To Reconstruct or Not to Reconstruct, that is the question...

If you are wondering why I did not choose to have reconstructive surgery when I had the mastectomies, I would kindly ask you to scroll down to Hooter Hotline #4, "The Tenth Circle of Hell." It was a big decision. If I had not been faced with wrestling all surgical options personally, I would never have known how complex such a decision is.

At first glance, the concept of reconstruction with implants almost seems expected, the norm. Our culture is saturated with conversations about breast enhancement. It's not difficult to name a dozen celebrities or acquaintances with implants. It makes me think of pleading with my mother for my first pair of blue jeans in the mid-1970s, "Everyone has a pair," I begged. It used to be sort of scandalous to have breast implants, but now it is no different than having a nose piercing or tattoo.

Now that I've been on the other side of the dilemma, I know that I too, have been guilty of assuming, "She has to have mastectomies? At least she can get reconstructive surgery, pick the size she wants and get on with her life." Some how I felt better knowing that women had this option to be "whole again." It sounded so reasonable, so simple, but I was not prepared for the perplexing decision it became. There were more than a few folks, who upon hearing that I was not having reconstruction, seemed shocked that it was not the obvious thing to do.
Just so you are all up to speed, I want to share my rationale for not choosing reconstruction at the time, which happens to be how I feel about the subject today. By the time the pathology from the second lumpectomy revealed that I had widespread ductal insitu, the mastectomy part of the decision was easy, if not a true relief. No more dancing around the "what ifs" of removing one or both breasts. Now I was facing a third surgery by month three of my diagnosis and I just needed to be done and get on with healing. Reconstructive surgery combined with mastectomies requires more recovery time, more pain and a series of fluid injections in the spacers that create the pouch behind the pectoral muscle where the implant will be placed. The uncomfortable creation of the pouches would happen while going through chemo. Uhhhhhhhhhhhhh, I'm thinking chemo will be enough of a challenge without adding insult to injury.

My oncologist mentioned at one of my appointments that a reconstruction patient had actually called in and cancelled her chemo appointment because she was having so much discomfort from her fluid injection the day prior. It might just be me, but something is wrong with that picture. A doctor shared with me the results of a study which found that many women (between 50-60%) are not happy with their reconstructive surgery and regret it. Wow, that is an impressive percentage, certainly big enough for me not make a hasty decision about it because "it's the thing to do." I sought out women that had various forms of reconstruction as well as those without. At work, at Christmas parties, they took me into closets or pantries and showed me their work. They were very honest about what implants were like. I would like to salute the women who were so frank with me. It was such a loving and giving act to let me in on the "secret life" of reconstruction or life without reconstruction. They helped me sort through the fray and ground me with their own reality. One woman said that her implants felt like there was always ten pounds of pressure on her chest.

I remember asking the plastic surgeon to show me reconstruction photos at my consultation. I looked at several women's photos and was struck by how unnatural they looked. There were more incision lines and asymmetry than I had imagined. Some had tattooed nipples, some had salvaged nipples and some had none. Honestly, I don't think they were any less ugly than my current situation. Reconstruction did have some advantages though; restoring a feminine profile, recreating cleavage and filling out undergarments/clothing for a natural look. A breast cancer survivor friend of my gave me her opinion of reconstruction, "They're not the ones God gave ya!" After my brief investigation, it seemed to me that reconstruction was not necessarily the close substitute for the real McCoy that most folks think. Regardless of whether a woman chooses reconstruction or not, she will have a 4-6 inch swath of numb skin across her chest where breasts once were. My decision not to reconstruct was also bolstered by the knowledge that I could get the surgery done at a later date if I wished.

So what about now? I love the freedom of not wearing a bra every day. I feel kind of "rogue" being unabashedly flat-chested. I'll tell you tomorrow about my episode with the silicone prosthesis and why I leave them on the piano..., but now, I can wear any blouse I want without double D's deflecting wardrobe choices. On the other hand, any hint of benefit rapidly evaporates when I pass through a room wearing a lace-trimmed spaghetti strap cami and I catch my husband's gaze shift instinctively where "the girls" had been. My wish in that moment is not that I had reconstructed, but that I could still offer him the soft, sensitive, beautiful set God gave me. My sense is that reconstruction can't measure up to that.