Category: surgery

Boob shopping.

I’m not a decisive person.

Wedding dress shopping, for me, was kind of a nightmare.

I named my youngest daughter ‘Stella’ for a night, woke up the next morning all like, “Nah Josh, I don’t think she’s a Stella. Let’s go with Alice,” and then it took us the rest of that day plus another to settle on a middle name.  But my husband is pretty used to how I roll.

“Well, I better call my mom,” he joked that morning after Stella/Alice was born, “before anyone has anything monogrammed.”

Josh and Alice Jolene
Josh and Alice Jolene

This is why I’ve never wanted a tattoo.  I just know that two months later I would hate it.

I buy shirts that are *so me* for, like, three weeks before I hate them forever.  “Were my eyes closed when I bought this?” I think to myself.  “Who am I?”  (But I have to continue to wear them because WHAT AM I MADE OF? MONEY?)

I tell you this so you will understand my struggle right now.

I’m 99 percent sure that I’m going to go ahead with reconstruction (Always leave a little wiggle room, no?), but now I have to decide how to go about it.  Like what kind of boobs I’m going to get.  That’s a big decision for someone who clams up at the dollar menu.

I had my last Herceptin infusion last week (!!!!!) and after an emotional bell ringing — it was strangely more much emotional than the bell ringing to mark the end of chemo — I headed down one floor for a consultation with my reconstructive plastic surgeon.

Herceptin COMPLETE!  And then I hugged the nurse assistant and had a cry by the elevators.
Herceptin COMPLETE! And then I hugged the nurse assistant and had a little cry by the elevators.

I had only met him once, two days after my diagnosis, and my impression of him was probably influenced heavily by the haze that I was in.  I remember him as being cocky and maybe even a little loud and apathetic.  Nothing is further from the truth.  I mean, Dr. Build-A-Boob (let’s just call him that) is definitely confident but in a surprisingly quiet kind of way.

But first, I met with the fellow.

I had stripped down — and when your boobs are detachable, those have to go too — and covered back up with the hospital gown, and just when I started to get comfortable, in walks the fellow.

He was cute and charming and caring.

I knew immediately that I didn’t want to disrobe in front of him and hugged my gown a little tighter.

This had happened once before, at my last echocardiogram a few months ago.  The technician was a guy about my age but not as cute as this plastic surgeon in training.  At that appointment, I decided to treat it as a social experiment, and as I opened my gown for the ultrasound, I studied the technician’s face.  HARD.  In fact, he’ll probably request to never care for me again.  I don’t know if I was waiting for him to flinch or start crying or run away screaming, but I do know that I was ready to detect even the slightest amount of disgust in his eyes.   To my disappointment (but also really not), I saw nothing.

This time, Dr. InTraining didn’t ask me to disrobe (Thank the good Lord.), and instead sat with me for at least twenty minutes discussing my boob plans and options while I made slightly inappropriate boob jokes.  I had lots and lots of questions (a plus to delaying the surgery until you are past the “I HAVE CANCER??! fog), and he patiently answered them all.  By the time we were done talking, I felt optimistic about surgery and kind of like I had a new friend, and I was stoked that he didn’t ask to see the war zone that is my chest.

Then, he went to get Dr. Build-A-Boob, who definitely would need to assess my situation, which was fine by me.  Dr. BAB is a little older than me, not quite so cute, and frankly, saw what I was working with before they were gone.

What I didn’t anticipate was Dr. InTraining coming back in the room as an onlooker.

So here’s where I’m going to tell you about my two real options.  I basically have to decide between implants and a type of breast reconstruction know as DIEP, where they basically craft new boobs out of skin and fat from your lower belly.  There are pros and cons to each, but in order to give me a real picture of my options, Dr. BAB needed to also take a look at my belly fat, and when he said, “Can you unbutton your jeans, please?” I knew it was going to get real real up in there.

It is embarrassing enough having someone inspect and poke around your belly fat under FLUORESCENT LIGHTS, but to have a bystander involved is downright humiliating.

I uncomfortably muttered things like, “Yeah…haha…chemo made me gain this weight,” “I’m fifteen pounds over my normal right now,” and “I’ve never weighed this much not pregnant.”

So yeah, I was suuuper cool about it.

