You’ll get a new pair: Breast Reconstruction

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You’ll get a new pair: Breast Reconstruction

Post-surgery wound care

“Congrats! You’ll get a new pair,” friends sometimes said when I told them about my breast cancer diagnosis. Cancer clapped back, “not gonna happen.” 

My sisters and I inherited voluptuous breasts from a long line of Polish women, the evidence on display in photos of our grandmothers. Two of my sisters underwent breast reduction surgeries to relieve back and shoulder pain. We were C and DDD cup ladies who frequently compared notes about “five barbell” sports bras and the most supportive options for daily wear, such as duct tape strapped over a Champion sports bra in the days prior to Title Nine Sports. Women sign on for “boob jobs” to approximate what we came by naturally.

It is commonly assumed that, if you are diagnosed with breast cancer, you’ll emerge from treatment with a perky set of new breasts, as though cancer offers an accidental, all-expenses-paid (by insurance) augmentation. This “benefit” probably happens for some cancer survivors, but I don’t know many of them. If a woman receives the proper treatment for Inflammatory Breast Cancer, there is virtually no option for reconstruction until about two years after radiation. The path toward reconstruction, if it is chosen and even possible, is fraught with challenge. 

Both of my natural breasts are gone. Amputated.  Sliced clean away in two radical mastectomies that each left a foot-long, slightly tilted scar bisecting both sides of my chest, winding through my armpits and petering out where the torso rounds into the back. With my chest flat and pulled tight as a drum, there was no skin left to accommodate expanders that are commonly used in reconstruction. Thus, while I was never in the market for a “new pair,” Inflammatory breast cancer put its foot down. Not an option.

Cancer patients spend a good deal of time in rooms like these
Americans fiercely rebuild everything in the wake of destruction; homes, businesses, roads, and bridges. Bodies too. A point of national pride, we refuse to surrender when things seem broken beyond repair. Much good has come of this mindset, but cancer brings its own complications. Not to mention, it is much easier to remove a body part than to create a new one.
 
Many women will choose a breast-conserving surgery but this is not possible for Inflammatory Breast Cancer, in which the malignancy has permeated the skin of the breast. It all needs to go: the breast tissue and as much of the skin as possible. While preparing for my second mastectomy, the cancer was so extensive that the surgeon planned to transfer skin from my back to close the wound. Once in the OR, he was able to pull the skin taut enough to suture while still ensuring clean (ie cancer-free) margins without the added effort to extract a slice from my back. However, when the anesthetic wore off, my chest felt as tight as the strings on a brand-new tennis racket.  Eighteen months and oodles of physical therapy later, I still feel much the same way.
 
Implant-based reconstruction, involving the use of expanders, requires that some skin be spared, which is not an option for IBC patients. Among my friends who have endured expanders, pain is the most common side-effect. The experience of rebuilding the breast hurts a lot more than its amputation and most find it a difficult recovery. A close friend developed an infection in her expander six months after its initial placement. She underwent surgery to remove the expander and remaining breast tissue, leaving her flat on one side.  Even worse, the surgeon was unable to remove the entire expander as tissue and skin had grown around it, leaving her with the remnants of a failed reconstruction.  No new pair for her either.
Exam room with "no cancer" on computer screen
The place where important treatment decisions are made
IBC survivors may be eligible for a flap-based reconstruction which involves removing skin and fat from another part of the body, usually the abdomen, to create an entirely new breast. Because of the intensity of radiation, which often results in oozing burns, this type of surgery is generally not attempted until a woman has had a minimum of 18 months to heal post-radiation. Flap procedures are insanely complex microsurgeries in which transplanted blood vessels must establish connections with chest wall arteries and veins to ensure a stable blood supply. Without it, the transplant doesn’t survive. I have heard horror stories of failed flap surgeries and have learned there is no substitute for the expertise of a skilled plastic surgeon.  Flaps have “died” on a woman’s chest and necessitated removal.  Plus, let’s face it, transplanted abdominal skin may be a mediocre alternative for the natural, female breast.  Stretch marks left by pregnancy are commonly relocated atop a woman’s chest, and I know of one woman whose flap, which came from her lower abdomen, continued to sprout pubic hair. Yes, she shaved her new breast on a regular basis.
 
Nearly two years after my first cancer diagnosis, I underwent a diep flap surgery. I had zero interest in reconstruction and was entirely comfortable wearing a prosthesis. However, the procedure offered my best chance to escape lymphedema because lymph node transplants work best in tandem with a flap-based reconstruction. The surgery took 12 hours and called for a three-week recovery.
 
