Shallow on the outside, DIEP on the inside

Ok, I have to cop to a certain degree of disingenuousness in my last post. 

Despite my whole "rah, rah, rah, I'm such a feminist, screw the way I look, la, la, la", it really isn't as simple as all that.  I'm not immune to cultural pressures about how women are supposed to look.  Far from it.  In fact, I have to admit that I'm a rather vain and shallow mutant.  I'm reluctant to embrace ethnic stereotypes about certain types of American princesses but suffice it to say that I love clothes.  I love the way I look in clothes (at least when I'm in shape) and if I thought that having a mastectomy would leave me significantly disfigured, I don't think I could do it.

And at first I thought I wouldn't do it.  I rejected the idea out of hand and the fact that my paranoid doctors at CancersRUs weren't pushing it too hard seemed good enough for me.  But strictly out of curiosity I began to surf the net looking for information and photos of women who had had prophylactic bilateral mastectomies (PBM) and reconstruction. 

What I discovered truly amazed me.  This is not your mother's mastectomy.  Gone are the days of porn star implants that make women look like mail order blow up dolls.  Gone are the days of shocking horizontal scars that make women look like extras in slasher movies.  Gone are the days where reconstructions necessarily take weeks or even months.  Nowadays,  many reconstructions are done with tissue transplants and microsurgery.  For women having a PBM, the reconstruction can be done concurrently with the mastectomy in a single surgery.  These types of reconstruction procedures have acronyms like DIEP, GAP, TRAM and finally, no pun intended, the stacked DIEP.   

If I understand this correctly, after the real breast tissue is removed, living fatty tissue is excised from a woman's abdomen (or hips or tush, depending on where she has the most material) and moved into place to form the new breasts.  The tiny 2 mm blood vessels in the donor tissue are then microsurgically reattached to the original blood supply in the chest wall thereby creating new breasts that look and feel like the real thing because they are in fact made out of tissue that is quite similar to the original breast tissue that is removed.   Because excess fat is siphoned from other parts of the body and the body is recontured to make everything look good, many women actually come out of the surgery looking better than they went in.

Thus, in what strikes me as yet another highly ironic twist of fate, the rather primitive "treatment" of prophylactic surgery is matched, tit for tat (!), by cutting edge, state of the art microsurgery.

There is also the option of "nipple sparing".  For women who don't have cancer (and even for some who do), it is possible to have a mastectomy wherein the entire outside of the breast is preserved.  The availability of nipple sparing really provided the final plank in the bridge that I mentally needed to cross to come around to the idea of the PBM.  I came to appreciate the fact that if I chose to do this now, on my terms, I could avail myself of the best surgeons, the latest techniques for reconstruction and I could have "nipple sparing".  If I were to wait and I developed breast cancer, I would have to make all of these decisions "under the gun".  And the medical necessity of getting rid of the cancer would dictate what type of mastectomy and reconstruction I would have which would not necessarily be as aesthetically optimal as what can be done now when I do not have cancer.  

For me, knowing what I'm getting is better than waiting to find out what's behind door #3.

PBM with immediate reconstruction is a complicated and physically traumatic surgery.  I will probably be completely out of whack for about two weeks and unable to work for at least a month.   The PBM is going to change the shape and feel of my breasts and there will be (hopefully small) permanent scars, not just on my breasts, but also on the site where the donor tissue is taken.
 
But when all is said and done I know that I'll still be able to recognize myself in the mirror. 

Practically speaking, given a realistic expectation of a decent reconstruction, sacrificing the boobs seemed like a reasonable price to pay to avoid an 85% chance of getting breast cancer. 

Not exactly bargain basement. 

But still reasonable.  

Comments

[Teri Smieja]

I agree, and have said pretty much the same thing, but not with such fun to read words as you! You are doing great, and it's good to meet another mutant that seems to be feeling much the same way that I am about all of this stuff..