Life After Mastectomy: Adjusting to Reconstruction

As soon as my doctor recommended a bilateral mastectomy after diagnosing me with breast cancer, she quickly followed with a discussion about reconstruction, as if to soften the blow. Somewhere in the back of my mind, the idea of being rebuilt at age 40 seemed like the first potentially positive trade-off to the whole ordeal. Still, it turned out that deciding how to reconstruct was as difficult a decision as deciding whether to reconstruct. There are a number of options: saline and silicone implants, using tissue and muscle from the stomach or other areas of the body, or combination of methods.

After weighing my risks and consulting with my doctors, I opted for saline implants. During my mastectomy, tissue expanders were inserted under the muscle in my chest. Over a period of time, they slowly expanded to create pockets for the implants. The expanders were uncomfortable, hard, and oddly shaped. I was concerned that it was a sign of things to come and considered having them removed and foregoing the implants altogether. After some reassurance from my doctor, I went ahead with the process as planned, and finally the silicone implants were inserted.

If you are considering breast reconstruction with implants, I hope you'll find some of these lessons I learned helpful:

• My most important lesson: unlike augmented breasts, which are an enhanced alternative to natural breasts, reconstructed breasts are an alternative to no breasts. Put simply, you cannot expect a reconstructed breast to ever feel or look exactly like your own natural breast.

• Reconstruction takes time - I have spent more time on reconstruction than on treatment. Reality tv tries to convince us that healing takes place between commercial breaks, but in real life, reconstruction will not happen in sixty minutes. To have a good cosmetic effect, patience is absolutely required, and a follow-up procedure or scar revision may be necessary to get the desired effect.

• You will have to adjust to the feel of the implants. The expanders will feel hard, but the implants will be better. Still, implants will feel like, well, implants. It may make sleeping, getting a massage, or visiting the chiropractor uncomfortable for a while. I cannot lie comfortably on my stomach or even on my side due to some sensitivity at the incisions and the scar tissue around the area.

• After the incisions have healed, if your scars feel tight or painful, or if you experience general pain around the implants or notice a reduced range of motion in your shoulders or arms, discuss it with your doctor. My doctor suggested I see a physical therapist, who taught me how to massage my incisions and keep the tissues flexible.

• If you're not completely happy with the shape of your new breasts, a lightly padded bra can make a big difference (not in size, but to provide a nice shape). These bras often have underwire which should not be worn until your surgeon gives you clearance.

• Your clothes may fit differently. I have found that the implants sit differently on my body than my 40-year-old natural breasts. I am now more comfortable in v-necklines than scoop or square necklines.

While I will never feel completely restored from the bilateral mastectomy, the reconstruction has allowed me to feel somewhat normal when I dress for work, or when I catch my reflection in an unexpected mirror. And when I meet new people, they have no reason to suspect that I have ever had breast cancer.