Chapter 3: The Mastectomy

I bought a new breast today. It's a size 5-right, made of squishy pink silicone, and weighs about a pound, the same as the breast I lost. The new breast doesn't come cheap: I paid $354 for the prosthesis, plus $60 for two new bras, plus tax, for a grand total of $414. My insurance company says it will pay 80 percent of the cost.

Back in September, when a surgeon first told me I needed a mastectomy, my response was, "No way." I wanted a lumpectomy, to remove just the cancer, and even as the surgeon explained her reasons for recommending a mastectomy over a lumpectomy, my mind was looking for a way out. One reason for a mastectomy, she said, is that a lumpectomy would leave a "bad cosmetic result." Meanwhile, I was thinking, "So it looks a little weird, at least I'd still have a breast."

The idea of a mastectomy felt like a mutilation.

But I got second and third opinions--and all three sets of doctors agreed on the need for a mastectomy. Then I did some more reading, and took the time to come to terms with the choice I faced: that it was the breast versus my life. Then the choice became easy. "I can live without a breast," is the way I explained it to my children, "if that means I can live a long time." ("Or even a longer time," I added in my head. Life looks suddenly short when you hear that word, cancer.)

My doctors asked me if I wanted to consider reconstruction. For me, the answer is no. I feel strongly about this. Reconstruction is an elective surgery--and a long, complicated one. There are some risks, as with any major surgery, and the recovery time is longer than for a mastectomy. I don't want to go through that again any time soon.

The other big issue for me is that it's not a real, functioning breast. If I lost a hand, I would want a functioning artificial hand. Hell, I'd take a hook. But the best you can get with breast reconstruction is what the books call "a breast shape." It's not a functioning breast--no milk, no sexual sensation. Just a glob of fat from somewhere else on your body with a tattooed nipple. For me, the answer is, why bother?

My doctors would want to wait a year after the mastectomy to do a reconstruction anyway--that gives you time to heal from surgery and time to recover from chemo. Also, because most women either gain or lose weight in that first year, they say, it's better to wait until your weight is stable because a reconstructed breast will not change size with weight gain or loss as the other breast will.

"Fine," I said. "I don't think I want to do it, but we can talk about it again in a year."

Saying Goodbye
The night before my mastectomy, I said goodbye to my right breast in the shower as I scrubbed with a special antibacterial soap to help prevent infection in the operating room. I washed my breast, knowing that by the same time the next day it would be gone, part of it off to a lab for analysis, the rest sent to an incinerator, I suppose, with the other medical waste. There is a tremendous feeling of unreality: This is not happening.

I remember nursing my younger son, Robin. I loved nursing. I have a vivid, physical memory of going to see Kevin Costner in "Dances With Wolves" when Robin was less than a year old, and nursing him through the entire movie on that right breast to keep him quiet. I remember the feel of his mouth on my nipple.

When I woke up after surgery, I was strapped into a contraption called a Surgi-bra, which someone had stuffed with wads of gauze so it looked like the breast was still there. It took me two days to look under the Surgi-bra at my incision, and I felt faint and weak in the knees when I did.

But there was very little bleeding, and I didn't need the wads of gauze. The incision, I decided, was pretty tidy and not too upsetting, but the big hollow under my arm was a surprise. It's a wounded-bird look, and I felt very vulnerable looking at it.

I abandoned the scratchy Surgi-bra in short order, in favor of a soft cotton Calvin Klein undershirt and a plaid flannel shirt. These shirts and black sweat pants became my uniform.

The surprising thing is, once the breast is gone, it doesn't bother me, even though I had been so adamant about not wanting a mastectomy. How can I explain my feelings? I am focused on other things, more important things--my survival, getting through the chemo. They are more important than the breast I've lost.

When I'm all through with the chemo and feeling healthy again, this may change. Then, I may well feel the loss of my breast more than I do now. And I don't have a husband or a lover, so sex, and the sexual use of my body, is not an immediate issue. I can take my clothes off for a doctor without flinching, can even sit there and admire my surgeon's neat handiwork, but I don't know if I could take my clothes off with a man.

My scar is neatly done, a curving red line across my chest, with a smaller incision closer to the armpit from the sentinel node biopsy, and an angry red spot where the drain was. The skin over the whole area is numb, which feels weird, and it is still sometimes tight or tender underneath, where scar tissue is forming.

I want to buy a poster of an Amazon--one of those one-breasted, mythical women warriors--to hang over my bed.

Shopping at Nordstrom
I bought my new breast in the lingerie department at Nordstrom's flagship store in downtown Seattle. It's a beautiful store, already decorated for Christmas when I go in, but not a place I usually shop. But I'd heard good things about Nordstrom's ability to fit a prosthesis, so off I go.

I called earlier in the week, thinking I'd probably need an appointment. This was a hard phone call to make; what do you say? I wrote out a script before I dialed:

"Hi. I understand you sell breast prostheses?" ("Yes.")

"Could I speak to that department please?" ("That would be lingerie, on Three.")

"Hi, I've had a mastectomy and I'd like to be fitted for a breast prosthesis. Can I make an appointment?" ("No appointment is necessary, come in any time.")

"Oh. OK. Thank you."

I was sweating by the time I hung up.

It's almost as bad at the lingerie counter when I arrive, 8-year-old Robin in tow, on a Saturday afternoon. By the time I make it clear that I'm there to be fitted for a breast prosthesis, I'm hyperventilating.

Once Mary Moore arrives to take me in charge, however, things get better. Mary has been fitting prostheses at Nordstrom since 1991, and she's both a pro and a warm friend, right from the start.

The first step is a well-fitting bra that will completely cover the prosthesis. Mary explains that there are "mastectomy bras," but that she usually doesn't recommend them for younger women, she just works to get a good fit in a regular bra. I end up with a cream, stretch-lace, underwire bra similar to what I've worn for years.

Then Mary brings on the boobs, in a stack of boxes like shoes. She explains that prostheses don't come in cup sizes, they come in sizes 1 through 13, and are different shapes and colors as well as different sizes. After a couple of tries, we decide a size 5-right is right for me.

Mary asks about my incision, if it was done that way in order to do a reconstruction later. I explain about the sentinel node biopsy and the simple mastectomy I was able to have because my lymph nodes were negative. Mary hasn't seen a woman who's had this fairly new procedure before.

We end the one-hour fitting with a hug.

Back home, I admire my new breast and bra in the bathroom mirror. It looks good. It feels right. I didn't think I cared, but it's good to have two breasts again, even if one is just silicone.

The next day, my enthusiasm has cooled. Out of the bra, the silicone boob looks like Jabba the Hut, slug-like, wrinkly, and jiggly. I nickname him Jabba.

Bring on the Buzz Cut
This is the week my hair is supposed to fall out--between treatments three and four, I've been told--so I go home and buzz-cut my head, taking my hair from about 3 inches down to a half-inch. It looks pretty good--sort of a Joan of Arc look--except for the back, which is hard to cut evenly over my shoulder.

My eyelashes, eyebrows, and body hair will go too. I'm not sure when.

@ Jeanne Sather 2006