At age 31, Kristin was told her only option after her mastectomy if she wanted to keep her self-esteem intact was to reconstruct her breasts. Kristin experienced significant pain and post-operative complications from her tissue expanders, and her plastic surgeon installed much larger implants than she initially wanted. She was never comfortable, physically or emotionally, with her implant reconstruction, and suffered for five years before finding a surgeon who took her concerns seriously. She explanted and after ten months being flat, Kristin is finally comfortable in her body.
I had only one option: expanders placed under my skin at the time of my mastectomy and gradually filled until they reached the desired size, at which point they would be swapped for silicon implants. It sounded terrifying to me. I asked for other options. There were none. He declared that a breast reconstruction could keep a woman’s self-esteem intact after breast cancer; research had proven it. He said I would love my new breasts, probably even better than my old ones. Spoiler alert: he didn’t know what the hell he was talking about. Having never had breasts, breast cancer, breast implants, or the experience of total permanent loss of sensation in his chest, his confidence was ill-informed. But at the time I saw no reason to disbelieve him since he was the expert on breasts and plastic surgery after cancer – but I forgot that I was a kind of an expert too…
I asked for other options. There were none.
My mom lost her right breast to cancer when I was seven. She was only thirty-four. She never left home again without her replacement boob fastened snugly around her petite five-foot-three frame by a large, beige, straitjacket of a bra. She hated her heavy, rubbery prosthesis – especially in the blistering Arizona summer heat when the sweat gathered up behind the silicon patty and ran down her stomach. Thirteen years later it was her left breast that had to go. I remember my mom’s self-conscious fretting over whether or not to put on her prosthesis before going to pick up a pizza. Honestly, no one would have noticed one way or the other and I don’t think they would have cared even if they did notice, but still she fretted.
Despite my mother’s experiences, or perhaps because of them, I believed the plastic surgeon when he told me that going flat was not a good option for a healthy woman of my age. So only a year after my mom’s death from ovarian cancer at age 56, and now faced with my own cancer diagnosis at age 31, I decided to reconstruct my breasts.
The process was more painful than I had anticipated. I had some minor complications which turned into major complications when I became dependent on opioids and went through withdrawals, which landed me in the hospital. After that, everything went pretty smoothly but I was consistently having second thoughts about my choices and every time I expressed my misgivings about reconstruction I was talked over and dismissed by the surgeon. It was disorienting. I didn’t know how to respond. He assuaged my discomfort by telling me I had total control over the process and could choose what size I wanted to be. I took the decision seriously: I pondered, I wrote in my journal, I called a friend, and I considered the role my breasts had played in my life up to that point. Amidst all the jokes of “go big or go home” that I kept hearing from nearly everyone I knew, I decided that I wanted my breasts to be only just big enough to look “normal”, but no bigger. At my next appointment I announced my decision to my doctor, at which point, instead of acknowledging my choice, he said,
“But you don’t want them too small…”
I did not know how to reply to that so I was quiet. He told me that when I felt they were big enough I would need to have one more saline fill in order to make the “pocket” one size bigger than the implant, so that the implant would fit: I only had to let him know when I had reached that point. A couple weeks later I notified him that I had arrived (and surpassed by one appointment) my desired breast size. I was surprised when he chuckled and told me that I wasn’t done, made a joke (that I no longer recall) with a *wink wink* to my husband, who was there with me trying to be supportive, and filled me up again. I went on to have one more fill after that per his expert opinion. Later that month when I was under anesthesia in his surgery center he decided that my “breast pocket” was big enough to accommodate an even larger implant than we had discussed. And that’s how I ended up with some very stiff, very high, very round balls stuck to my chest. For five fucking years.
After surgery, I sought consolation and encouragement in online cancer support groups; compassionate women said not to worry, that my new breasts would “fluff” and “settle” in time. But they didn’t. I tried to be patient; I took deep breaths, I appreciated my silhouette in the mirror, I tried on lots of new clothes, and I waited for the day when I would feel at home in my body. But instead, panic gradually began to set in. I had days when I wanted to rip the orbs off my chest; but then I had months in between where I didn’t think about my breasts at all. During those times I thought to myself— I can totally do this. The size of my breasts caused a few minor problems: I could no longer find bathing suits that fit me. My breasts were too high to be contained by a one-piece swimsuit and I looked like a porn star no matter what bikini I wore. I was in my mid-thirties at this point, with three children, and getting attention in public for the size of my chest; this was not something I ever wanted.
I was told that only women with gender-identity issues choose to forgo reconstruction.
Sometimes the panic became overwhelming and I’d schedule a consultation with a plastic surgeon, not knowing what I was looking for but feeling desperate. Twice I was told that without my “foobs” I would be deformed; I was told my self-esteem would suffer; I was told that smaller implants would absolutely not make me feel more comfortable; I was told that women who remain flat experience the same “sensory issues” I was experiencing; I was told that my fake breasts are so beautiful and it would be a shame to remove them; I was told that only women with gender-identity issues choose to forgo reconstruction.