Lymph nodes in my lower abdomen were moved up to my chest and a good bit of belly fat and abdominal skin (the diep flap) came along to form a new breast. I got a tummy tuck out of the deal, for which I have no complaints, but I was left a 21-inch purple scar twisting from beyond one hip to the other.
red-flowers
When I was first diagnosed with cancer, I never anticipated that I would end up with zero natural breasts and three belly buttons. The day before my flap surgery, I learned I would lose my original navel, which made me sad because this precious bit of tissue represented the primal, in-utero, connection with my mother. The surgeon promised to create a look-alike belly button, constructed from skin at the top of my thigh. He could leave it off altogether but said that patients freaked out if they awoke from surgery to find a smooth torso unmarked by an umbilical indent. Although the first recreation looked great, the surgeon thought it too tight, leaving potential for future problems.  Six months later, during a follow-up surgery, I received a third belly button, which turned out to be a keeper.
 
While in the hospital after the surgery, one of the nurses commented that my flap had come out “pretty,” adding that “most don’t look that good.”  They constantly checked the blood flow as any hint of a problem would demand an immediate return to the OR. Fortunately, my flap settled in without incident and became a decent replica of a real breast.  The great thing about flaps is that they never sag and one needn’t bother with a bra.  There is no sensation in the new breast, which is disconcerting to some who have undergone the procedure. Although I am not inviting an altercation, I could be punched in the chest and not feel a thing.  Six months after the original operation, the surgeon fashioned a nipple from skin on my upper thigh.  At my post-surgery appointment, he beamed with delight, completely satisfied with his handiwork. I am eligible for a 3-D areola tattoo but haven’t done it yet.  Maybe one day.

Almost exactly two years after the flap surgery, I was diagnosed with cancer again.  A second reconstruction isn’t likely because there isn’t enough skin or belly fat to build another breast.  The day before my second mastectomy, the surgeon warned that if he had to use skin from my back to close the wound, it would permanently shut the door on any future reconstruction.   I had to decide right then and there how he should proceed.  That was easy; all I cared about was staying alive.  Get rid of all the cancer and to heck with rebuilding.   

Sliced and diced during four surgeries, my entire torso is a testament to surgical skill; a patchwork of indents, dips, meandering incisions, and pouches of skin that bubble in a “dog ear” under my arm.    I remain reconstructed on the right side and stretched tight and flat on the left. 

Although a woman’s expression of femininity is often associated with her breasts, the scars traversing my chest and abdomen do not change who I am.  My identity as a woman is much more than the sum of my amputated body parts and exists at a place far deeper than the fatty tissue that once resided upon my chest.    I may not look it but I still feel like a natural woman.  

14 thoughts on “You’ll get a new pair: Breast Reconstruction”

  1. Shannnon Parker

    One of the most intimate posts yet. It gives voice to what all women fear and few want to discuss. You did it with such straightforward language and an undeniable sense of courage

  2. Thank you for sharing all that you’ve been through, Clare. I especially like how you ended your piece – we are not our body parts!

  3. I’ll never forget those 12 hours …. you’ve been through so much Clare. I’m grateful for your courage and will to endure!

  4. I appreciate you sharing this blog on your FB page. So well written – I have read little about breast reconstruction as it tends to be glossed over, and I now have a greater appreciation of its challenges, and you’ve caused me to pause and consider the choice we have in our perception of what makes us who we are.

    1. Hello – thank you so much for taking the time to read and comment. Reconstruction is indeed far more complicated than I ever imagined. I appreciate your interest!

  5. Clare, Thank you for giving us a peer into your own journey with IBC. I’m very glad that you are here to write about your experience but was also sad to read at the end that you’re experiencing lymphedema on both sides. If the reconstruction was a way to have lymph node transplant, did it not take?

    1. Hello – thank you for taking the time to read. The lymph node transplant was very successful but my arm got worse when I was on chemo for the second cancer. Currently, my right arm is pretty darned good but I still wear a compression sleeve and glove. The transplant continues to deliver results and gets better with time. Appreciate your comments!

  6. Authentic full disclosure from your heart that beats so bravely behind that flat, scar-mapped chest…. Surely your testimony will inspire and encourage women who face the same or similar brutal surgeries. You are my first-born, and your story is wrenching for me to read. I am proud of your resilience and your courage.

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