomy, you most likely will have to have radiation. Which means that you will have to postpone any reconstruction because your tissue will not be able to heal well from any plastic surgery for at least six months, and you’re a lot better off to wait the full two years. If you sacrifice your entire breast, you can usually avoid radiation and thus you can get “immediate” reconstruction. Those of you who have followed this blog for a while know how I feel about the euphemisms of breast cancer surgery in the first place. Well, here’s another one: there’s nothing immediate about “immediate reconstruction.” Immediate reconstruction means that after the breast surgeon cuts off your whole breast, the plastic surgeon will place an expandable sack of saline in its place, pull what’s left of your skin over it, and stitch it up. This sack is called an expander. The purpose of it is to help stretch the remaining skin gradually, over the next several months, so that your body will eventually add enough skin to permit the plastic surgeon to insert an implant that will be the size of a normal breast. The expander starts off with a small amount of saline solution in it, and every few weeks or every month, depending on individual protocol, your plastic surgeon will inject more saline into it to expand it some more, to prompt your body to make some more skin. After several repetitions of this process, the “exchange” takes place, the surgery in which the saline sack is removed and the permanent implant is placed. Then, you get to decide whether you want surgery to construct and later tattoo a new appendage that looks like a nipple.

Two Boobs Or Not Two Boobs?

If you’re still not alarmed and appalled by this, bear in mind that all of it HURTS a great deal for most women. Think about it. And the alternatives to this are equally unappetizing. Other options involve removing a slab of muscle, fat and attached blood vessels from your abdomen or your back, sliding it all under your skin up to the missing or misshapen breast, and fashioning a new breast out of that tissue. It tends to heal better eventually and feel more ‘natural.’ But it means you have two scars and two surgical sites to heal from, one around your new breast (or “foob” as we call ’em) and one all the way across your abdomen or all the way along your shoulderblade. It also means you will have a muscle missing from your back or belly, which will have a lifelong impact on your strength, posture and body mechanics. If you don’t have to have a mastectomy and you don’t want to look like Dr. Frankenstein has worked on you, you could have a simple implant put into your affected breast. But then you run the risk of developing a capsular contracture around the implant, which is a hard pocket of scar tissue that the body forms around the implant in an attempt to protect you from this “foreign object.” Gruesome.

I admire my courageous sisters who go through the seemingly endless adventure of plastic surgery for breast reconstruction. Some of the end results do look amazing. But since I’m 54 and not 24, I’m not sure I care enough about how I look to go through all that. Honestly, after what I’ve already been through, I wouldn’t let another surgeon near me right now with a twenty foot pole. I just want my poor boob to be left alone! So, in the meantime, I guess I’ll avoid plunging necklines and do my best with my prosthesis.

Please click on the post title or the comment link below to post a response.

This entry was written by Kathi, posted on Tuesday, March 31, 2009 at 08:03 pm, filed under Diagnosis, Recurrence, Screening, Health & Healthcare, Nitty Gritty, Radiation, Surgery & Reconstruction and tagged , , , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

5 Responses to “Boobs-R-Us?”

  1. I can understand where you are coming from. It is basically what is more important to you. I had a friend that did the stomach muscle thing. She did have a hard time getting up because of it. She had both breasts removed, nipple and all. Her breats looks normal, as much normal as you can, except for the scars and no nipples. She contemplated tatoos but I don’t know if she ever did. We lost contact when I moved to Florida.

  2. Interesting coincidence. Over on my Brit Sister’s Blog ‘Alright Tit,’ whose blidget is on my sidebar, she has just had reconstruction surgery on her affected breast & has an infection in one incision. She is 28, not 54. At the end of the post, she admits what I’ve said before, which is how there is no “all clear” with breast cancer. But it’s a good post to read to get another perspective on this subject.

    I’m gonna put a link here in fact:

  3. I read your post with great interest. I too am 54 and facing a bi-llateral mastectomy in a fewweeks. I’ve decided aganst immediate reconstruction (and may never do it)and found your comments to be very helpful.

Leave a Reply