But Dr. BAB didn’t just, like, see if he could ‘pinch and inch’ or whatever.  He pushed and pulled and squeezed and contorted my little (but bigger than ever before) belly every which way.  At one point, he put his hands on exactly half of my lower stomach and simultaneously squished them together and pulled them out in order to get an idea of how big of a breast he could make out of it.  So I guess he was feeling me up in a way?  Jk.

Anyway, after that emotional trauma, we again went through he pros and cons of implants vs. DIEP.  I am a candidate for both, and I have to be honest, even though the surgery for DIEP is a bigger deal, recovery is much more brutal, and it just sounds kind of gross, I was leaning toward that option.

That is until Dr. Build-A-Boob informed me that he wasn’t sure if he would be able to build me back up to my natural size.

Ahh gee, well, thanks…

But wait, I’LL BE DAMNED IF I HAVE THIS SURGERY AND END UP SMALLER THAN BEFORE.  Oh, hell no.

Is that vain?  I don’t care.  It’s true.  After all this, there is no way in hell that I’m going to settle on a A or barely B cup.

“So you want me to gain twenty pounds?” I ask.  “Cheeseburgers all around in the name of bigger boobs?”

He agreed that that’s a possibility, but I’m not sure it would work.  A cup size of belly fat would, at least, quadruple the junk in my trunk.

And before you go there, my mother-in-law and husband already beat you to it.  Yes, they could use other sources of fat (my badonk), but Dr. BAB doesn’t recommend it.

So what I’m left with is my pros and cons list.

The route to implants starts with expanders — to literally expand my skin and create a space for boobs — that would have to be ‘filled’ every two weeks or so for about four months (I think?).  I imagine that hurts 50 times more than tightening braces, but I don’t know anything about either.  Then it requires a ‘swap’ surgery to replace the expanders with the implants, and surgery every 10-15 years forevermore to replace the implants themselves because implants expire.  Did you guys know that?  Weird.

Although it’s more surgery, it’s an easier surgery, taking only around two hours each time (DIEP takes 10-12 hours!), AND I can go bigger.  I’m not trying to get crazy here, but I can’t swallow being smaller than before after having to deal with so much crap.

But implants are not a perfect fit for me either.  Since they are literally just mounds on your chest — and I have no fat or breast tissue to surround them — they would be just mounds on my chest, and one of the things that currently bothers me most is the concavity of my chest, especially my upper chest.  In fact, it was this upper chest hollowing that led to me considering reconstruction because it is noticeable in a lot of clothes.

This is embarrassing for me to show, but it's the truth of mastectomies.  Check out the concavity and hey there, prostetic!
This is embarrassing for me to show, but it’s the truth of mastectomies. Check out the concavity and hey there, foob!

As far as DIEP is concerned, it’s potentially only one surgery and done.  It uses my own tissue so I wouldn’t have anything foreign in my body and the infection rates are much lower as such.  It would address the concavity and the look is more natural.  Also, the procedure includes a free (??) tummy tuck.  I mean, not that I really need it, but it’s definitely on the pro list.  On the other hand, it would leave a pretty mean scar from hip to hip.

There are lots of other pros + cons, and Dr. BAB really tried to help me nail it down.  Like, in a nice, caring way.  He tried to help me decide which would work better for me, but it was like the time I tried to choose between JTT and Joey Lawrence.  At eleven, I. just. couldn’t.

He told me to go home and discuss it with my family, but what exactly does that even mean?  I tried to talk to Josh about it, but (1) he also doesn’t really know and (2) if he even hints around the visual or tactile benefits of one over the other, I basically accuse him of not caring about what’s best for my health.  Oh Heather, haha.

So what am I supposed to do?  Call my dad?

I know for sure that my mom would support me in not being cool with having a boob job to go smaller so there’s that.  And my mother-in-law definitely has her opinions, but they aren’t usually based on what you would call facts.

It’s been over a week, and this is where I am still.  Unsure and struggling to make a decision.  And it’s not exactly like I’m trying to decide between fajitas or pizza for dinner.  This is just phase one you guys.  Wait until I have to decide what to do about nipples.

A Boobless Year in Review.

