A cockeyed optimist

Four years ago, faced with one diseased breast and a fairly pessimistic view of what the future held in store for the other one, I made a hasty decision.

"Off with their heads," I joked.

And so it came to pass that I had surgery to remove every last ounce of breast tissue, from the center of my ribcage all the way up through my armpits, as well as quite a lot of the skin that had covered said breast tissue and a strip of fatty tissue containing 18 lymph nodes from under my right arm, leaving only the chest wall (the underlying muscles) and a thin layer of skin covering it.

I have written here before about the pitfalls of mastectomy and reconstruction, but I have never, not once, not for one eensy weensy nano second, ever regretted my decision. Nevertheless, as time has passed, I have grown increasingly dissatisfied with the results of my reconstruction.

See the nice photo above? Yeah, well, welcome to the Magic Kingdom.

It's not my plastic surgeon's fault. I think he did what he could with what was left after the surgical oncologist did her thing. I was too small (here's a disadvantage of being young and thin) for "flap" reconstruction, which forms breasts out of fat and muscle tissue from the tummy or the upper back. And for whatever reason, either I or my plastic surgeon was not eligible for silicone implants. As such, immediately after my surgical oncologist put away her scalpel, my plastic surgeon placed empty saline implants under the muscles of my chest and then injected a small amount of saline to begin the process of expanding my skin to accomodate what I thought at the time would be a couple of C cups.

How wrong I was.

As it turned out saline implants under nothing but muscle and skin have the look and feel of baseballs wrapped in cellphane. The more saline my doctor injected, the worse they looked and felt. So, after sizing all the way up to my originally intended size, I ended up downsizing all the way to what would be a small B, if I were to fit into a bra at all. Try putting a bra around two baseballs, and you'll understand why I never really wear a bra (other than these lacy, stretchy things made by Hanky Panky, which they like to refer to as "softbras", but which we used to call "training bras" back in the days of yore).

And then I went on with my life. Happy to be obsessing over my curls instead of sporting a wig, then a buzzcut, then some really bad bangs, and happy, really, to be bitching about Supta Kurmasana and making the excuse that really, it's all because of the bad boobs.

Enter the lovely and brave Ms. Facing Inward. She has her own story to tell, so I will not tell it here, but suffice it to say that within five minutes of meeting her face-to-face, we were pulling up our tops and comparing notes. Yada yada yada, I made an appointment with her doctor, whom she refers to as The Best Doctor In the World, or something like that.

Last Friday evening, after a really bad traffic pattern involving closures of all of the Central Park transverses and a cab driver who would not under any circumstances follow my instructions, after a rather creepy discussion with a paranoid doorman in a building on the Upper West Side, after a desperate call to MFI, followed by MFI's diligent calling and blackberrying from California to a doctor traveling south from Westchester on the Henry Hudson Parkway, I finally met with Dr. S.

Dr. S explained to me that I did not have to live with baseballs under my skin, that instead, he could remove the saline implants, loosen the scar tissue that had formed and replace the saline implants with silicone implants and place a layer of "Alloderm" between the implant and my skin. Alloderm is cadaver tissue. But what it has is what I need: a nice supply of collagen that my own skin will absorb and integrate to cushion and insulate the implant, creating a more natural look and feel. Dr. S. co-authored an incredibly reader-friendly article that explains it all, if anyone is interested: Breast Reconstruction Using Alloderm.

Eight weeks from tomorrow, I am going for it, once again. I'm nothing if not hopelessly optimistic. Maybe this time....

Oh, and there will be another bit of gratuitous, vanity-gratifying surgical tweaking happening at the same time because these days, I try never to get my breasts reconstructed without doing a little bonus round on some other part of my body. I will leave the details of that to your imagination, should you choose to go there.

Or maybe one day I will reveal it here. We shall see.

YC