Double Mastectomy Can Be an Art Project?


Breast cancer survivor with the recently discovered PALB2 genetic mutation discusses her upcoming prophylactic double mastectomy with reconstruction.

Why doesn’t the same surgeon who removes the breasts do the reconstruction? Answer: Because it is a conflict of interest. The general surgeon’s goal is to remove as much breast tissue as possible to prevent cancer recurrence. The plastic surgeon’s goal is to rebuild the breasts starting with what is left. Who knew? My plastic surgeon and general surgeon have been generous with their time and very patient—I am a question-asker and note-taker to the extreme.

Is a double mastectomy a “free” boob job? No. A mastectomy is a much larger and more invasive and painful surgery. Stretching the muscles and skin to accommodate the new implants is a long and painful process, and there is often a loss of nipples, sensation, warmth, strength and range of motion. Do not say to someone getting a mastectomy due to breast cancer, “Oh, you are getting a free boob job.” There is a lot of loss.

I am weary, a little sad and a little scared. Still, all of my preoperative appointment doctors thought that a prophylactic double mastectomy is the right choice for my genetics, family and individual breast cancer survivorship situation. These decision affirmations were important and encouraging to me: I trust my doctors. This whole thing is about improving my odds of not getting breast cancer again. It is also to hopefully end up with a body image I can live with when I look in the mirror—by reconstructing my breasts. That part worries me, of course. Are you old enough to remember the television shows The Bionic Man or The Bionic Woman? One of the show introductions went something like, “We can rebuild them. Make them better, faster, stronger…” I would settle for “safer and similar” if we were talking about breasts here.

There are down sides: This will take months. I know there will be loss of feeling, but I remember someone years ago told me that sex happens between the ears and they were absolutely right. My breasts don’t live between my ears. Check. I know my new breasts won’t be warm because they are implants. I am trying to look at this from the perspective that I am usually too warm anyway at this stage of life and medically induced lack of estrogen. Yes, I am talking about chemotherapy, surgical and medication-created hot flashes.

Still, this whole thing is roughly a one-year process, and I am trying to gear up for it. First there will be expanders. They will be gradually expanded to create the pockets for the long-term implants. Then there will be surgery to take out the expanders and install the implants. Next, there will be fat grafting to try to make the whole works look more natural and to conceal anything that needs concealing (ripples, indentations, etc.), and last, but not least, there are procedures and tattoos to create nipples. Wow, what a process for someone who still needs to work on learning patience.

Part of me is actually a little optimistic about the breast reconstruction. My breasts, especially since the cancer lumpectomy, are not symmetrical. Maybe the new breasts will end up more symmetrical? My breasts are not, hmm, as perky as they were in my youth. I am given to understand that the new girls will ride higher and look perkier than my old girls, which tend to sag and each go their own way. That sounds cool. I have also heard that, since the new breasts will be under my chest muscles and held in place by those muscles, that a bra may be optional! No more biting straps and gouging elastic indentations. I would be so thrilled by that!

Mostly, I am going to be relieved to not be carrying ticking time bombs on my chest anymore. Talk about getting something off your chest! I will go from a 30 to 60 percent chance of fighting breast cancer (again) to a less than 10 percent chance. My plastic surgeon clasped my cold clammy hand with both of his warm hands and worded the whole upcoming experience very eloquently. He said to think of this experience as moving beyond a breast cancer mindset and instead into the mindset of this process as an art project—to get to something that I can live with when I look in the mirror in the morning. I get to be an art project! Mostly, I will get to sleep better and move forward with my life, which is really what getting through cancer is all about. I am more than ready for that, and I will keep you posted.

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