The fact that I had to amputate my boobs is hilariously ironic (re: terribly tragic) for two reasons.  For one, I had to cut them off when they were DOING THE ONLY JOB THEY WOULD EVER HAVE: breastfeeding.  (I mean, other than snagging a husband.  Hey-O!  😉 )  But seriously, out of all my years, I was only actually going to put my boobs to use for, like, two of them, and in the middle of THEIR ONLY FREAKING JOB IN LIFE, they decided to try to kill me.  Lazy bastards.

It’s also hilariously ironic (re: decidedly heartbreaking) because my breasts were pretty much my only body parts that I didn’t have a problem with.  They were kind of awesome, really.  Smallish but packed a punch, you know?  Quality over quantity and stuff.  I couldn’t have had buttcheek cancer or carcinoma of the stained teeth?  Or needed an amputation of thigh fat?  (JK.  No cancer is good cancer.  Also, I made those up.)

I think a lot of people wonder why I didn’t have reconstruction.  The truth is that I couldn’t handle it.  It was just too much.

What I'm currently working with.  Also, oh nos!  My boobs on the internets!
What I’m currently working with…  Also, oh nos! My boobs on the internets!  Sorry, dad!

Breast reconstruction IS NOT the same as getting a boob job.  Not at all.  So please don’t, “Well, at least you get new boobs!  YAY!” anyone who tells you that they have breast cancer.   She will be silently cursing you and probably giving you some pretty serious side eye.  Because no.

To my surprise at the time, there are many ways to build new boobs, but they all involve lots of pain and often multiple surgeries for a result that probably won’t ever look natural.  And if you go the implant route, you’ve got to swap those out every ten years or so.  Ugh.

I was all signed up to start reconstruction immediately following the mastectomy.  Like, I had literally signed the consent form and had a plastic surgeon on board.  Then something that the doctor said — that they have to say — just didn’t sit well with me.  There was a ten percent infection risk.

Hey man, that seems high, no?

There is very little time to make such an important decision, and your head is not exactly clear.  I tried to get the breast surgeon to tell me what to do because I also had to decide what to do with the healthy breast (Spoiler alert: I gave it the old chop-off too.) and sometimes you just don’t want to have to make the big decisions.

“If I were your wife, if I were your daughter, what would you recommend?” I asked.

“I would tell you that it’s your choice,” he answered as if he has this conversation dozens of times a week — which he probably does.

“No, I mean, what would you tell your daughter to do?” I repeated with what I thought was an edge of ‘It’s cool; we’re friends here’ in my voice but was probably more akin to hysteria.

“It would be her choice.”

“But you’re a doctor.  This is your specialty,”  I pleaded.

“It’s your choice.”

Gah.

Nope.  I couldn’t handle it.  The thought of anything else (besides the cancer) going wrong was too much.  I just wanted to be healthy.  I just wanted to raise my daughters.  I cancelled the reconstruction.

I’m still not sure if that was the right choice.  But that’s easy to say now that I am healthy and back to raising my daughters.

When I woke up from surgery, I couldn’t look down.  When the nurses came to empty my drains and assess the incision sites, I tilted my head and rolled my eyes toward the ceiling as they pulled back the dressing.

At home, Josh took care of everything.  In the shower, I turned my head and averted my eyes and he washed me.  I studied his face for a tell of how bad it was.  He doesn’t have a very good poker face, but his post-mastectomy face is impressive.

It took me almost a week to look.

I gingerly unvelcroed my sexy new surgical bra and forced myself to look in the mirror.  I couldn’t do it head on so I met myself with half-open eyes.

I was horrified.

It took me much longer to really look.

In the short year since, I have grown used to it.  I don’t surprise myself in the mirror anymore, and I can face myself head on.

20150512_165138

But I do have conversations like this:

“Penny, do you think I’m pretty?”  Yes, I know.  Probably not the healthiest question to pose to my four-year-old daughter, but cancer was a pretty heavy blow to my sense of vanity.

“Yeah!” she responded thoughtfully.  “I like the sparkle on your eyes.”

Then she looked down. I wasn’t wearing my prosthetics.  She reached out her little hand and swept it across my chest.  She rubbed back and forth a few times before looking up at me.

“Mom, even though you don’t have boobs, you’re pretty when you wear your prosthetics.  When you don’t, you’re not.”

I realized that I don’t want my daughter to understand beauty as purely physical or only by conventional standards.

