March 23, 2008

A Body Resculpted

One woman finds that saying good-bye to her breasts is both harder and easier than she ever imagined

“I’ll cut them off.”

For years, that’s what I said after my doctor explained my risk of getting breast cancer. It’s not that I considered my breasts to be expendable. It’s just that with my family history — my mother died of ovarian cancer at 48; her sister died of breast cancer at 39; and I’d tested positive for the BRCA1 gene mutation, which increased my chances of developing both diseases — my doctor had been abundantly clear that if I was ever diagnosed with cancer, my safest option would be to have a bilateral mastectomy. But losing my breasts isn’t what frightened me. What scared me most was dying young and leaving my kids, Josh and Maddie, motherless. Then again, it’s easy to be cavalier when the prospect of a double mastectomy is merely a possibility in the distant future.

I’d already had my ovaries removed at 39; my doctor told me it was my best choice, considering what had happened to my mother. In the meantime, my M.D. monitored my breasts with exams and mammograms. Still, technology doesn’t necessarily trump DNA, and I worried about the faulty rung in my ladder. However cautious I was, I knew I might someday get The Call.

The doctor phones and asks, “Is this a good time?”

No. Call back in 40 years.

Decades of waiting have not prepared me for this diagnosis of cancer in my right breast at age 45. When I see my husband a few hours later, he and I clutch each other. “I’m sorry,” I whisper into his wilted cotton shirt as though I’d spun my own defective double helix.

“No, don’t apologize,” Steven says to me gently. “We’ll get through this.”

I hope he’s right.

Maybe sacrificing my breasts, emblems of womanhood, will buy me back my life as mother, wife and friend. I tell Steven, “I’m having my breasts amputated.”

I go to see my doctor in person, and she reconfirms that given my risk of developing another primary breast cancer, bilateral mastectomy makes the most sense. Actually, I’m lucky. My cancer was discovered early, and my prognosis appears to be good, although we won’t know for sure until we get the final test results. I just want my diseased breasts gone. We leave the doctor’s office and pass a sign I’ve seen countless times: POSTMASTECTOMY SHOP. I wince and turn away.

In the car, Steven and I plan how to tell the kids, as though artfully cloaking a death threat can make it less menacing. “Hey,” I say, “at least there will be no more mammograms or underwire bras. That’s a perk.” We both smile. “Y’know, I bet we can do a top 10 list. Number three: What a way to lop off a few pounds!”

“I’ve got number four,” Steven pipes up. “You’re losing only two of your boobs.… You’ve still got me!”

The next week, we meet the plastic surgeon to talk about reconstruction. I choose the simplest procedure with the fewest potential side effects.  During my mastectomies, he will insert tissue expanders under my pectoral muscles, which he will then inflate over the course of three months.  Afterward, in a second surgery, he’ll replace the expanders with saline implants.

He asks to see my breasts. Awkwardly, I open my paper gown. “Nice?” I think. “Not for long.”

Trying to be cheerful, I ask, “Will you make me nice breasts?” although my voice sounds strained to my ears. The doctor forces a half smile. “I’ll try.”

In nine days, my breasts will be gone. Reconstruction will leave me with a passable cosmetic pair, but once the nerve-rich breast tissue is removed, they may not have any sensation whatsoever. That night, I lay in bed next to my husband, aware of the covers against my body.

“I’ll never feel your hands on my breasts again,” I choke out. “Touch me. I don’t want to forget — I want your touch to be imprinted on my skin.”

Steven reaches over, but his touch holds no promise of escalating excitement. It’s as if his hand, mechanically cupping my breast, magnifies our sadness, priming us both for the dead zone my chest will soon become.

Less than a week before surgery, pre-op testing reveals abnormalities in my liver. Metastasis? “Our priorities would change,” the doctor says. I’m terrified. The day before my scheduled surgery, the doctor calls my cell phone while I’m jogging with friends on what I’ve come to call my 10-mile Run for Strength. Her news: My liver cysts are benign. I can proceed with surgery. As passersby sip coffee, I spring into the air, pumping my fist, and whoop, “Yes! I only have breast cancer and can have them both cut off! This is great!”

That afternoon, I take a trash bag to the bedroom and dump all my bras, bathing suits and shirts that will no longer fit. Before bed, I catch a glimpse of myself in the mirror, then close the door, slip off my nightgown and stare. Should I take a photo? Too mawkish. I lift each breast, dense with sensual and maternal memories. You’ve nursed Josh and Maddie. Your job is done. “Good-bye,” I say, sighing.

During surgery, pathology reports find that my lymph nodes are cancer-free. When I learn the news, the relief penetrates my postsurgical haze, through what feels like a 2-ton boulder pressing against my dissected chest.

It’s not until the next morning, my head still cloudy, that I begin wondering how things actually look under there. I weakly pull down the collar of my hospital gown. I want to see…but I don’t. I tuck my chin and twist my head to the left, then to the right. Bandages. I trace my fingers along the adhesive to check for gaps. None. I close my eyes again.

