Breast Reconstruction after Mastectomy; It wasn't what I had expected...but I am so glad I did it

Reading the New York Times Science Section today, I saw that the columnist I love to hate, Jane Brody, had churned out yet another autobiographical column, this time on her knee reconstruction and how she feels about it a year later. Not that knee reconstruction isn't important, but I wonder why Brody doesn't spend more of her autobiographical time on her life as a breast cancer survivor? Then I thought about my own life as a breast cancer survivor, and how there is SO much information out there about treatments, but not so much information out there about living past the treatments. I'm not saying anything earthshattering here - it's a common complaint that there is lots of info on how to survive breast cancer, but not a lot of info on how to LIVE after breast cancer.

One aspect of "living" after breast cancer is an aspect that is still often overlooked by frightened newbie patients, and that aspect is breast reconstruction following mastectomy. Not all breast cancer patients have mastectomies, and of those that do, not all have their breast(s) reconstructed. I know one woman who said that the idea of planning for a life after treatment (i.e., reconstruction) seemed like bad "juju". In other words, she felt that she was jinxing herself by addressing vanity issues when her life was at stake. So, four years later, she is a lovely woman with a breast on one side, and nothing but skin and rib bones on the other. Not a size A breast; NO breast. Nothing.

I think that is sad. And I have to lay part of the blame for the result on her doctors. I was lucky: my doctors led me by the hand and said, "here is what you should consider doing if you are going to undergo mastectomy." I never had to ASK about plastic surgery. My breast surgeon, Dr. S. simply said, "After you see me, you are going to see Dr. A to discuss your reconstruction options." Dr. S paved the way, made it easy, made it seem like part of the treatment.

And in fact, it has been found in some studies that women who HAVE reconstruction at the same time as their mastectomies (this is called "Immediate Reconstruction") have a higher survival rate than those who don't choose reconstruction. Of course, it is not altogether clear whether this higher survival rate reflects a healthier population - one which is healthy enough to endure seven or eight hours of surgery, which is what a mastectomy with reconstruction can take, as opposed to an hour and half - the time it takes to perform a mastectomy without reconstruction.

But perhaps the higher survival rate is due to a sort of "wish fulfillment" - a desire to live beyond the cancer. Or perhaps it is due to a positive outlook - that there WILL be reason to have breasts after all is said and done. Or perhaps having the reconstructed breasts helps the survivor to NOT focus on her illness long after her treatments are over.

Of course, having had immediate reconstruction, I have to admit that this last statement doesn't exactly ring true. My reconstructed breasts do not exactly help me to forget the illness I survived. They don't look like natural breasts - but more like Barbie breasts. They don't feel like natural breasts - but more like extra-firm water beds. They don't sag (that's a good thing), but they also don't bounce (that CAN be a good thing). And sometimes they get in my way when practicing yoga - try putting Barbie into Mari D. It's not enough to twist - I have to twist enough to clear the breasts past my bent knee.

Nonetheless, I am still glad that I chose reconstruction. I look perfectly normal in clothing, and I was able to experiment with different breast sizes before I finally chose to live as a 32B, which was quite a change from 34C, my pre-cancer size. It turned out that smaller reconstructed breasts just looked better on me. Still, it would have been nice if I had more realistic expectations.

Back in the summer of 2002, I was talking excitedly about getting some nice new breasts as part of the whole deal. But in truth, they were never going to be the "nice new breasts" that I envisioned. At best, they were going to be nice new "fake" breasts. At worst, I would be disappointed in their shape, size, contours, whatever. I came across this article from Susan Love's website about unmet expectations in breast reconstruction. I don't remember this article being on Love's website back in 2002, not that it matters: I am not sure if I would have given it much thought, had I read it back then. I simply HAD to believe that I was going to go into my surgery with my 36 year-old, starting-to-sag breasts and come out with some brand new perky "hooters". I HAD to believe it. SOMETHING good had to come out of this mess.

And that was just fine. Because expectations or no expecations, I'm glad I decided on immediate reconstruction after my double mastectomy. I may not have come out of my surgery with stripper-quality boobs, but I also didn't come out feeling butchered. I didn't come out with NOTHING where there used to be SOMETHING. I came out with hope.

So why am I writing this? My hope is that if someone googles "breast reconstruction after mastectomy" and finds this entry alongside Susan Love's, I hope it helps that person to decide to go ahead and GO FOR the reconstruction. No, they WON'T be your old breasts. But they will be something.

YC