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The truth is, reconstruction does not give you the same or better breasts than you once had.
By Dori Hartley — Written on Apr 04, 2022
Ever wonder why we're all so crazy about breasts? Because they're so desirable, that's why.
This is a reality that every woman who's undergone a mastectomy deals with each day.
Society's love affair with breasts is a daily reminder that our quest for self-confidence is going to be a bit more circuitous than other women's.
If you've never seen a mastectomy site, you might picture a smooth plane of skin and scar tissue molded masterfully into a flawless breast by virtue of a miracle procedure called reconstruction: all parts are beautiful, intact, and ready for their close-up.
When Angelina Jolie famously wrote a New York Times piece about her decision to have a preventive double mastectomy and reconstruction of her breasts, I noticed that the reactions among my friends and acquaintances — aside from admiration — were along the lines of, "Hey, she's Angelina Jolie. It'll be easy for her. Give her a couple of days and she'll be back on the red carpet with the greatest breast job ever."
Understandably, the word "reconstruction" is very comforting to a woman who's just been handed a cancer diagnosis — even more so when that diagnosis is briskly followed by an appointment with a plastic surgeon.
The idea of reconstruction is like a big security blanket that makes us feel that whatever it is we're about to go through, we'll be fine and dandy in no time.
But as a woman who's lost a breast to cancer and had reconstruction, I can tell you firsthand: it's more complicated than that.
The reality of a woman's post-mastectomy body — and the way it makes her feel — is a very delicate topic for a woman — and for her partner, for that matter. It's just easier to generalize the entire experience by assuming all breast jobs are equal. Quite simply, they're not.
The truth is, reconstruction — not to be confused with augmentation — does not give you the same or better breasts than you once had, no matter how successful your surgery.
Once you lose your breasts to cancer or prophylactic surgery, whatever you get in their place is what you have to live with, whether it's a non-reconstructed flat plane, a masterwork of cosmetic surgery, or a botch-job.
And unlike an augmentation, which many women feel proud enough to flaunt, no one really talks much about their reconstructed breasts; it just feels too personal.
Losing a breast forces you to learn the meaning of emotional vulnerability.
And despite your strength and resolve, that vulnerability will show — in the way you perceive yourself, in relationships, in the protective walls you build. The longer you live with these scars — which are 10 percent physical and 90 percent psychological, by the way — the stronger you get.
But the most vulnerable of all questions always lingers: "Am I still desirable?"
Just the other day, a friend of mine wanted to know if I'd be willing to talk with his friend's wife, a woman just about to undergo a double radical mastectomy due to cancer.
One of the things he told me was that his friend — the woman's husband — was so heartfelt in his endeavors to make his wife feel loved and supported during the process that he promised her a "brand new pair of store-bought, as big as she'd like."
It was his way of saying, "Don't worry about your breasts, honey, we'll buy you a better pair as soon as you're finished with this whole messy ordeal." Sounds great in theory, and I'm sure hubby meant well but was it she who was worried about the size, look, and immediate replacement of her breasts... or was it he?
A husband's concern over the appearance of the new breasts, a boyfriend's curiosity about the scars, or a cue signaling anything other than complete acceptance can undermine a woman's confidence.
I'm not saying that she's not entitled to be concerned about her looks, but the last thing she needs after losing her breasts is to be caught up in someone else's idea of what's aesthetically best for her.
Then there are the logistics. Let's start by saying that "store-bought" implants do not have the same cosmetic effect on a mastectomy site as they do on a woman who is augmenting her own natural breasts.
Breast augmentation is a procedure that slips an implant (ranging in size) beneath the fatty tissue of the breast to basically plump up what's above it, making a natural breast appear larger. The external appearance, the skin, the shape and size, the nipple — all of it, once fitted with an implant, has a larger, fuller look.
A mastectomy removes the entire breast, which leaves no fatty tissue, no nipple, and no extra skin to slip an implant beneath.
The woman must first undergo a skin-stretching process in order to accommodate the implant; that's done by placing a tissue expander beneath the tightened skin, which is later replaced in yet another surgery by a silicone or saline implant.
The road to reconstruction is a long one.
What does a finished reconstruction look like? It looks like a small, round, featureless, flesh-colored mound in place of where the breast once was.
It is quite soft and nice and is of great comfort to a woman. If she wants, she can opt for a nipple (by tattoo or skin graft) at a later date. But many women tire of all the surgeries and simply accept the breast mound as is.
So, whether you're Angelina Jolie, me, or any woman out there who's had to say ta-ta to a breast or two, it doesn't matter how much money you have or don't have if you're one of the most beautiful women on Earth or just a plain Jane living a plain-Jane life; losing a part of you that's so closely tied to being a woman is a challenge that is both daunting and surmountable.
It's daunting because of the vulnerability it introduces into your life — it’s hard to feel so fragile, so emotionally raw, so alone.
What's surmountable is the misconception that you've become something less than who you are. That you can get over. I did. In fact, give it enough time and you'll get over all of it, I promise.
You're not ugly, undesirable, ruined, unlucky, or worthless, as I thought myself to be for so, so long. It takes time to acclimate to the battle scars that will become part of your back story.
And when all else fails, there's always humor.
Want to freak out friends and family? Nothing works better than whipping out a nipple-free breast mound at your next barbecue. Time — and laughter — heal all wounds.
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Dori Hartley is a portrait artist, essayist, and journalist. She's been published in The Huffington Post, ParentDish, The Daily Beast, Psychology Today, XOJane, MyDaily and The Stir.