Voices awaken me later that morning. Four strangers are mobilized around my bed. “We’re the plastic surgery team, here to check your incisions,” a doctor says. Two of them unsnap my gown, exposing a stratum of bandages and tape. One man yanks the tape off, and they all lean in. Noses close to my chest, they palpate and speak among themselves. I try to eavesdrop, craning my neck to peek. My fleshy breasts have been replaced with two 4½-inch horizontal lines of stitches, the black thread tracking across my newly puckered planes. The swollen skin looks a half size too big. An involuntary “oh” escapes from my throat. “So that’s what it looks like,” I rasp nonchalantly. We all act blasé. Just a few body parts hacked off. Chop, chop.

One of the doctors hastily turns on his heel and declares, “Everything looks fine.”

Oh?

A brief but profound sense of loss penetrates my chest.

Ten days later, at home, I receive the complete pathology report. My cancer was ductal carcinoma in situ, which means it was confined to my milk ducts. I won’t need any radiation or chemotherapy. We rejoice, marveling at my Houdini-like escape, at how I’ve managed to emerge from all of this unscathed, sort of.

Weeks pass, and I regain strength and go back to running. I return to my plastic surgeon periodically; each time, he injects saline into the tissue expanders, and I experience topographical growth: After he empties a syringe into my chest, my breasts bloom in a fast-forward trip through puberty. I’m an artwork in progress, resculpted every two weeks, which I find alternately entertaining and freakish. My breasts are constantly sore, as if they’re screwed on my body too tightly. And I don’t know what to call them. Perhaps Thing, inspired by the old “Addams Family” television show. Or Thing One and Thing Two. Whatever they are, this pair of Things is certainly not sexual.

I avoid my nakedness in the mirror, feeling a self-revulsion that takes me by surprise. I never thought I packed my identity in my bra. For one thing, I’d always considered my ample C-cup breasts cumbersome; they had a tendency to draw unwanted attention, my nipples saluting through my shirt with the slightest breeze. And they chafed when I ran.

But my breasts had also been lovely. And they were real.

Six weeks after my surgery, my family and I take a trip to New York City. My doctor assures me that the metal ports inserted in my chest for the saline injections won’t set off airport scanners, but I’m nervous in the security line. I pass. Phew. The guard pulls us aside. Steven leans toward me and points to a code on our tickets earmarking us for special security screening. A guard runs a wand along Steven’s body. His belt buckle sets the detector buzzing. Josh’s turn. Belt buckle. Bzzz. I start to sweat. A rivet on Maddie’s pants. Bzzz. I’m queasy. The guard motions to me. “Put your arms out.”

I lift my trembling arms. He runs the wand down the right side of my chest. Bzzz. My stomach lurches. He tries again, puzzled. I steel myself for the inevitable. Bzzz. Then the other side. Bzzz. My heart pounds. “I recently had mastectomies for breast cancer, and now there are metal ports in my chest for my breast reconstruction,” I explain to the man, my voice quivering.

The guard glares. “I’ve never heard of that.”

Travelers file past as my disfigurement broadcasts its menace to society. My eyes well up. “There’s metal in my chest.” Steven, Josh and Maddie watch. I don’t want my ordeal to upset them.

I’m passed to a female guard. Surely she’ll understand, I think. “I had mastectomies,” I say. “I’m in the process of getting breast reconstruction, and I have metal ports in my chest.”

She appraises me and leads me into an anteroom. I’m incredulous: How can she not believe me? Another female guard joins us. Humiliated and sobbing by now, I try to explain again.

“I’m sorry, dear, but we have to do our job,” she replies. “You could have explosives strapped to your chest.”

I have to lift up my shirt for these strangers? It would be degrading enough to expose my real breasts, but displaying their absence — my ugliness — seems even worse to me. The guards stand around, quietly watching, waiting for me to act. I’m center stage in a freak show, but I see no alternative other than to comply with their demand if we want to make the flight. My chest heaves. Now! I close my eyes, grasp the hem of my shirt and lift it up high to reveal my bare chest. Then I lower my shirt and, covered once again, put my face in my hands and weep.

“We’re sorry, dear,” one guard says kindly. “It’s all right.”

No, it’s not. I blow my nose, wipe my eyes, smooth my sweater and open the door. Steven, Josh and Maddie gather round, rubbing my back. “Are you OK?” they ask, soothing me.
Keep it together. “I’m fine. Really.” Sniffles escape as we walk to the gate. When we board the plane, I turn to Steven and deadpan, “After all that, I sure hope nobody has any explosives.”

“I’m ugly with these misshapen mounds,” I tell Steven in bed, a few weeks later. “I’m afraid I’ll repulse you.”

“You couldn’t repulse me. You’re beautiful. All of you.”

I know my husband loves me, but I’m skeptical that he believes all of me — all of this — is beautiful. I’m afraid to have sex. What if he recoils when he sees me? Before I can imagine the full range of his reactions, Steven lavishes love on me, vanquishing my anxiety. The penguins on the flannel nightshirt I’ve refused to remove practically join me in weeping tears of relief.

