Cancer log 160: …

Cancer log 160: Reconstruction?

I am not going to put pics of my naked boobs up here, but trust me when I say that the left one basically looks like you scooped out a quarter of it. It's dramatic. I went in for my six-month follow-up with my oncology surgeon today, and she was a) pleased that my mammogram had come back clean, but b) clearly startled by how misshapen my breast was. It was almost funny -- she didn't quite apologize, but you could tell that she felt bad about it, as if she'd failed me somehow.

Lady, you cut out ALL THE CANCER. You are my hero. Please not to worry if you didn't also give me the breast shape of a twenty-year-old in the process. That was not the goal.

She *thinks* the reason it's as misshapen as it is, is because the reduction surgery I had in 2011 affected how the breast responded to her surgery, essentially. A large seroma formed (a collection of fluid that builds up under the skin) after the surgery, and when that went away, it left a missing quadrant, essentially. So she said that she would definitely support my pursuing reconstruction, if I wanted, and she suggested considering a fat grafting procedure. Conveniently, my regular oncologist had already set me up with a consult appointment with a plastic surgeon, so I went directly on to that.

I wasn't really sure what that was going to entail -- I didn't know what he'd suggest, what was possible. There are *many* reconstruction procedures and options, depending on a) your body and b) your surgeon and what he has experience with.

It turned out that what this one wanted to do was fat grafting, a process where he'd take a little fat from my lower stomach (there's some to spare there on me; this is less feasible if you're very thin) and inject it into the breast, where hopefully it would 'take'. It would actually be a series of procedures, probably at least 3 of them, three months apart, because you can't do a lot at once, or the fat will just die -- you're essentially layering it into your flesh, encouraging it to integrate with the blood supply in the rest of the breast.

(In case anyone was wondering, they don't take *that* much from the belly, so mostly, women didn't see a really noticeable difference. Apparently if they take a lot, like an actual tummy tuck, then insurance is more likely to consider this a cosmetic procedure and not cover it.)

I didn't really know what I wanted to ask the surgeon right then, so I said I'd talk it over with Kevin and get back to him. He gave me his card and said he'd be happy to meet again before scheduling the procedure if I had more questions.

I came home and started researching fat grafting. Breastcancer.org has great resources for comparing different reconstruction options, and the forums are invaluable for reading about more details from many, many women. http://www.breastcancer.org/treatment//reconstruction/types

Of course, I have mixed feelings about the whole concept. On the one hand, this is essentially a cosmetic procedure, even if it is covered by insurance. It isn't going to restore any functionality to the breast; in fact, I'm guessing I'll end up with a slightly larger patch of numbness. But mental health is part of health, and I can't deny that the appearance of my breast really bothers me. Is some of that part of this sexist, youth-obsessed culture we live in? Yes, obviously. Would I rather I could just rise above it all, and be completely comfortable in my scarred, aging body? That would be nice. But I don't think I'm really there.

It's weird, because Kevin and Jed seem fine with the malformed breast, and nobody else is likely to see it, unless I run out and start picking up new lovers, which I do not think I have time for, aside from any other considerations. The placement of the missing portion means that it's not that noticeable in a one-piece swimsuit, and I've never worn a bikini in my life. It's fine under clothes, esp. with a bra. So I really could just go along without doing the reconstruction, and nobody but me would care.

But I think I might care. Not least because every time I catch myself in the mirror, coming out of the shower, getting dressed, etc., I'm reminded of cancer. And I would like to forget, a little bit.

I think I need to do another meeting with the surgeon, at least, and ask him questions, now that I know what to ask. Here are some of them (from the site) -- they seem like good questions, although some of them also feel a bit...insulting? Awkward, anyway.

How many reconstruction procedures have you done?
Which types of reconstruction are you most experienced in?
Will I have a new belly scar, or are you able to work with the existing bikini line c-section scars? (Some surgeons do.)
Do you actually take some skin too and make a flap, or are you just plumping out under the big scar? (Which seems less likely to work, but what do I know?)
How long will the surgery take?
What kind of anesthesia will I have?
What will my breast look like after reconstruction?
Do you have photos of similar reconstructions that youve performed?
What results are realistic for me?
How much activity can I do at home?
Will I have to wear compression garments, and for how long?
When will I be able to return to normal activities such as driving and working?

After an hour of reading through women's accounts of fat grafting, I'm still not sure what I want to do. It's a little odd, because on my drive home, I was mostly decided to do it, but on reading the forums, it turns out that the procedure almost certainly requires wearing Spanx-like compression garments for several weeks afterwards, and this feels petty, but I really dislike compression garments. I had to wear them after the reduction surgery, and after the two c-sections, and they're stiff and uncomfortable and sweaty and annoying. And spring is just arriving, and summer is coming after that. I am apparently not particularly worried about two hours of general anesthetic for the procedure, or a week of soreness after the surgery, but I just know that I'd be super-whiny about the compression garment. Also, I have a lot of gardening work that I'm eager to throw myself into, and I'd have to ease up on all of that until recovered from surgery. Is that enough to keep me from the procedure? I don't know.

One thought on “Cancer log 160: …”

  1. I’m confused why you are conflicted due to timing? Surely you can choose when the surgery would be done and could pick a more appealing time (late fall?)

    Is there a time limit for how long insurance would cover it? If so, how long? Could you schedule it, for example, next January when life is otherwise boring?

    It sounds to me you can’t entirely separate how much of you is tempted by the reconstruction for societal pressure and how much is because it reminds you of cancer. Or if it reminds you of cancer but you’re afraid that it might also be societal mores in disguise. You need to do what you want, but if the issue truly is that you don’t want such an explicit reminder of cancer, then the decision is different than a question of beauty.

    You’ll figure it out. I have faith in you.

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