Tough Decisions
Choosing between what's behind Door #1, Door #2, or Door #3
Hello, Friend.
Sometimes life throws us curve balls requiring us to make tough, unexpected decisions.
Has this happened to you?
If so, this one’s for you. I can’t wait to hear about a tough decision you’ve had to make.
Let’s have a conversation about tough, unexpected decisions.
But first…
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Tough Decisions
Choosing between what’s behind Door #1, Door #2, or Door #3
Making the decision about what to do following my bilateral mastectomy felt like being forced to choose between what was behind Door #1, Door #2, or Door #3 — and all the options sucked.
I felt backed into a corner, and no matter which door I chose, it was highly possible I’d regret my decision. By the way, saying this does not mean I’m not grateful for having had options or that I’m being negative. (Yes, I’ve been called that.)
Basically, women have three choices post mastectomy. Get implants — which means having cold, foreign objects in your body. Go the autologous route and use your own tissue; which entails extensive surgery, lengthier recovery, and pretty humungous scars from being carved out not unlike a Jack-o-lantern. Or go flat, which presents its own set of challenges including societal gawking and judgment.
See what I mean when I say all the options suck?
Again, I’m glad there are options. Let’s talk briefly about them.
Note: To clarify, not all women have access to all options because nothing about any of this is a one-size-fits all. No woman, no situation are the same.
Door #1 — Implants
I’m pretty sure everyone is well aware what breast implants are; but for clarity in breast reconstruction world, it means a surgeon uses a saline or silicone filled balloon to recreate a breast.
(And I just have to add here that this is nothing like having breast augmentation.)
If you choose implants, you’re sort of looked upon as one who wants the quick and easy fix even though in reality, implants are neither.
Besides not being quick and easy, implants do not last, as I learned first hand when one of mine ruptured. (Story for another day.) Of course, I knew they weren’t a forever solution, but somehow looking too far into my future felt like hexing the whole darn thing. Back then, who knew if I even had a future, so why would I worry about the future of my implants?
Besides, I’m a procrastinator. I tend to worry about things at hand. There will always be plenty of stuff to worry about tomorrow.
Door #2— The autologous route
An autologous breast reconstruction surgery involves using your own skin, fat, or muscle to form a breast shape following a mastectomy or lumpectomy.
For obvious reasons, these surgeries are more complex, way longer, and not even always available as an option depending on where you live and what kind of medical access you have. (Also a topic for another day.)
I opted for this door in 2020 following my implant rupture. I chose DIEP flap breast reconstruction. During the pandemic no less. More on that later, too. Long story.
Door #3 — Aesthetic flat closure
Aesthetic flat closure is a surgical procedure used post mastectomy to remove excess fat, tissue, and skin in order to create a smoother, more even, and more comfortable flat chest contour.
The thing about flat closure is that it’s not even always presented as an option. It was never presented to me. In hindsight, that makes me more than a wee bit angry. Not because I necessarily would have chosen it but because it wasn’t even presented as an option.
Says a lot about our breast obsessed world in itself, does it not?
In the past, I’ve heard stories about some (male) surgeons hesitating to do this surgery because they feared a woman would change her mind and want “real reconstruction” later. The arrogance of assuming a woman doesn’t know what she wants reeks with patronization.
This often left women with what’s known as dog ears (extra skin) and uncomfortable feeling chests.
Patriarchy in medicine is alive and well. Thankfully, more women doctors are in this field today, but we need more.
There is judgment in Breast Reconstruction World, too. From other women. I kid you not. As I mentioned, implants are sometimes viewed as the quick and easy option.
Messages seep out from the autologous group suggesting the “best” option is using your own tissue. Because who would want a cold-to-the-touch, rigid implant when you can have a warm, more natural feeling breast?
Women choosing to remain flat sometimes make those of us choosing the other doors feel like we’re letting womankind down. Or maybe I’ve projected that feeling on myself. That’s likely it.
