After Your Mastectomy: Reconstruction, Prosthesis, or Go Flat?
The First Decision: Lumpectomy or Mastectomy?
“You have breast cancer.” Those are the words no woman ever wants to hear.
“You will need to have a mastectomy.” Those words pile bad news on top of bad news.
I was first told that I had breast cancer about ten years ago. It was ductal carcinoma in situ (DCIS.) If you are going to have breast cancer, that is the best kind to have. It means the cancer is still enclosed in a breast duct, and it has not spread into other parts of the breast or, worse, other parts of the body.
In my case, the first cancer was in the right breast close to the surface. A lumpectomy was recommended to remove the cancer and preserve the breast. The lumpectomy was successful—I had “clean margins” meaning all of the cancer was removed, and I was “node negative” meaning the cancer had not spread.
It was good news not only because it meant that all the cancer had been removed, but because it meant that I would not need to undergo chemotherapy. I did have to have eight weeks of radiation, just in case there were any stray cells of the cancer still in my breast. I also had to have five years of hormone therapy taking a prescription pill every day that would suppress estrogen because my type of cancer could “feed” on estrogen.
A few months after the operation, my oncologist advised me to have a genetic test to determine whether or not I had the BRCA gene mutation. This mutation means that the body cannot produce a key protein that attacks cancer cells. It means there is an above average risk of breast cancer as well as ovarian and colon cancer.
The BRCA gene mutation was suspected because my mother was of Ashkenazi descent and this population group in known to have a higher incidence of the gene mutation. Also, my mother died at age 52 of ovarian cancer and my aunt (my mother’s sister) died of breast cancer at age 46.
A woman with BRCA2 mutation has about a 45% to 65% chance of getting cancer by age 70 (1) I was 62 years old when I first got cancer, so I congratulated myself for having fended off cancer for so many years.
My oncologist recommended that I have a prophylactic mastectomy. His advice was to have both breasts removed because I had a 40% chance of getting breast cancer again. I decided the odds were in my favor and I could take a watch-and-wait approach. Every May I had an MRI of my chest and every November I had a mammogram. I told my oncologist, “I’m done with cancer.”
As it turned out, I wasn’t done with cancer. Ten years later, a mammogram, confirmed by a biopsy, showed that I now had cancer in my left breast. The cancer was located close to the chest wall.
It was time for me to have a mastectomy
- If I didn’t, the next time I got cancer, I might not be so lucky as to catch it early.
- I had already had two false alarms each requiring a biopsy.
- A mastectomy meant I would not need radiation and hormone therapy.. I also wouldn't need the annual mammograms and MRIs.
- Finally, I was 72 years old, so I asked myself: “Why do I even need breasts?”
I told my doctor, I wanted to get it over with, the sooner the better.
The Issue of Reconstruction
I felt like both my surgeon and oncologist just assumed that I wanted to have reconstruction. My surgeon even made a pre-operative appointment with a plastic surgeon so the reconstruction could be done at the same time as the mastectomy.
At first I was thrilled I could have perfect perky breasts again, like the ones I had in my twenties. Or maybe I could go for Va-Va-Voom.
However, as I searched the internet, I learned the operation would be longer, the recovery would be harder, and the risk of complications (both during the surgery and even years later) would be greater. Plus, the new breasts would not have any feeling.
A few days before my appointment with the plastic surgeon I called my surgeon. I said my “instincts” (strong emotional feelings) were telling me not to have reconstruction. I said that reconstruction would be like being in denial. I felt it would be psychologically healthier to accept that my breasts were gone and then just get on with my life.
My surgeon said that I was making the right decision. She said that foregoing reconstruction is the recommendation she would give to her own mother or grandmother. (She explained that she had wanted me to see the plastic surgeon only so I would know all my options.) After that conversation and after talking with women who had had reconstruction and others who had not, I cancelled the appointment with the plastic surgeon. Later, my oncologist concurred. He said I had made the right decision.
As of this writing, it has been a little over two months since my surgery. My surgeon has said that my healing is going very well. I am happy with the decision I made not to have reconstruction.
Wear a Prosthesis or Go Flat?
Some women get elaborate tattoos (or even modest ones) across their chest. It’s not for me, but if you like tattoos, you could have fun with it.
Some flaunt their flatness and make no attempt to hide it. They want to be very edgy and in-your-face about it. I imagine them saying, “Yeah, I’m flat. Do you want to make something of it?”
I wanted to be more discrete. So before I got my prosthesis and now on those occasions when I want to go flat, I make use of these little tricks.
- I found that a loose blouse with an unbuttoned vest works very well. Fortunately, I hate to ever let go of any of my clothes. I still had vests back from when the Annie Hall look was popular.
