Category: Surgery Talk

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 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.

Reoccurrence and the God Connection

No matter how many ways the cancer card is turned, regardless of how I look at its face, being dealt it at this stage in my life is a devastating reality.

I can eat my way back to strength, take salt baths, take light, regular exercise and rest a lot, which is essentially in the hope of assisting all the aggressive treatments of cancer. But it doesn’t change the reality of having had cancer, something which is inevitably leaving its stamp on my whole being.

The questions lingering on my mind are,

“What did I do wrong?”

“What if I had eaten more healthily?”

“What if I had breast-fed each child for longer?”

“What if I had chosen a less stressful life path (worked part-time instead of full-time or even continued on with my extended maternity leave)?”

“What if I had been more of a purist in terms of food (organic versus conventional agriculture), cosmetics (always reading the label to ensure they had zero parabens and whatever else is deemed harmful nowadays), packaging (the use of plastic versus paper)?”


Would I have avoided getting cancer?

There’s the genetic predisposition explanation, which remains unexplored for now but as that journey, separate in itself, unfolds, I intend to write about it in the future.

The feelings associated with having got cancer at my age are surprising me. There’s guilt precisely at not having opted for the purer route. There’s inferiority when looking at other women my age who haven’t been struck. “She won’t get breast cancer because she’s too health conscious or because she exercises so much.” And this brings a feeling of impurity. My body has become diseased, the exact reason for which I am unsure about, and there is a certain sense of failure, above all a bodily failure.

Doctor Arantxa Moreno, the first professional to consult me on breast cancer, said,

“Have confidence in your own body.”

Now I comprehend why she said that. Somehow I think she is aware of how sick people can lose spirit, lose hope, lose confidence and lose vitality, all the qualities absolutely necessary to invest in the long road to recovery from cancer.

Because always at the end of that route exists the possibilities of getting fully better, partially recovering but suffering debilitating consequences, experiencing reoccurrence or not recovering at all.

I am hopeful of a full recovery. I have confidence in my body as I feed it with fortifying foods and drinks everyday. I am gentle with it too, recognizing when I need to just sit or lie down and do nothing or have a long restful sleep. I also believe modern medicine is so advanced that breast cancer, when found early enough, as mine was, can be cured.

I am fortunate enough so far not to suffer any uncomfortable consequences of the mastectomy such as lymphedema in my arm or muscular imbalance in my neck and back often caused by a unilateral breast removal.

However there still remains a small chance that this breast cancer will come back,  either in the same place, in the other breast or will metastasize to a distant location like the bones or the stomach or liver (most likely metastatic sites of breast cancer). If the doctor isn’t willing to give you a guesstimate of your cancer-free survival rate, there are an abundance of tools on the Internet (
It sounds morbid but I’m definitely a person who likes to know the facts. That way I can confront the reality and deal with it in my own way.

But actually I don’t really need a life expectancy predictor from the Internet with its cold statistics. The harsh reality of cancer is revealed to me at every hospital visit. For the most part, there are relatively healthy people like me, I would say, arriving with their mothers or daughters, husbands or wives, doing what must be done to get on with life.  Hopefully these represent the 70 to 90% of “cancer-free survivors” in the next 5, 10, 15 or 20 years.

It’s also impossible to avoid seeing the very sick people. The other 10% who possibly will not survive the disease.  The emaciated woman, wheeled in regularly in a wheelchair by her elderly parents, who one day I was appalled to see being wheeled in by her husband with her four-year old son, perhaps, holding her hand. And the forty-four year old woman, who I met at the beginning of my journey, who has been battling breast cancer, since she got married, eleven years ago. Her prognosis then was good but it still came back after two years. She now has metastatic cancer in her bones and liver and her last hope is to take part in drug trials.

There, but for the grace of God, go I.

So although I’ve not finished this journey to recovery, I’ve already got a glimpse at the possibility of cancer reoccurrence and where that can lead to. I believe there are therapies to help deal with the fear and anxiety caused by this possibility. I must admit, I was in a panic about it for quite a while.

But I’ve relaxed about it all, thankfully. I’ve had the opportunity to properly confront and contemplate my own mortality, which ironically has dissipated the fear associated with that.  I now more fully comprehend and believe my life is in the hands of another entity, God, my Creator and

“Thy will be done on earth as it is in heaven”.

