Recently I’ve gotten back into the pool, slowly building up my lap numbers and time in the water to around 45 minutes. It’s hard work but very satisfying and the toning effect on the old treatment-ravaged bod has been almost instantaneous. Even though my togs have a pouch for my breast prosthetic, I’ve never worn one to swim anywhere let alone in a chlorinated pool, fearing degradation of whatever material is used to shape that fake left bosom. And that’s all good from an aesthetic point of view because when one wears body-hugging racing cozzies, being one breast down is barely perceptible. From a functional perspective, however, the one-breasted swimmer can’t help but feel a little lopsided when coursing through the water.
At the very beginning of this Big Breast Adventure three years ago now, 48 hours before I was due to take my place on the table, my surgeon delivered the tough news that my entire left breast would have to come off due to the position and depth of the tumour. That moment, even more so than the stark diagnosis delivered by my GP earlier that day, was when I fully got the fact that I had breast cancer. My nursing sister sister Mary Anne and I looked at each other and simultaneously sighed, ‘Oh dear’.
Almost as a consolation prize, my surgeon quickly added that, thanks to the wonders of modern plastic surgery, a breast reconstruction (should I choose to have one in the future) could be fashioned from my own tummy fat. As I gave the thumbs up to Mary Anne, mouthing the word ‘bonus’ if memory serves, I was imagining myself with a huge reconstructed rack due to my own ample supply of the required raw material. That gave me some comfort prior to surgery when, being the patient and all, one does have a tendency to cling to straws.
After the surgery my meetings with the breast surgeon were frequent in the first year – at three weeks, then three months, then six months until now when the visits take place annually. And before each of these annual visits I have to have a mammogram and ultrasound on the remaining breast to keep a check on whether or not the cancer might have spread there. Just as an aside, my surgeon told me that in the past, people with lobular breast cancer diagnoses such as my good self usually had both breasts removed even if cancer had only been detected on one side. This is because lobular cancers are known for their wanderlust often travelling elsewhere in the body, the other breast being a logical first stop. But logic and cancer are often oxymoronic, at least in my case, and these days surgeons don’t take the other breast off as a matter of course, presumably because it’s considered unnecessary surgery. With 20/20 hindsight and a season pass to the Warringah Aquatic Centre, I kind of wish they had removed both breasts as a job lot three years ago.
Last week I trotted off to the Imaging department of the the Mater Hospital for the annual mammogram and ultrasound on my remaining breast. As I clutch my surgeon’s referral and last year’s scans in my hot little hand I have a hard-to-shake feeling that I am returning to the scene of a crime! The mammogram is a pain in the breast to undergo because, never having been particularly well-endowed in that department, the squeezing and skin-pulling required to sandwich a small amount of tissue between two transparent plates in order to get a decent x-ray is far from pleasant. It also pulls on the scar tissue of the incision line where my left breast used to be. The poor operator kept saying ‘sorry, sorry’ as my face froze into a wince during the 10 second scan-time. The ultrasound is much more fun – not that one would visit Mater Imaging voluntarily in search of fun – but fun as far as annual scans go. You get to lie down for a start and the operators are generally more chatty as they’re not spending their time telling you to ‘lean in’, ‘stay as still as you can’, or ‘sorry, sorry for that searing scar pain’. Gooey residue from the gel they use to ease the path of the handheld probe notwithstanding, the process is relatively comfortable by comparison to the mammogram.
However, the discomfort of the tests is a minor consideration when one considers that this regular check-up process is one plank in the scaffolding of my ‘ex-cancer patient’ safety infrastructure. Both my breast surgeon and my radiation oncologist, whom I see on a six-monthly basis, rely on these scans and physical exams of my right breast to ascertain my ongoing health in this arena. However, if my scans/physical exams remain clear over subsequent annual visits (which I for one sincerely hope they do) it’s only logical that my breast surgeon’s attention will eventually turn to the question of whether or not I want to go ahead with some kind of reconstruction. Here are my options as I’ve heard them from the experts to date:
Option 1 – Implants: As Mr Ollivander the wand maker (played by the late, great John Hurt) said after Harry Potter blows something up in his Diagon Alley store when trying out a wand, “No, no, definitely not.” (Revisit this wonderful and just-a-bit spooky scene from the movie Harry Potter and the Philosopher’s Stone here.) While I’m sure there are many fine implant prostheses out there and many fine breast and plastic surgeons to implant them, seeing that I’ve had a foreign object cut out of me as recently as three years ago I’m in no great hurry to have one put back in! Pass.
