To Reconstruct or Not To Reconstruct? That IS the Question.

A good bra has been a central part of my wardrobe ever since, well, I’ve needed one. And that necessity happened to coincide, more or less, with the opening of Dungarvan’s first specialized ladies lingerie shop, Helen’s Boutique. Her bras were more expensive than what had been found before in my hometown, as, in the confines of her little shop at the far end of O’ Connell street coming from Grattan Square, Helen stocked more variety of better brands.

I remember my first fitting and purchase of what seemed like a “granny bra” to me but as my mother couldn’t stress enough the importance of good support and an even better fit, in my young teenage years with my rather large dense breast, I had to sacrifice frills and lace for thick straps and underwires.

The return to Helen’s became an annual affair and gradually as my weekend and summer jobs became more lucrative, I was able to take over the funding of my own garments of breast support. It is a buying habit I continued up until the summer before last, because as I told Helen last year, I have never found another lingerie shop and proprietress to be as consistently helpful and supportive, pardon the pun! The vanilla colored bra for my wedding dress, all my maternity bras, black bras, skin-colored ones, under-wired, strapless, plain t-shirt ones to the feminine lacy kind, I’ve always gone back to buy them at Helen’s Boutique.

So now I’m in to a new bra era: the orthopedic mastectomy bra. It’s really no different from a normal bra except for the pocket it hides away in the cups to accommodate fake silicon breasts, which are easily popped in. I haven’t been able to travel back to Dungarvan yet since my mastectomy in May so I still don’t know if Helen can continue to be my “bra specialist”. In the meantime I’ve found another supplier, who is extremely friendly and accommodating and seems to stock a good selection of very stylish mastectomy bras.

So the not so humble bra remains the central all-important piece of my wardrobe.

The decision to address the “missing breast” issue with an external silicon breast, as opposed to an internal reconstructed one, has of course been entirely my own. It is a very personal decision and requires careful consideration.

When I first approached the centre, which is a separate dedicated cancer unit in the hospital where I’ve been receiving all my care and specializes in breast cancer, I became acutely aware of becoming part of a system of work. After the initial appointment with an oncologist, you are slotted in for all the staging tests. Then, you meet the gynecological surgeon, then the plastic surgeon, then the oncologist and finally the oncological radiotherapist. A whirlwind of information is presented to you in appointment slips and consultations. Once the best plan of action has been determined for your particular case of cancer, surgery first followed by chemotherapy and then radiotherapy, for example, the ball starts rolling into action very quickly.

The decision to have my breast reconstructed with an internally inserted prosthetic silicon breast under my skin was assumed to be accepted by me, I suppose by virtue of the high numbers of patients undergoing this kind of breast reconstruction regularly. And initially I didn’t give it any thought. Reconstruction, yeah, of course. Isn’t that all part of the breast cancer treatment package nowadays?

And then one morning, one of the doctors who I had to see, was delayed and I hadn’t brought anything to read. A quick root around in my bag and I found that grey sheet of paper that I had thoughtlessly crumpled up as reading to be done at some other time. It has turned out to be the paper that has determined my aesthetic fate for the foreseeable future. It was entitled, “Risk Factors of Silicon Breast Reconstruction”.

It listed amongst others, allergies, autoimmune response, muscle damage, infection, septicemia, silicon leakage and the necessity to operate every ten years to change the implant.

In retrospect, I realise these papers are informative and a legal requirement and not necessarily indicative of the reality. I assume statistically more women receive successful breast reconsctructive surgery than not. But at the time, whilst reading all the possible scenarios of how the surgery can go wrong, I became very doubtful about the reconstructive procedure as an option for me. I reached for my phone and began searching for the alternatives to breast reconstructive surgery with silicon implants. (Personally, I would have preferred if my plastic surgeon had presented these options to me himself so that a discussion could have opened up about the pros and cons of the options available. Finding out for oneself via the internet and weighing up the positives and negatives without the support of a professional seems too much like being left to your own devices.)