Over time, Steven gently insists that we navigate my new landscape, unwilling to pretend that my shoulders attach directly to my abdomen. He won’t treat the terrain over my heart as a no-man’s-land. “Can you feel this?” he asks.

“No. Try here.” I move his hand between my breasts. “I feel that. And higher.” My new breasts aren’t sensual, but when we survey them together, they’re not oddball accessories, either.

On my next trip to the plastic surgeon, he inflates my expanders and asks what size breasts I want.

“I was a C-cup. I want to be smaller.”

The nurse arches her brows. “Are you sure? Most women want their new breasts to be bigger.”

“Not me. I want to be an A or a small B.”

“I don’t know how big that is,” the doctor says. “We measure by cc’s.” He calculates. “We’ll do 220s.” If his math is wrong, I’ll either be shopping in juniors or Frederick’s of Hollywood.

Suddenly, wherever I go, I size up women’s fronts. I check out the cashier ringing up my Altoids. Too big. I peep from behind a sardine tin at a fellow shopper. Too small. I surf the Internet, print photos and label them TOO BIG, TOO DROOPY and JUST RIGHT, as though a fairy-tale doctor can finesse flawlessness from my remnants. I count the days until surgery for what I’ve come to call my Hollywood boobs, pondering how implants could make a woman feel sexier. Mine make me feel fraudulent.

“It will take time to adjust,” says my brother’s childhood friend, who happens to be a plastic surgeon. “The bonding between a woman and her new breasts takes time.”

“Is this how they’re supposed to look?” I ask, unveiling my works in progress — ironic, since for a spell 25 years ago, I’d have given my eyeteeth to show him what was under my shirt.

“Yes. You’ll look fine after surgery. But remember, this is reconstruction, not replacement. You won’t look perfect.”

“I wasn’t perfect before.”

“Your body and breasts were normal for you. But now, you’ll have to get accustomed to a new normal.”

The morning of my surgery, my plastic surgeon greets me and, when I press him for details, is vague about the exact size of my implants — oh, 220s, 225s, whatever. Whatever?! Afterward, when it’s all over, I awake, eager to know how they look and wary of pain. But the implants are comfortable, nothing like the thicker and larger expanders. My upper body feels liberated!

The next day, I get my first glimpse. Size seems OK. A bit bigger than I’d hoped, more a solid B than a B minus. Scars still divide each breast, but overall, they’ll do. A week later, I return to have the surgical drains removed. When I arrive home, I grab my most body-conscious shirts from the closet, then survey myself in front of the mirror. A racerback running top, a clingy tee. Nicely compact. I could go braless. My new breasts are proportioned better for my frame than my real breasts had been.

Shopping for my first bra feels as odd as, well, shopping for my first bra. I grab one and steal into the dressing room. Before I slip it on, I catch my reflection and, for a second, am taken aback. Long, dark scars. No nipples. The new me. Just move on.

Soon, I’m going running again. The winter feels unseasonably cold, but when a chill passes through my chest one afternoon, it strikes me that it’s not simply the weather: My implants seem to conduct the cold — at least, that’s the way it feels to my body — whereas my former breast tissue, full of fat, insulated me.

I return to the gym and discover how weak I’ve become in the past four months; it’s a struggle to bench-press 5-pound dumbbells. When I do, I notice that my chest feels funny, so I look down. My pectoral muscles no longer sit snugly on my rib cage and contract under my breasts. Now, wrapped over my implants, my pectorals are part of my breasts, flattening my falsies each time I heft the weights. The new normal. As I lift, one of my scars slides into view, exposed by my skimpy workout top. A primitive line mapping my journey. I hastily cover myself and thereafter avoid wearing that top. Later, a friend who has had breast cancer confides that she finds her own mastectomy scar sexy. Sexy? Perhaps my own scars don’t merely mark me as aberrant. Maybe they’re also symbols of experience and victory.

As time passes, the emotional charge connected to my new breasts dissipates; before my mastectomies, I’d wanted to have them completely restored. More and more, that seems less important. Now, a few years later, I still have no nipples — I haven’t wanted to invest the time or energy in the process, and it seems silly to do it merely to avoid scaring people in the gym locker room. My breasts are simply my breasts, like before, except they are perkier and don’t have any nipples, so I can go around braless. Yet I still don’t feel very sexy, despite the fact that my husband clearly thinks I am. I know my sexiness doesn’t start or end with my breast tissue, but I can’t get past the saline. What I do feel is happy, attractive, strong and healthy.

Of course, there are times I miss my old breasts, especially when I see my teenaged daughter developing as I once did. The other day, she was wearing a camisole I considered too revealing. “Why don’t you dress more modestly?” I chided her. Then I added, “You like your breasts, don’t you?”

“Yup,” she said, pulling her shoulders back. “Besides,” she added matter-of-factly, “who knows how long I’ll have them?”