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Strangled by a Pink Ribbon Or: Breast Reconstruction Surgery 101

I do not have cancer. Or if I do, it’s still worming its weaselly way to the surface of my life. Like most people, I have relatives who have had various incarnations of the disease, some who have died of it. I was recently counseled by my doctor that given my family history, I should be tested for the BRCA1 and 2 genes. It has been on the back burner for several months now, a chore I know needs tending to, but one I’m loath to address. Because knowing that I am a carrier would leave me with the awful question of: what now? If I test positive, the good news is that my insurance will pay for a prophylactic mastectomy. And then, I’m entitled to a brand-new pair.

I am not particularly attached (other than at the literal, fleshy level) to these pointy little orbs on my chest. I am a scant A-cup. I really only wear a bra because of nipple decorum. I don’t “need the support” like some women, my pecs hold them up just fine. And though they fed my son, and still nourish my sexuality, I don’t think I would miss them terribly if they fell off altogether in the shower one day. This is how I feel today, on the front end of my childbearing years. But my maternal grandmother was diagnosed in her late thirties; do I really have the time to put this off? Do I have the luxury of being flippant? And as Jewish women, do you? If you carry the gene, you have an 85% chance of developing breast cancer and 60% of developing ovarian cancer by 70. A 2009 study noted that Ashkenazi women are 20 times more likely to be carriers of the gene than the non-Jewish population.  There is some concern about genetic counseling being used to stigmatize Jews, but most simply take the statistic as strong caution to be vigilant. I might set aside my concerns over racial profiling if it could keep me alive (but I digress).

I recently took a teacher training program to learn to teach yoga to cancer survivors (if you are so inclined, this is the one to take, IMHO). Tari devoted a large portion of the program to the challenges posed by the “reconstructive surgery” process. It turns out that, in an effort to return women to “femininity” and “normalcy” (not my words), we end up limiting their range of motion.

So how do you rebuild a breast?

You have a couple of basic options: implants, or self-harvested reconstruction. The word “harvest” has positive connotations, it conjures up notions of bountiful soil, spilling over and nourishing the farmer. Yum, who doesn’t like a nice harvest? And implants, well, celebrities get those, don’t they?

1) Implants. A two step procedure. First: insert expanders. Allow these to stretch, pull and separate the pectoral muscle away from the chest wall [note: this will be painful, at times excruciating, and may also induce your body to form life-long scar tissue]. These muscles will now hold up your implants. Assuming your body does not reject them outright [note: not entirely uncommon], and setting aside the potential for auto-immune reactions, you will certainly have to have these replaced multiple times over the course of your remaining years. This is high-maintenance healing.

2) Self-harvested: there are multiple variants on this form of reconstructive surgery. The most common is the TRAM flap surgery. Here, the doctor will detach the transverse rectus abdominus from its point of origin and tunnel it up to the chest area, here he/she will shape the muscle into a breast, possibly supplementing with an implant. Now that you no longer have a transverse abdominus, you may need to have a mesh sown in place to keep your insides from herniating outward. Luckily, this procedure also entitles you to a tummy tuck. You won’t have abs to properly support your organs or spine, but your stomach will be nice and flat. Whatever functional scoliosis develops as a result of this procedure may be unavoidable, but you will look great as you hunch into your latter years.

The DIEP Flap allows for the formation of a breast using your own tissue, and spares the muscles form the site where your tissue is harvested.

Sorting through these options is overwhelming to even a healthy woman. So, imagine the thought processes of a woman who has just emerged from the hell of cancer treatment. Imagine the allure of “normalcy” as it is now being sold to her by her surgeons. Note the language: “Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.” Explain to me how this can be physically rewarding, given that there is no sensation in the tissue? The nerves are severed. There is no medical benefit or need for reconstruction, it is purely cosmetic. Are they referring to a sexual partner’s physical “reward”? And as for the dubious emotional reward: if we accepted that women actually come in different shapes and sizes, and that that shape and size will change as we age, might the need for this paltry reward disappear?

The poet Audre Lorde had cancer, and a mastectomy, and refused either reconstruction or prosthesis.   She addressed the question best in her The Cancer Journals: “Prosthesis offers the empty comfort of ‘Nobody will know the difference.’ But it is that very difference which I wish to affirm, because I have lived it, and survived it, and wish to share that strength with other women. If we are to translate the silence surrounding breast cancer into language and action against this scourge, then the first step is that women with mastectomies must become visible to each other.”

–Liz Lawler