Option 2 – Reconstruction with stomach fat: We’re getting warmer now because I’ve always said that a tummy-tuck would be the only plastic surgery procedure my vanity would allow. I’ve also been led to believe that this sort of procedure results in a more natural looking outcome. However, there are a couple of drawbacks to this cunning plan. Firstly, I’d need to have the right breast removed before the reconstruction could take place. Artful and deft as I’m sure plastic surgeons are, they can’t fashion the missing breast in exactly the same way as the one that still occupies my chest, so both have to be gone in order for the punter to have a shot at a balanced rack. This removal takes place at the same time as the reconstruction which brings us to the second major drawback – time in surgery and recovery from the operation. As one might expect, this is a huge undertaking. I’ve been told this procedure would take between nine and eleven hours actually on the table in theatre. After that there is the recovery time which is long and probably quite painful because the entirety of the patient’s torso is involved in the process. So, while a reconstruction using my own stomach fat is a beguiling proposition, as time goes by it’s looking less and less attractive to me and to my poor husband who flinches every time the notion of ‘9 to 11 hours in surgery’ is mentioned.
Option 3 -Take it off! One alternative to both of the previous reconstruction scenarios is to remove the right breast completely and leave it at that. At least then the two fake breasts I would wear in polite company would be exactly the same size and weight. Presumably, they would then hang in the same way, giving me a much more balanced look that I’ve been able to enjoy at any time in the past three years. Also, taking off the right breast would mean vastly less time in surgery – about two hours max – and the road to recovery afterwards would be much shorter and smoother. Practical and aesthetic considerations aside, though, I feel that at 55 years of age the use-by date of my breasts has well and truly passed. Becoming, once again, as flat-chested as I was in pre-pubescence would afford a great deal of freedom and it would certainly cut my drag in the water at the pool.
And so it would seem I am reconciled to Option 3 – undergoing a surgical procedure to remove the right breast and getting a second prosthetic that matches the one I already have. While there’s no hurry for me to make a decision on this, the question about reconstruction is raising its head more and more frequently in medical circles and elsewhere. Opinions of friends, family and the wider community are wide and varied, ranging from the ‘unnecessary surgery’ argument to ‘but you won’t feel like a woman if you don’t have breasts’ line of thinking. Try as I might to re-engage my ‘internal bullshit detector’, the one that’s served me so well over the past three years, I can’t seem to settle on a final decision about what to do.
The very fact that I am vacillating on this whole issue is probably a secret-squirrel signal from the Universe that I should do nothing. Almost as soon as that realisation popped into my head, further confirmation came from my trusty oncologist whose compelling commentary cut through the literal and metaphorical cosmetic arguments I’d been grappling with. The good doctor said that doing nothing for now was the best course of inaction. This is largely because any surgery (whether it’s eleven or two hours duration) will weaken me. We’re not at the five-year anniversary of my diagnosis as yet, this timeframe being a benchmark of sorts that indicates the long-term efficacy of treatment of a cancer patient. It is also the point at which intensive monitoring of the patient by way of blood tests and annual scans can be relaxed somewhat in the majority of cases.
What Dr Copeman was getting at with his direct yet compassionate advice is this – while everything is going swimmingly with my recovery to date, we’re not out of the woods yet. If the unfortunate were to happen and I experienced a relapse in the next two years, surgical intervention may be required in addition to my still-in-recovery-from-last-time body having to cope with a whole host of new medical interventions/drug therapies that would undoubtedly be prescribed.
I’m sure I speak for Dr Copeman as well as myself when I express our ardent hopes that a relapse is not in my future at all, let alone within the five-years-after-diagnosis timeframe. Having said that, it’s best to be prudent in these matters. If having my remaining breast removed now puts me at a disadvantage should the need for some other kind of surgery/treatment arise in the future, then best not to do it for the time being.
Having reset my internal bullshit detector to stun, I’m putting this whole ‘what to do with the remaining breast’ question behind me for the moment. And as for cutting my drag in the pool? I intend to take the advice of that great philosopher of our time, Dory from Finding Nemo (given voice by the inimitable Ellen DeGeneres) and ‘just keep swimming, swimming, swimming’.
All the breast!
P.S. Thanks to those of you who’ve already sprung for the book My Big Breast Adventure or How I Found the Dalai Lama in My Letterbox. If you’re yet to snag your very own copy please visit the For Pity Sake shop, add the coupon code SOMERVILLE at checkout and you’ll receive free shipping.