After each consultation I retreated into a fog of self-doubt. I knew for certain I was physically uncomfortable in my body and now I began to look inward to discover any possible signs of gender-confusion lying dormant inside me. Nothing was adding up.
About three years after the placement of the implants, I travelled to a family reunion in a mountain town in Colorado that was at a significantly higher elevation than my home in Arizona. I was in the hotel unpacking my bags when I bent over and heard (and felt) a loud gurgle that traveled from my left breast up through my neck. I jerked myself upright. For the rest of the weekend, every time I moved too much or bent over, the gurgle immediately followed. I was certain my breast implants had popped. I put on a snug bra and tried not to move. I called my plastic surgeon in Arizona and left a message and as soon as I got back into town I went in for a checkup. However, as soon as I reached lower elevations, the gurgling stopped and the plastic surgeon was incredulous at my story. He told me that nothing I described could possibly have happened because implants don’t do that. He offered to get me an MRI if it would make me feel better, but the cost was around $2,000 and I didn’t have the money for it at the time. He was certain that all I needed was a little bit of fat grafting and some nipple tattoos and I would feel awesome about my breasts. He sent me to the other room to meet with the financial consultant and I left with a quote for the work necessary to make me happy (a grand total of $3,400). I sat with that information for a few weeks, considered everything he had suggested, and then suddenly realized that I had not been heard, or helped, at all. But I had no idea what to do about it.
A couple years later during a consultation (different city, new plastic surgeon) I was told that the problem is all in my mind. This doctor suggested that a prescription for Gabapentin would probably make me feel much better about my breasts. I left with a referral to a pain clinic, and a fresh batch of self-doubt. I had discussed with her my fears about rupture: the FDA recommends an MRI of breast implants 3 years after placement and every 2 years after that, a test that I had not yet been able to afford (and five years had passed at this point). I felt ongoing anxiety about what was potentially happening in my body and a total loss of control. This surgeon said not to worry about it because Mentor implants have been proven “strong enough to be run over by a car”. I tentatively accepted her answer, but in hindsight I wondered, if it’s true the implants have been tested under the wheels of automobiles and apparently passed with flying colors, why does the FDA recommend they be diligently checked? What are they checking for?
Despite my misgivings I did my best to take the surgeon’s recommendation about medication seriously and I truly intended to follow through with the pain clinic but weeks went by and something kept stopping me from making that call. And then one day I came to my senses.
I was ANGRY.
Finally, angry that after five years no one had listened to me. Angry that my thoughts, my feelings, and my comfort had been unimportant from day one. I was left with the fact that in five years I had never “bonded” with my so-called “breasts” like I had been assured I would. And the reason is because I never wanted them! You can’t bond with a foreign object that was forced into your body, and you can’t heal from an assault when everyone is pretending the whole situation is great and that the real problem is your attitude. My “breasts” had continued to be foreign, oddly-shaped, pointless bags of silicon whose sole purpose seemed to be to make other people feel better about looking at me. I decided that moment to pursue other options. I decided I would see 100 surgeons if I needed to until I found one that treated me like a human being.
The very first surgeon I saw was absolute gold. He asked me dozens of questions and listened carefully for almost an hour. He asked me how I felt about my old breasts (the real ones), he asked me how I felt about myself, how puberty was for me, about my history with my own femininity, with motherhood, etc. When I got to the part about cancer and my experience with reconstruction he sort of shook his head and scowled and said I should never have had to change my identity to suit my reconstruction but rather my reconstruction should have suited ME. I was stunned at the clarity of that statement and everything in me said ‘yep that’s it exactly’. I scheduled the implant removal surgery that day, not knowing what it would cost or what the recovery time was like or how I would look when it was all over. I didn’t care. I was just done. And even if I could have found a way to somehow live with my implants, I couldn’t live with the way I’d been ignored and made to feel small and helpless. I wanted out of the system that valued my appearance over every other consideration. I wanted to feel safe in my body. I wanted to feel at home.
I hope that more reconstructive plastic surgeons will catch on to the idea of being invested in the long term mental health of every patient. I hope more doctors whose profession involves surgically altering women’s bodies will take the time to study the issues surrounding women’s sexual identity and especially how it expresses itself uniquely for each woman during breast cancer treatment. They are too-often employed in an industry that values false beauty standards above autonomy, comfort, cost or the possibilities of health risks. I don’t blame them solely for not understanding. But I am angry. Angry that I was not heard and that things were done to my body without my consent while I was under anesthesia.
“At some point in my life, without realizing it had happened, breasts for me no longer represented womanhood. “
I’ve been flat now for ten months. My chest looks very different but I’m not afraid of different! Those highly sought-after, highly-valued, very expensive, much worshipped and adored (but absolutely nothing like) breasts, are gone from my body and in their place my self-respect and autonomy are beginning to bud. At some point in my life, without realizing it had happened, breasts for me no longer represented womanhood. After all, my mother remained a woman even with scars and a concave chest wall. I’m not afraid to look like my mother. And although I hope my daughter will never have to go through what I did, she is not afraid to look like me, either. Because I love my body, I dress it up, I praise its virtues, and I dance naked in front of the mirror as often as I can.
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