Well, one alternative is a different kind of reconstructive surgery, a manipulation in the body, which is more “natural” when it comes to acceptance or non-rejection of the implanted matter. This is because the reconstructed breast is “built” out of fat and muscle tissue from ones own body, either from the abdominal area or the back. There are varieties but it is generally called DIEP or TRAM flap surgery. It sounds wonderful, (especially if the fat is coming from the abdomen – hey a tummy tuck and breast augmentation all at once!!!) but the surgery time can take up to twelve hours. And it involves more than a transfer of fat and muscle. There’s blood vessels and circulation to consider too. Not such a simple procedure, I soon realized, and the down side is that the body doesn’t always accept the transferred tissue, despite coming from one’s own body.

The other alternative is not to reconstruct, to go breast free. I first read about this in the waiting room, waiting for the doctor who was delayed, in the throes of my panic about risk factors of silicon breast implants, on the website http://www.breastfree.org. This site contains information about and testimonials from women who have opted for exactly what the website name advertises, going breast free.

It didn’t take much convincing. It is the less popular choice, only 20% of women with breast cancer opt to go breast free. But there is no doubt that it is the safer option. Recovery from the mastectomy itself is easier, virtually pain-free I would testify to and shorter. And there is no question or doubt about whether the subsequent treatments for the actual cancer are compromised. They’re not.

So I chose cancer cure first, reconstruction maybe later. As it is, I’ve missed the boat on the silicon implant reconstructive surgery as that must be decided on before the mastectomy (this is because, a tissue expander has to be inserted during the surgery for removal of the breast and saline solution must be regularly injected in to the missing breast site to create an internal pocket into which the silicon implant can be inserted). I can decide on the flap surgery at a later date.

Going breast free is definitely the less pretty and more inconvenient choice. One is left with a big scar around which anything from fat to scar tissue is likely to form. The images of results of breast reconstructive surgery on the internet are quite impressive. The anxiety and conservative nature of my personality have come even more to the fore for me. And I have trust issues too, I suppose.

I’m the person who, when consulting the two gynecological surgeons for a first and then second opinion, while listening to all they had to say, I found myself examining their hands and nails! Those hands were the hands that were going to be cutting into my skin, touching my interior and sewing me back up. One surgeon had slender hands with long fingers and beautifully manicured nails. She had a presence and calmness about her that I admired. The other surgeon had short stubby hands with nails bitten down to the quick. She had a tired face and rarely smiled.

In the end it was the latter who operated on me because she was part of a system that I trusted more as an entire package. So on accepting the lady with the bitten fingernails, I found myself worrying about things like, why she had bitten nails; if she’s a nervous person, would she have had her coffee before operating on me; so, the time of my operation became an issue for me. As it turned out I was operated on mid-morning. When I was wheeled in to the operating theatre and she looked in to my eyes, smiled and asked, “everything alright?”, I felt like quizzing her on her night’s sleep, her breakfast, the number of coffees she’d had that morning, her partner, her children…

Instead I just replied with a faint half-smile, “yes, everything’s alright”. I thought, I place myself in your hands and I’ve prayed for you this morning. It’s all out of my control anyway so may God be with you.

That’s all the trust I placed in that surgeon. Now I’m not sure I could work up to that level of trust again for a twelve hour breast reconstructive surgery. I’m a fragile being with an even more fragile shell of a body.

For the time being, I prefer to focus my energy on my present image, disfigurement and all, and love it with good moisturizing and sun protection creams.  Invest in the best silicon foobs on the market and a good stylish bras. Buy flattering clothes and pretty earrings.  Exercise and feed my body with wholesome nourishing food.

And re-educate myself and my children about the importance of nurturing a beauty, the kind that shines from the inside out and transforms any face, any smile, any body type into a grace transcendental of any external image.

2 comments

  1. Ana

    Hola Deirdre!
    I think you´re stronger than you believe.
    You´ve been able to make such a difficult and important decision for your life, and be consistent with it…not regret…while others are not able to decide where to take a coffee or wine.
    You are very beautiful, and besides you know always take your inner beauty in all your posts, so you are an example (for me, at least) how to deal with the bumps on the road.
    Remain as you are!!
    Besos. Ana
    P:D: sorry very much for my English.

    Like

  2. Michael Brennan

    Really nice post D, and as always I have so much admiration for your strength in showing your vulnerability, and for being so open about your experience. You’re right in saying that real beauty comes from within.
    Much love,
    Mike X

    Like

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