“Why don’t you think I’m pretty without them?”

“Because it looks like you’re dead.  Like someone scraped off your boobs or something like that.  It makes me sad.”

Whoa.

I muster, “It makes you sad to look at my scars?”

“Yeah.”

And, honestly, I can’t argue with that.  It makes me sad too.

Not having boobs isn’t alllllllll gloom and doom though.  In fact, I made a list of all the advantages of the ‘flat and fabulous’ lifestyle.  It’s short because, let’s be real, boobs are awesome.

  1. It doesn’t feel like you’re laying on a speed bump while STOMACH SLEEPING.
  2. My husband can get to second base without me around and/or noticing OR skip that base all together.
  3. I get to say fun things like, “Put mommy’s boobs down now!  They are not toys.  You know that.”
  4. Because they are now considered ‘medical equipment,’ insurance pays for my bras.

    Free bras for daysssss.
    Free bras for daysssss.

Also, although I may not win a wet T-shirt contest, I can do fun things like this.

BoobCollage

Can you pack your husband a picnic with treats as awesome as your boobs?  Or greet him so kindly at the door?  Comfort your daughter with a piece of you and LEAVE IT WITH HER?  (Jk.  I don’t actually do that.  That’s weird.)  A little surprise for the mailman?

I do what I can.

Two months ago, if you would have asked me if I was ever going to reconstruct, I would have told you probably not.  That I finally feel decent again and more surgery sounds sooooo terrible.  That I was okay like this.

More recently, though, I have been having lots of sad boob feelings.  I’m pretty sure it’s because things are returning to normal.  My hair is growing back.  Family dynamics are getting back on track.  It’s just not so cancery around here, you know?

But really, it’s because I don’t feel like myself without boobs.  It’s not as much about vanity as I thought.  It’s more about not feeling comfortable in my body.  You might think this is a stretch, but, in a very small way, I feel like I can relate with Bruce Jenner right now.  I feel like I understand the transgender community in a way that I didn’t before.  Feeling comfortable in your skin is so important.  It can be defining.

As a child, I watched my mother dress in awe.  Her body, her feminine movements were magical, and I couldn’t wait to also have a woman’s body — like her.  With this “haircut” (which I realize is temporary) and without breasts, I feel uncomfortable in my skin.  I feel like that part of my identity has been taken from me, and like Penny, it makes me sad.

It is for this reason that I am now *thinking* about reconstruction.

All of this to say: I have an appointment with my plastic surgeon in a week.  I am now weighing my options and trying to decide if it’s worth all the pain, time off, and money.  I also don’t know if I hope to have enough abdominal fat for a DIEP or not.  Amiright, breast cancer ladies?

Hi, can you tell me where the emergency exit is?

Before all these cancer shenanigans started, I would sometimes wonder how I would do in “the fire.”  You know, like, what kind of stuff am I really made of?  Could I give an ass kicking to whatever it was that threatened me and mine?  Or would I just crumble at the weight of it?  (Am I the only one who has thought about what it would be like to have cancer?  Or to be paralyzed?  To lose a child?)

An unrelated but super cute old pic of Penny "fighting fire."
An unrelated but super cute old pic of Penny “fighting fire.”

To be honest, I’ve lived a pretty cushy life.  I’m not saying that I haven’t had my fair share of adversity and heartbreak, but it’s pretty first world problem kind of stuff.  Middle class white girl stuff.  I’ve never broken a bone, have always had a roof over my head, and if I was ever in any real trouble, which — besides the cancer — I really haven’t been, there’s an army of friends and family who I could rely on for help.

Like these guys.
Like these guys.

I have to say that being in the fire was nothing like I imagined.  I now almost flinch at the constant comparisons of cancer patients to “fighters” or “warriors” or “survivors.”  To me, it implies that we have some sort of control over the outcome if we can just rise up enough, and it implies that those who ultimately die of the cancer somehow “lost” or weren’t good enough.

The way I see it is that the only “battle” that I really fought was with myself…and I’m still fighting that battle, fyi.  Because cancer is the biggest mind eff there ever was.  (Well, I’m sure that’s an exaggeration, and I can absolutely think of worse things, but for me, right now, yes, the biggest mind eff.)  There was nothing I could do about the cancer except to go along with my doctors’ treatment plans.  No amount of positivity would will the cancer away, and for that matter, no amount of kale juice or turmeric or cannabis oil would either.  It was, in fact, my doctors who were fighting that “battle.”  I was merely the battleground.

