The decision to go for breast reconstruction took a long time to arrive at and a number of factors came into play along the way. Over a period of two years, I went from being 100% sure that I didn’t want to go for reconstruction to being 95% sure that I did. The remaining 5% being due to the scary prospect of extensive surgery. The eventual decision to go for it had a lot to do with the trusting relationship I had developed with my surgeon and the amount of control I felt I had over the situation.
I was diagnosed with breast cancer in June 2015. In August, after I had had a therapeutic mammoplasty and it was discovered that we didn’t achieve clear margins; meaning that I would now need chemotherapy and then a mastectomy, I attended a Breast Reconstruction Awareness (BRA) Group meeting in Oxford.
The BRA Group meeting was very well led and was very informative. They talked about DIEP flap reconstruction at the meeting, which uses tissue from the tummy to reconstruct the breast (https://www.macmillan.org.uk/information-and-support/treating/surgery/types-of-breast-reconstruction/using-tissue-from-your-tummy-area.html#5353 ), and it sounded pretty horrendous to me. After the presentation there were a number of very brave women who were prepared to show and tell. Some of the DIEP flap reconstruction results were clearly remarkable and some looked a bit …well…not so good. I remember thinking that I would have been so disappointed with that result if I had put myself through such harrowing surgery. When I left the meeting, I knew that I definitely wasn’t going to have reconstruction and that I would have to accept being flat on my left side. At that stage I didn’t realize that there were several other breast reconstruction options:
I consider myself to be a strong woman who deals with what life throws at me. I therefore went through chemotherapy knowing that at the end of it, I would be having a mastectomy. I think my surgeon (Consultant Oncoplastic Breast Surgeon) asked me whether I wanted immediate reconstruction and my answer was a resolute ‘no’. This was the right decision for me at the time. Chemotherapy had taken its toll and all I wanted was to get rid of the offending breast. The surgery took place in January 2016. I had already accepted deep into my core that I would cope with being flat on one side as long as I looked normal in clothes, i.e. with the right bra, prosthesis and neckline. My 22-year-old daughter was more upset than I was when she saw my mastectomy scar.
Following my mastectomy, I had developed seroma beneath the scar and the radiotherapy I had in May 2016 made it turn ‘fibrousy’. It just so happened that this created a roundedness where my breast had been and it gave me a little bit of a cleavage. During one of my routine visits to see my surgeon, we tried to aspirate the seroma with some, but not complete, success. She then told me that this would need to be removed surgically and she also asked if I wanted to consider delayed reconstruction. My answer was again an emphatic, ‘no’.
I had the seroma removed and suddenly realized that I was now very flat. My surgeon suggested that perhaps the seroma had created a pseudo-breast and that maybe I was missing it. I kind of knew what she was saying but had already decided that after this surgery site had healed, I was going to have a tattoo to cover the scars. I had researched this and had found some wonderful designs. I wanted the message here to be ‘F**k You Cancer’. I thought I would be proud to show it off.
At another follow up appointment, my surgeon asked me if I would like to talk to a psychologist about my feelings, etc. She said that I seemed very ‘closed’ and was not expressing any of my feelings about what had happened to me. I said that I didn’t want to do this. But she was right; I had buried my feelings in an effort to accept what had happened and to get on with my life, and I didn’t particularly want to talk to a stranger about it.
At a subsequent appointment she explained latissimus dorsi (LD) flap surgery
(https://www.macmillan.org.uk/information-and-support/treating/surgery/types-of-breast-reconstruction/using-tissue-from-your-back.html) which uses tissue from your back and said that I would be a good candidate for it. She asked me again if I wanted to have reconstruction and this time, to my surprise, I said that ‘maybe’ I would. She told me to go away and think about it and if I told her that it was what I really wanted to do, she would be happy to do it for me. I thought about it and decided that ‘yes’ I did want to go ahead.
So, what had changed?
Several factors contributed to my decision. Firstly, I had had many appointments with my surgeon. She had performed three lots of surgery on me and I was always pleased with the results (as far as one can be in such circumstances). Whilst she is clearly an excellent surgeon, she is a nice person as well. We had been able to get to know each other a little over a period of two years, and formed a more meaningful connection, and I trusted her. If anyone was going to perform LD flap reconstruction on me, it had to be her.
Secondly, I didn’t wear a bra with a prosthesis in bed. This meant that when I got up in the morning, I was lopsided under my pyjamas. I coped with this perfectly well when it was just me and my daughter in the house. On a few occasions, however, I had people to stay. One morning, my sister and brother-in-law brought me a cup of tea while I was still in bed. Sitting up to drink it with them and being lopsided made me feel very uncomfortable. This had a bearing on my decision.
Finally, my breast cancer treatment was done to me. I am extremely grateful for it, of course, as it clearly saved my life; however, I felt like I was on a conveyor belt with a huge number of other unfortunate women like me and it was not a comfortable experience.
My breast reconstruction was done for me, not to me, by someone whom I liked and trusted and this made me feel more in control. She also did the reduction/matching of my right breast and most recently made me a nipple.
Dealing with a with a woman’s breasts is deeply personal, private and emotional and the relationship between the surgeon and the patient is key to the women’s psychological wellbeing.
Having a nice pair of breasts now has changed my life. I feel like a new and much happier person. I will be eternally grateful to my surgeon for what she has done for me. She seemed to sense that there was something going on deep inside me that I had encased and refused to deal with. If I hadn’t gone ahead with the surgery and had remained flat on one side, I fear that I would have seriously regretted it at some point in my life and it may have been too late then – who knows?
Just an areola tattoo to go and I will be all set.
Jeanette Costigan, 17 August 2018