The mysteriousness of suffering on earth is beyond my comprehension but having faith in the path God has paved for me and accepting that cancer is a part of it has made me more aware of the simple joys of life.  My quest now is to slow way down and learn to appreciate and enjoy them more, but not by my own force and energy as I have always endeavoured to do in the past.  I am learning (and faltering at every post so far) to let my Creator flow through me and direct the show that is my life.

And perhaps, I ponder, that is just a small part of the plan.

On Losing a Breast

You know you’re having a mastectomy when you open up your ipad and all the opened tabs are about breast prostesis, lymphedema, orthopedic bras and wound care.

I remember the first time I heard the word mastectomy. I was about 10 years old and my mother’s friend, Margaret, had had a double mastectomy. I imagined with my childish capacity to understand,  this woman having the lumps at the front of her chest sliced off. It caused a momentary disgust, I’m sure, but that was that.

Ever since then, the mention of the word mastectomy has been synonymous with breast slicing without any thought whatsoever to the real implications of that “minor surgical operation”.  I mean why should I have thought any more of it? (Really I amaze myself at my own lack of empathy towards others. )

And then I had my own breast sliced off.  And that’s exactly how my lovely sensitive eight year old boy, Pablo,  could only imagine it as he winced at the idea of his mother being hurt or damaged. Carlos, his father, had the better sense than me to reassure him that it was only a cut to remove the part gone bad, like a rotten apple, inside. That appeased Pablo somewhat.

Like him,  it was difficult for me to imagine how my manipulated chest would look like as I sheepishly asked my surgeon days before she performed that operation.

“Well. .. flat,” she replied.

Of course, how else would it look? I suppose deep down I was really referring to the provision of remaining skin, flappy or not, excess or not, for a possible future “natural” breast reconstruction.

I cried quiet tears that were drained away in the shower the weeks preceding that operation, some were for my breast, some were for the image I was about to lose. (All the other tears were for other things, which I will write about in other posts).  I was imagining the first time I would look in the mirror at my new image minus a breast as I sobbed into the falling water droplets. It’s a technique I realise I use to help me through the difficult moments: imagine in anticipation and cry, cry, cry to my heart and souls’ relief beforehand.

The night before, Carlos took one last photo, one last “before” image of my naked body as it was, having developed over forty years. (When I think of it now, it really wasn’t necessary. How many photos have I got to remind me of how I looked like, looking great in some,  looking not so hot in others? And how often do I pose naked for a photo? Next to never, apart from a few cheeky holiday snaps on a nudist beach in Galicia with Carlos fifteen years ago.  How my body has changed naturally since then. The belly is somewhat less flat – a testament to three healthy pregnancies and enjoying some not so healthy food! And the breasts had dropped, as the consultant plastic surgeon informed me,  much to my mortification, the day he sized me up for a possible silicon breast implant.)

The next morning I was packing my bags with my newly purchased post-operative bra, one that fastens in the front so that it’s easy to tie and with a sewn in pocket on each cup for the soft cushioned post operative prostethic breast, (foobs as they’re called in America – of course), which I hadn’t brought myself to buy just yet.

The morning I was to be discharged from hospital, and only half taking in the instructions on good wound care, I was conscious of my facial muscles twitching and turning up when the nurse hurriedly removed the bandages which were hiding my scar.  I braved a look.  It wasn’t all that bad.  It was one clean looking cut and a very flat chest.  I didn’t cry.

I’m getting used to my new image. I rarely look at myself naked in the mirror, not because I don’t want to but I don’t need to. I’m surprised at how quickly the after shower routine has become a natural part of my daily morning preparations. Briefly it consists of placing a light cover on my now closed wound, which is simply to prevent the unbearable feeling of cloth rubbing across the damaged skin nerves, popping the foob into the breast pocket, tying the bra and then getting dressed.

I take more time than I ever did before to moisturize my skin, put on some light make-up, put on a pair of earrings and a touch of lipstick.  Then, and only then do I look in the mirror, fix up the puckering caused by the seems of the foob and off I go.  From the mirror looking back at me, I hardly notice that I have a fake breast in situ.  So I’m guessing others would have to stare very hard to notice anything amiss.

It will take longer to get used to the internal changes caused by losing a breast, the tingling of my skin, the burning sensation under my arm, the pains in my arm, the coldness across my chest when I swallow anything cold and the phantom twitching in the shadow of my non-existent right breast.

And now that It’s gone, I have never appreciated breasts so much.  As the summer kicks in, I look at the young catalogue girls, modeling the new season’s bikinis.  They really are a beautiful part of the female body, they really are sexy.  Later on they serve a great purpose feeding infants.  My breast has served me well and I really will miss it.