I heard a lot of “Heather, you are so brave!  I don’t know if I could do it…”

What?  Arrive at your doctor’s appointments on time?  Because if I had ANY choice in the matter, I’d run the other way screaming.  If it was the same either way, I’d choose to never have a day of chemo in my life.  And surgery?  Wouldn’t. Have. Happened.

I actually really appreciated those kinds of kindhearted words.  Don’t mind my internal quips because I really do know people were just trying to build me up…and maybe doing that whole “How would I handle this situation?” thing with themselves.  It actually did give me strength (Thank you!), but I was never really sure how to respond because I didn’t feel particularly brave.  I felt trapped.  I felt forced to do awful, awful things that I didn’t want to do.

Looking back (because five months out from chemo is such a long time), I think I was missing the point.  I think I was being a little hard on myself and possibly you guys.  Just like the cancer “fight” is largely a mental battle, I think being brave is also a mind game.

Sure, I absolutely, unequivocally did not want to have a double mastectomy, but I did it.  And that morning, my only goal of not freaking out was accomplished.  Instead of focusing on what I was losing, I managed to keep my mind on what that surgery was giving me — my life.  I convinced myself that this surgery was pretty much the best thing to ever happen to me (besides my husband, my children, Mmmbop, the Frito Burrito, jeggings, this blog, and my eyelashes growing back).

Thinking back on that, I realize that I am super brave, so take that, fire!  Not only did I send my beautiful breasts to the bad boobie graveyard (RIP, righty.  Screw you, left boob.), but I did it with a smile on my face and a gratefulness in my heart.  I may or may not have — but, for sure, definitely did have — some pretty rough chemo days that I wouldn’t call “brave.”  In fact, I did crumble.

But now I know what that feels like, you know?  The gifts cancer gives are pretty few and far between — it’s categorically an asshole — but if cancer ever did give me a gift, it was the gift  of knowing who I am.  I learned more about myself in this last year than I have in a lifetime.  It was like I woke up and saw myself.  I learned who I love (There are exactly six friends who really, REALLY matter to me.), what I believe in, and even what I like to do.  I learned that I am not so patient, Josh and I really do make a good team, and bald is not my look.  I learned what the fire felt like.  I learned that, even if I crumble sometimes, I am brave.

Still, I don’t want anymore fire in my life for a while or for, like, ever.  So friends, good gifts ideas for my birthday or Easter or next Tuesday are smoke alarms, fire extinguishers, emergency exit signs, etc.  Just kidding.  I’ll take shoes.  (Size 6.)  Besides, you’re probably still trying to figure out if you made the cut anyway.

Let me tell you a story about my best friend.

It’s day five. I was warned that days 5, 6, 7, and 8 would be my worst. I can only say *with fingers crossed* that I am still okay. Tired, achy, unsettled but mostly functional. Still braced. Since I don’t have much news to report and I’m pretty stationary, I thought I’d tell you a funny story that happened in the middle of an incredibly emotional, overwhelming day.

It was a couple of days after my diagnosis before I had my first official cancer appointment.  My husband had already taken off a few days from work.  He was even home the day the doctor called me with the results of my biopsy, which I thought was crazypants because everything was going to be just fine, Josh, thankyouverymuch.  Yeah, I’m glad he was there.  I basically could take no more words from my lovely Ob/Gyn and threw the phone at him, or maybe the wall.  All this to say, we decided that he needed to go back to work and that (one of) my oldest friends Lori would accompany me to meet my surgeon.

The details on how long we’ve actually known each other are shady.  We grew up on opposites sides of an adjoining alley, and I think we’ve been friends since we were four or five-years-old (along with our Christen, who I just can’t fail to mention).  Let me tell you about Lori though.  Lori is very shy.  She is also smart and funny and caring.  The girl has been there for me.  There were bubbles baths (at appropriate ages!) where we washed each other’s backs and tried to guess what words were were spelling on the other’s back.  We, together, struggled to find ourselves in high school.  Sometimes together, sometimes not.  When Taylor Hanson left me brokenhearted by marrying a fan (not me!) at 19, she was there.  I ran to her house in my pajamas the morning after my mom died.

