About three days after my first breast surgery, I stood in the bathroom, before the big mirror, and readied myself to take the bandages off. This is never my favorite thing to do. I like company when I do it--someone to just be there with me in case it's incredibly horrible. And it never has been, but I don't like taking chances. This morning, I was eager to take a shower, wash my hair, feel the warmth of the steam and water refresh me--and eager to get the bandage off. I had been wearing this pink flowered frilly compression top that looked eerily similar to the tube tops that were banned from my junior high school in 1979--except this one opened with a velcro fastener in the front, and was designed to compress the breasts and allow more .... healing. The trouble was, the tape holding the bandage in place had given me a red, itchy rash, and there were small fabric hooks along the upper edge of the tube top that rubbed against the rash, and it smarted, in a really buggery sort of way, and I couldn't wait to be done with it. The top just wouldn't stay up particularly well, either, and the constant maneuvering was contributing to my discomfort. The whole thing reminded me of wearing strapless dresses to formal to-do's during my high school and college years, dresses that had barely stayed up, even with regular adjustments (ie, pulling them up, double-fisted, every few minutes to ensure that they didn't slide down all the way: pop! goes the nipple...). I just never had enough to keep anything up. It wasn't any different now. And, in fact, it was worse--as I was about to find out.
I peeled apart the compression top's velcro enclosure, and started to peel back the tape. The gauze came off right away, and there it was--my lopsided, worn-out, sorry-looking, asymmetrical left breast, looking suddenly smaller and decidedly different than my right one. I hadn't been told to expect this. I was a bit surprised, but also surprisingly okay with it. I mean, I've lived with scars and imperfections my whole life; I count them among my more interesting features, and certainly, they have stories to tell.
I think I was about two when I bashed my (rather large) head into a table and had to be stitched up in the forehead. A tiny faint sliver of a scar remains. In many photographs, portrait shots included, I sit wearing a dress--and a black eye. When I was seven, I was riding my Schwinn blue banana seat bicycle, the one with the high handlebars (the coolest bike I've ever owned), around the neighborhood with my sister, Rebecca (she had a ten-speed by then, with skinny tires). We were flying down a hill when suddenly, around the corner, a thick line of sand stretched before us. Rebecca cruised through a narrow gap on her bike (again, skinny tires), but I panicked, braked, and skidded, throwing myself off my bike and onto the pavement with so much speed that I scraped off much of the skin on my right leg, tarred and feathered the wound with bits of asphalt and pebbles, and lodged a small rock into the inside of my knee. I limped my bike home, where my sister deliberated as to whether she should heed my requests (screams, if I remember correctly) to call my mother, who was at work, or not. When my mother did arrive, she rushed me to the doctor's, where they cleaned me up and stitched me up. Trouble was, it was the beginning of summer, and despite my best efforts to stay out of the water all summer long, and to keep it clean, diligently scraping off the green muck that seemed to grow on my knee like moss, it never did heal up well, leaving behind a strange opalescent scar that in junior high, would prove to be a huge source of self-consciousness and social discomfort, keeping me out of shorts and turning me inward and shy. By the time I got to Exeter, my friend Natalie used to love telling stories about my scar to whomever had asked, stories that were filled with drama and action and danger. My favorite was how my sister had taken a hot fire poker to my knee (there was, after all, still an sizable indentation where the rock had been, clearly visible when I straightened my leg) during a particularly bad fight; I can remember Natalie's sound effects, sizzzzzzlllleee. Thanks to Natalie, I no longer cared how it looked. It had become a part of me, just as my other scars had--the line on my forehead, the bit under my chin from falling off my bike after my pedals had suddenly come off, the slightly crooked fingers I had broken playing softball and basketball and that had never been set properly. All stories, experience. And there's a certain pride in that.
So if this were done with, if the road ended here, I could easily live with my left breast looking the way it does. When I taught in Brookline, I often took my fifteen minute break outside, where I'd cross the street and walk to the corner store to get an iced tea, hoping, of course, that the caffeine would enable me to get through the afternoon. The crossing guard was a big, gregarious sort of guy, and he used to kid me about my nose all the time. "You gotta fightah's nose," he'd say. I would always smile, tell him I was a boxer on the weekends. Of course now I could say, "You think my nose is bad? You should see my left breast."
Of course, the road does not end here, and the docs are just not done with my left breast. I have decided, absolutely, not to go with another re-incision. The prospect of having to add another surgery--when there may be a few more in my immediate future--initially directed my thinking towards having a mastectomy, something that both Dr. Fox and Dr. Specht had recommended over re-incision--a combination of the locality of the cancer, the smallness of my breast, and the fact that none of the margins were yet clear. And this brought me to another fork in the road: mastectomy with reconstruction, or without. I met with Dr. Pitts, the plastic surgeon, to get a better sense of what that road would be like, and it will be a long one, but from what I hear, from women who have traveled that route, it has been worth it for them. There are, of course, other stories, stories from early reconstructions, which by many accounts, sounded "barbaric," as a family member described them, when the skin wasn't stretched bit by bit over time, but instead, "the skin and wound weren't ready, and scar tissue built up, filling up the breast space and compressing the implant into a hard ball." This is called capsular contracture, and Dr. Pitts described it to me as a rare, but possible, complication. The implant has to be removed, because the normal scar tissue that forms around the implant tightens and squeezes the implant, becoming hard and painful. I would imagine, as this family member pointed out to me, that breast reconstruction has advanced significantly since then, and that while it may not work for everyone, it can be a pretty amazing way to reinstate symmetry and balance to the breast area, not to mention one's body image.
As you can see, I'm still trying to sort out the pros and cons, still trying to cement my decision for mastectomy with reconstruction. There are things I am nervous about: the length of time I will have to limit my activity level after each surgery (nobody likes to have to pussy-foot around, and I worry about how this will effect my mental and emotional well being, in addition to my more obvious physical state); the way reconstruction extends the process of being done with this (regardless of how glad I might be at the end with my new Halloweentown boob--think Sally, sewing up her legs, arms and maybe boobs, in Tim Burton's The Nightmare Before Christmas); the prospect of putting something foreign (first the expander and saline, and then the silicone implant) into my body (and how my body might react to that); the pain and the drain despite the gain (I have no plans to go bigger); and finally, the necessity of having to embrace the very real probability that after fifteen or twenty years, this implant will have lived its life, and will need to be replaced (but who knows what the technology might look like then--perhaps a Logan's Run quick laser fix--presto! new boob!).
But there are reasons, lots of good ones--and I'm just trying to get those reasons to outweigh my fear--before I have it done.
Confront your fears, list them, get to know them, and only then will you be able to put them aside and move ahead. --Jerry Gillies
Later: we've just returned from the ER, where Luke was examined for a possible broken nose. He had had an early morning AAU basketball game nearby, had gone for the ball on the floor, where the upper bridge of his nose collided with several hard heads. It's funny that as I was writing the bit about my fighter's nose, I got the call from Jim. Poor Luke--no broken nose, but a very swollen, sore, bruised and contused nose, which will no doubt blossom into two beautiful black-eyes by morning. I'll post pictures.
Take each day as you find it, If things go wrong, don't mind it, For each day leaves behind it A chance to start anew. --Gertrude Ellgas
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