- Additionally, scarves work wonders and I happen to love scarves. Tie the scarf so the ends drape over the chest. Another way to war a square scarf is fole it into a triangle and tie two of the ends into a knot. The knot is placed at the back of the neck so the scarf drapes in loose folds across the chest area.
- Additionally, a scarf can create drama. I took a long oblong scarf with silver threads in the design. I slipped the two ends into a circular t-shirt clip. (Another holdover from the past--the t-shirt clip was popular in the 90's. It is used to catch up one side of a long t-shirt so as to create a diagonal hip-hugging line.) I then arranged the ends that were in the clip into a bow-like configuration and placed the bow on my shoulder. The rest of the scarf was like a cowl neck across the front of my torso. (You might find some t-shirt clips in thrift shops. I just checked and they have a few on amazon.)
- A loose blouse with a lot ruffles or other fussy details in the front helps make the flatness less noticeable
- Loose jackets, shawls, and ponchos are always good.
How To Tie a Scarf
Take a look at the video below. Most of the scarf tying ideas (but not all) will work to camouflage flatchestedness. Experiment and have fun with it.
If you don't already have a great collection of scarves, look on the clearance racks and in thrift shops.
Ideas for Ways to Tie a Scarf
Selecting a Prosthesis
There are breast cancer boutiques with professional fitters. I decided I wanted to work with a fitter rather than buy from the internet. There are a lot of questions to be answered and decisions to be made.
A prosthesis consists of two items—a special bra and a breast-form that fits inside a pocket on the underside of the bra cup. Back when I was young we would have called the breast forms “falsies,” but I haven’t seen that term used. I call mine “foobies” because they are my fake boobs.
The next decision is: foam or silicone? The silicone forms feel more like a real breast, but they are heavier. The silicone forms are more expensive, but they are more durable. I decided on foam because it weighs less and thus might be more comfortable to wear.
Next I had to select the shape and cup size of the breast form. I wanted to look the way I looked before. A smaller cup size may weigh less, but I think a woman should select a cup size that is in proportion to her body. I brought my favorite pre-mastectomy bra with me so I could see how the form fit into the cup of that bra in order to determine that I would look the same as before. (The forms don’t have the usual letters to indicate cup size—they are labeled 1 to 14.) I also brought a knit top that fit close to the body to the fitting so I could see how the bra would look under clothes.
Some women end up not wearing their foobies because they feel they are too heavy and too hot. (All breast forms are weighted to simulate the weight of an actual breast.) I am very comfortable with mine. I forget that I even have them on. (Besides real breasts are heavy and hot also.)
I also like wearing the prosthetic forms because I still have some pain in my chest. I feel like the foobies are protecting my chest. It feels comforting. (Sometimes I wonder if they might protect me like an air-bag if I were in a car accident. I hope I never find out.)
I was lucky to be old enough to be on Medicare. I never had to pay a cent for any of this. I bought supplemental insurance back when I was 65 and first eligible for Medicare, so I didn’t even have co-pays. (All of the costs connected with my treatment were also paid 100%. What a wonderful change from my first experience with breast cancer when I had private insurance. I constantly had to fight with the insurance company for reimbursement.)
Post Mastectomy Prosthetic Options
The Swimsuit Problem
The prosthetic breast forms can not be immersed in water. I looked online for breast forms for swimsuits and they were all very expensive. Since I don't go swimming often, I didn't want to spend $500 for a special swimsuit and the swimsuit inserts, especially since I had a couple of brand new swimsuits already. (I bought them long before I knew I would need a mastectomy because I had booked a cruise.)
I put on my thinking cap and after a lot of trial and error, I worked out a solution to adapt my current swimsuit. I wore it on my cruise and it worked great. If you can hem a skirt, you can use this idea.
My Personal Experience Post Surgery: Pain, But No Grief
I had considerable pain after the surgery, but it turned out to be much less than I expected. The lesson is: Don’t believe everything you read on the internet. It all depends on exactly what type of surgery you get and how healthy you are when you get it.
I have not felt the need to grieve for my lost breasts. If I had been younger, my decisions might have been different. I’m glad that I had to make my decisions late in life. It made it much easier.
Everything that happens, good or bad, is a useful learning experience. I look at my post mastectomy years as an adventure and a challenge. I hope that everyone who has a mastectomy will feel the same.
For More Information
This article is about my personal experience and decisions. Your situation may be different. This is a good website that explains everything you should know about mastectomy in simple language. Cancer A-Z: Mastectomy
Questions & Answers
© 2018 Catherine Giordano