Loriandme

 

I can’t tell you the reality that hit me when we walked in to Barnes, and I saw those huge letters, “Siteman Cancer Center.”  Yes, I am a nurse.  No, I did not prepare for this appointment.  My last few days were full of fear and worry for my daughters.  I couldn’t handle statistics or, really, any other additional information beyond what diagnosis I had already been given.  As we entered and took in my new reality, my friend put her hand on my shoulder.

I can barely remember how my appointment began.  A flurry of words that I absolutely wasn’t ready for.  “Estrogen receptors….FISH test….Grade 2….40% growth rate…two tumors…”  Dudes, breast cancer is not breast cancer is not breast cancer.  As a cardiac nurse, I really didn’t know the scope.  Dr. G. then said, “Well, it’s not the best profile I’ve ever seen, but it’s not the worst,” and excused himself for a moment to take another look at my scans or whatever.

At this point, I was on my way out.  I looked at Lori.

“I think I might pass out.”

I slid out of my chair onto the floor.

“I’m just going to sit down here.  I think I’m going to pass out.”

Lori is often very quiet, and it had been her job to “take notes” for me.  She looked just as bewildered.  On top of that, she knew I was serious.  She had seen me pass out on the first day of third grade when Mrs. Swift announced that I would be line leader.  So. much. pressure.

Miraculously there was a knock, an open door, and a nurse.  She didn’t looked the least bit fazed.

“Umm,” I said straightening up.  “Is there any way I can get some water?”

I got back up.  Dr. G. came back in.  He examined me, and we talked some more.  His serious demeanor scared the bejeezus out of me.  “Hey there doc, can I get a little smile?  An encouraging nod?  I mean, we did just get to second base.  Not your style?  Okay, then.  I guess you’ll just bill me?”  He set me up with a consultation with a plastic surgeon for that afternoon to discuss my options for reconstruction, and off we went.

Although these offices were in the same hospital building, the vibe couldn’t have been more different.  Or maybe it was just Lori and me looking to get rid of some of the morning’s negative energy.  We got settled into our room with a video.  A video all about how to build brand new boobs.  There are more ways than I knew.

Dr. T, the plastic surgeon, entered the room like he was the answer.  I don’t know if it was an immediate feeling or if, over the course of our meeting, Dr. T sensed the level of commitment Lori and I have for each other, but at first he spoke to me about my options.  Then, it all kind of blended together, and at some point, I got the distinct feeling that he was speaking to “us” about “our” decisions regarding my boobs.  He made sure to look Lori in the eye and was very considerate of her feelings too.  I can’t tell you how much I loved and needed that to happen.

“If I do the implants, I was thinking about going bigger since I have the chance.  Like double F’s?”

“Errr….umm….I’m not sure…”

“I’m just kidding.”

“Yeah, you’re a small girl.  I’m not sure that would fit.”

While speaking of another reconstruction option that involves taking fat from your belly and making breasts out of it, Dr T says, “You are a small girl.  I’m not sure I can build you back up all the way.  Stand up and let me see.”

“I mean, I have some if she needs to borrow,” says Lori so, so very quietly.

I smile and oblige and flash my second stranger for the day.  He grabs my belly.

“Oh yeah, I think I can make this work!”

Oh, well, thanks?  Just what I wanted to hear?  I just had a baby eight months ago!  What do you want from me?

He moves up.  “Has this right one always been a little bigger than the left one?”

“Oh, uh…well.  I’ve been breastfeeding for the last eight months, and that one works a little better.”

“Oh, I see.  Okay.”

I covered back up, and that was basically that.

And I needed that.  My sweet lesbian lover and I laughed and lunched and fretted until my breast MRI appointment at 7pm.  There is almost no lonelier place than inside an MRI (or CT or bone scan, etc.), where you feel like it’s you vs. your body and that machine.  It’s a total loss of control.  My mind filled with my daughters and God.  It made me realize that I never did have control.  None of us do, really.  I can only control my reactions, and not always can I do that.  I CAN love now.  And I can laugh for days when my plastic surgeon thinks my best friend is my life partner.  Hey, she is a catch!