The Choice I Made and the One I Didn’t.

Before my mom left she tried to apologize to me for anything insensitive she might have said or done while she was here helping me through my cancer adventure.

I didn’t know how to respond to this. I feel all teary just trying to write about it. She was every kind of thoughtful and considerate and caring during this surreal time. She was the reason I wasn’t completely terrified the whole month long. She was also the reason I was able to let myself feel completely terrified once in a while. I find it a lot easier to face my fears about the future when I know I’m safe in the moment. Even though I’m a real grown up now (35!), I still find it hard to feel anything but safe when my mom has her arm around me.

So, I was shocked when she said she thought she might have said something inappropriate. How could she not know how wonderful she’d been to me? But then I thought about it and realized she had a point. There is no way to know what is the right or wrong thing to say to someone who is going through something so emotionally turbulent…especially if you’ve never gone through it yourself. And, of course, the stupid hurtful thing that gets said out loud is going to come from someone you adore and trust who only means to be helpful. (We may all have assholes in our lives who say insulting and infuriating things on purpose, but why would we care what they have to say?)

So, my mom was right to worry. It turns out the one and only cancer-related comment that really pissed me off did come from a very well-meaning and supportive person whom I adore and deeply appreciate. When I told her I was going to have a mastectomy she said, with genuine sympathy, “Is that what you’ve chosen to do?”

Here is what I wanted to scream at her: “NO! This isn’t what I’ve chosen! This SUCKS! If I had any kind of real choice at all, why would I CHOOSE this!? Who in their right mind would choose this if they felt like they had any other real option!? I’m going to get knocked out and have one of the organs of my body sliced off with a knife! It’s going to hurt like hell for I don’t know how long, and I will never look the same again! Don’t be an idiot! Shut the fuck up! Let me out of here, you thoughtless creep! God, I HATE people!”

Here is what I said out loud: “Um, well…my surgeon says that since I have two malignant tumors that are pretty far apart from each other, there isn’t any other option.”

While I didn’t have any choice about whether or not to have the mastectomy, I did have a choice about getting reconstructive surgery, though this was not made obvious to me at first.

Early on, before we even knew about the second tumor, my excellent surgeon explained the available treatments. If possible, she would remove the lump without really changing the shape or size of my breast. However, if the lump was too close to my nipple, she might have to remove that too. Furthermore, if the lump was spreading through more than one “quadrant” of my breast, a mastectomy would necessary. She then explained that for either of the first two options, I could have the procedure done here in Santa Maria and she would be my surgeon. But, for the third option, I’d have to go down to LA so that the plastic surgeon could be there too and do the reconstruction immediately following the mastectomy.

She then went on to explain that the cosmetic surgeon she would recommend sometimes worked a day or two in Santa Barbara and I might be able to avoid Los Angeles all together, but I wasn’t really listening. I was stunned that she had just assumed I would have reconstruction.

I interrupted her to ask, “If I didn’t get any reconstruction, could I have the operation here and would you be my surgeon?” She answered, “yes,” and I said, “because that’s what I’d do.”

She raised her head from the paperwork and looked right at me. I think now she was the one who was stunned. For one very long second we just looked at each other. Then she kind of shrugged and nodded and smiled at me. The office manager made some sweet and funny comments about how it doesn’t matter how many breasts I have, since I’m so beautiful and we continued to talk about my treatment plan. My surgeon commented that I could always have the reconstruction done later if I changed my mind.

No one at that office, or at the hospital, ever seemed to judge me for not having the “cover-up” procedure. No one acted like I was unusual or questioned the wisdom of my decision. Still, that long moment of silence and the fact that my extremely thorough and communicative surgeon completely overlooked discussing this option with me, really makes me wonder about other women’s decisions.

What percentage of women in my age group opt for reconstructive surgery after a mastectomy? What about the other age groups? If they choose the reconstruction, how much information do they have before hand? Are they made to feel like they have a choice? What are the factors they consider while deciding? Do they feel like they need to have the surgeries done on the same day or do they know they can have the reconstruction done later?

Here’s why I decided not to have the boob-job.

First, it’s not just a boob-job. I used to think reconstructive surgery meant they would just scoop out the inside of my breast and fill it back up with silicone. That’s not what happens. A mastectomy is removal of the entire breast, including skin, areola and nipple. There isn’t any thing left to fill-up. The doctors have to start from scratch. There are two different ways to do this. One way is to take skin and fatty tissue from other parts of your body to create a breast. Then, they remove some darker, more nubby-textured skin from a different part of your body to shape into a nipple. Then, they use a tattoo gun to create an areola-type area. This takes several surgeries, lots of healing, and, at best, results in some small scars and a breast that looks fairly similar to the other one. (There is a small possibility of large, infected scars and a lopsided, unappealing bosom.) The other way is to stretch out the skin that remains after the mastectomy is completed. They put in a “spacer” under the skin and slowly enlarge it until there is enough skin to make a breast. Then, into this pocket of flesh, they insert a silicone cushion. This technique doesn’t involve surgery on any other part of your body, except to get the nipple. There is still tattooing involved. It is less extensive, but it is still surgery.

No matter what reconstruction technique one chooses, it is stressful, painful, time-consuming and expensive. I just couldn’t see going through all this just for looks. I have never been the kind of person who would consider getting a “lift” or a “tuck.” I don’t have the kind of career, relationships or self-image that make my physical appearance seem important enough for such drastic extravagance. “So,” I thought to myself, “If I wouldn’t have ever considered a beautification-operation before cancer, why on earth would I consider it now?”

(I hope I don’t seem judgmental here. I have two friends who have had breast augmentation and several more who’ve had reductions. They are all delighted with their results and I am delighted for them. As an ardent feminist, I will staunchly defend any woman’s right to do whatever she wants with her body, and to define beauty in whatever way seems right for her. In discussing my own decision making-process, I am just talking about ME.)

There are several other side benefits to not having the reconstruction done. For one, I will never have to worry that someone is dating me “just for my looks.” Also, I’ve got instant credibility if I want to do public speaking on topics relating to cancer. And, I now feel free to stuff my bra with impunity. It might be fun to be a double D once in a while!

I hope that I’ll discover more benefits as time progresses. I hope that not having the surgery will allow me some time to deal with the emotional realities of being a cancer survivor. I think that if I’d had my figure “restored,” I might be tempted to just get on with my life and try to forget the last 6 weeks. But, this has been a life-changing experience and I really don’t want to forget it, even though it’s been painful and scary. I want to be reminded every morning how precious my life is, until I don’t need to be reminded anymore.

I also hope that I could be a model for other young breast cancer patients who might feel pressured to get reconstruction. I’d like to be a vibrant, sexy, confident reminder that there is a choice.

Finally, since I’m going around breast-less anyway, I’d like my new lopsided but healthy body to be a reminder to other women of how scary and common this disease is. It could also be a reminder of how curable it is when caught early. Maybe a few more Breast Self Exams will get done and a few more mammograms scheduled on time.

I can think of several other possible “bright sides” to my choice to forgo reconstructive surgery…but I can think of only one real down-side. I will never look “hot” in a low-cut sweater again. I think I can live with that.