To be honest though, sometimes I have felt like I’ve let the women’s movement down because I chose implants and later DIEP flap. I must be weak. And vain. And of poor character. All ridiculous notions, of course.
Still…
Why try to create fake breasts anyway? Who am I trying to please? Myself? My husband? Society? How can I call myself a feminist if I chose to create fake breasts?
Well, I can and I do.
It gets complicated, and it’s easy to feel judged and start second guessing your decisions.
Does this bring to mind for you, too, the issue of a woman’s right to have control over her own body, her right to choose, period?
It sure does for me. There are so many layers to this conversation.
The bottom line is, no one gets to choose what is right for someone else. Judging other women’s choices about breast reconstruction is not acceptable either. It’s just not.
The choice about which breast reconstruction to have is deeply personal and no one else’s business. Every woman’s tough decisions about her own body should be respected. Case closed.
Now it’s YOUR turn. Let’s talk about tough decisions about anything you’ve had to make. What strategies helped you make them? Do you have regrets?
This is a conversation very much worth having, so let’s have it. Below are some prompts, but feel free to share whatever’s on your mind.
What tough, unexpected decision(s) have you had to make, and have you ever felt like your decision was being judged?
If you were faced with this situation, which door would you choose?
Have you, or has anyone you know, had any kind of reconstructive surgery?
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Parts of this essay are from my third book, EMERGING: Stories from the Other Side of a Cancer Diagnosis, Loss and a Pandemic, available on Amazon, Bookshop.org, and Books-A-Million.
Visit my author website to learn more.
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Thank you for being here. I appreciate you.
As always, I see you. I hear you, and I care about what YOU have to say.
Until next time…
Take care of yourself, be kind to someone, be a light, and keep going.
With gratitude,
Nancy
xoxo
I know two women who chose to go flat: One wore tight fitting tops to accent her cave in look, the other found blouses with structured designs or fluid, draping fabrics that float off the chest. Both made different choices after choosing the same door. I have another friend who chose a silicone implant which resulted in an infection that needed a second surgery. She looked great until she gained weight and is now totally asymmetrical. These three women made different choices about their bodies. The most important choice was to have the surgery and survive.
Cancer has a way of forcing us to choose between options that start at not appealing, progress to less appealing, and end at "no way for me!" As you say so well, the absolute key for each woman with BC surgery looming is to be well-informed, have enough time to consider options, and make the choice that is best for her. No two patients and set of circumstances are the same. Societal pressures and patronizing doctors aside, we follow our hearts, and to an extent perhaps our fears, and hope for the best.
Factors in my decision to have bilateral mastectomy after my BC diagnosis with no reconstruction included:
-I had an elongated timeline with 6 months between my lumpectomy (surgery #1) and the mastectomies (surgery #3) (There was a failed re-excision between these, and also 4 rounds of chemo.) My decision became clearer as time went on. (An appointment with an arrogant and uncaring plastic surgeon in this time period left me feeling like "a piece of meat." It didn't really factor into my decision, but I will never forget how that made me feel.)
-I am a runner and was running marathons at the time. I wanted the best chance to keep running and run with less pain--other than that imposed by the late miles of a marathon-- so no reconstruction was the best option for me. I was only 43 and knew if I chose any type of reconstruction, I may be looking at more surgeries down the road. I am happy to report that following 5 marathons before my diagnosis, I ran 12 after. My first post-cancer marathon was 10 months to the day from my bilateral mastectomies.
-Nothing would replace the look and feel of the breasts I was given the first time around.
I have definitely been self-conscious at times, and have felt judged, but I like the flexibility of prosthetics when I want and flat when I choose.
I appreciate my doctors and that I did feel I could consider all the information they and others provided. My husband started out supportive and has never stopped. He told me the decision was mine and that what mattered most is me being here and healthy, not body parts.
I guess I had a lot to say. And I echo your efforts to not judge others who make choices different from mine. Thanks Nancy!