Breast Reconstruction is NOT Breast Augmentation

Let's get something straight. Having breast reconstruction surgery is not the same as getting a boob job. "Who would think that?!" you might ask, appalled. But plenty of seemingly well-meaning people have said some pretty crazy things to me about my soon to be new boobs. I think people want to say something positive and so the first thing they think is "well, you get a free boob job in the process!" or "well, you'll have perky boobs for the rest of your life!;" however, for many of us going through reconstruction, it certainly doesn't feel that way. Don't get me wrong, I've read some comments from people who were never happy with their breasts or their body and are actually happier with their new boobs or with the tummy tuck they got through TRAM flap surgery (transverse rectus abdominus myocutaneous; a procedure in which the new breast is made from abdominal tissue). On the other hand, several women I've spoken with, who have already had reconstruction, are very unhappy to have had to go through this process and are very unhappy with the boobs they now have.

Let's think about this. A breast augmentation, or "boob job," involves adding an implant to an existing breast, without altering the function of the breast and while minimizing scarring as much as possible. You can take out your implants later, if you change your mind, and still have your breasts there. As long as your breasts were functioning before, and as long and you suffered no complications from the surgery, you can still breastfeed. You still have sensation. You still have an areola and a nipple.

Mastectomy plus breast reconstruction involves removing the breast tissue, plus skin and the areola/nipple area (in some cases the skin, nipple and/or areola are able to be spared). Your milk ducts and lobules are gone. Your nipple and areola are gone. The skin loses sensation and becomes numb to the touch, so you can't feel anything over most of the breast area. Typically, and in my case, a tissue expander is placed and the remaining skin is stretched to make room for an implant. The implant will create the shape of a breast, AKA a "breast mound," so that you can wear normal clothes & bathing suits without worry, but is not actually a breast. You can't breastfeed from the affected side anymore. If you lose or gain weight, the "breast mound" will not grow or shrink with you (same during pregnancy). I like to think of it as a permanent/semi-permanent (sometimes implants need to be removed or replaced) subcutaneous prosthesis. It sits there, under your mastectomy-scarred stretched skin, taking the shape of a boob so that no one will notice as long as you're dressed. If you want, you can have your plastic surgeon fashion a new nipple out of the skin on the "mound" and you can have an areola tattooed around it (and the "nipple" colored in). You can also opt to have both the areola and nipple tattooed on. Apparently there are some great tattoo artists out there who can make some realistic-looking 3D nipples and areolas. Unfortunately, you never really get your nipple and areola back.

In my case, since I only had a mastectomy on one side, there is also the issue of altering the right breast to match the implanted boob on the left. This is the point where you should be thinking "Hang on, after all that you now have to cut into, and mess around with, your only remaining, healthy, intact breast as well?! That's crazy!" Yes, yes it is. An implant is round (unless you're talking the new-fangled teardrop shaped implants, which surgeons apparently are still figuring out exactly how to work with). This means that implanting the left side alone would leave me with one very round perky boob sitting high up on my chest and one normal, sloping breast sitting significantly lower. In order to make the two sides match I will need to have a slight breast lift (mastopexy) and a very small implant on the right side (to match the "curvature in the upper pole" that an implant gives, as my surgeon likes to say). Did I mention that since a breast lift involves removal of breast skin that I will also need my areola slightly reduced in size or else it will look tremendous sitting in the middle of my newly lifted breast? Did I remind you that this procedure leaves me with a bonus scar? You might be thinking "If it's so bad and if you're so unhappy about it, why do it?" Because it is the lesser of two evils. I am a very active person. I want to continue to be able to throw on my workout clothes, a bikini, a dress or a snug-fitting top and not worry about how my lopsided boobs look in them. I want to avoid having to wear a prosthesis. I want to be able to continue living my life as I always have.

That's what this is about. It's not about getting a boob job as a sweet concession prize for breast cancer. It's about preferring to just keep your own breasts, as they were given to you, but since that is not an option, doing whatever you can to continue to look as close to your old self as possible and to continue to live daily life as you had before.

There, I got that off my chest......literally!