Tomorrow I’ll get my new nipple. After spending these past months getting used to a new left girl, she will once again be instantly and permanently transformed into something even newer, and stranger still. I have doubts as to whether or not she, or I, will be better for it, but I’m scheduled for surgery at 1:50, I’m in the books, on the schedule, and have already paid my co-pay of $250 (a fairly decent price for a new nipple, I thought), so it’s a done deal. No turning back. And by tomorrow evening, I suspect I’ll be quite remembering what it’s like to have really sore nipples (or even a newly constructed “fake” one), my post-operative smarting ushering me back into my long ago nursing days, when Luke or Dominick had been on a bender, and my nipples were sore and chapped and calling out for bag balm.
Just how does the plastic surgeon make a nipple? Do you really want to know? Do I? Years ago, it was standard practice for plastic surgeons (mostly older white men) to take skin from the woman’s inner thighs (called a “full-thickness medial groin graft”) or even her labia folds (called “torture”) to construct a nipple. The groin graft is still used by some surgeons, but not by mine. Dr. Pitts will be using skin from my left breast (which is pretty much all that’s left of my original breast—aside from the pec muscle that now rides the implant like an elephant in a circus—since the mastectomy did away with my real nipple, R.I.P., all my breast tissue, and much of my skin, that had to be stretched to make up for the lost skin and accommodate the new implant) to recreate the “nipple-areolar complex.” I'll be fully awake in the OR, locally anesthesized but not properly sedated. I won't be able to see what they're doing, but I'll be able to hear what they're doing, and that might be just as freaky. And I'm just hoping that I won't have any really bad sneezing fits at inoportune times, such as when they're slicing into me, or stitching me up. Ooops, sorry, but your sneezes set the nipple off-center a few centimeters.
It’s awfully hard to imagine what this procedure will be like. Dr. Pitts drew me a nifty little picture of this local skin flap once long ago, but I’ve lost it, and only remember a rectangular shape with a center, circular knob that represented the incision. I figure it’s okay if I don’t get it fully; it’s infinitely more important that she knows what she’s doing, and she does, and I have total confidence in her.
But that hasn’t stopped my mind from wandering, and wondering.
My grandmother used to wear these fitted cable-knit wool cardigans that had big grape-shaped buttons. When I think of getting my new nipple, I think immediately of those wooly buttons, and see Dr. Pitts using thread and needle to stitch one on the center of my left breast.
A friend asked today if the new nipple will “do anything.” Perk up in the cold? Deliver milk to my future babies? Sorry to say, but no. But it will provide some symmetry to my set of girls, some semblance of well-disguised normalcy, a hint of a real nipple underneath a bathing suit or tank top, one less question, perhaps, or lingering stare.
But let’s be real here: my nipple is gone, gone, and this new nipple will not match function nor form to my old one, and instead provide only symmetry and balance—still important—to my long-winded reconstruction project. Long gone is my areola, which housed the Montgomery glands (ever wondered what those little bumps were for?) that lubricated my nipple for breastfeeding purposes. There’s simply no way of re-installing those. Gone, too, are the multiple layers of fatty adipose tissue, the supportive Cooper’s ligaments, the milk duct systems containing the lobes, the lobules, and the lacteriferous tubules that brought the milk down from the glands into the nipple. By way of the excised breast tissue, the nipple and areola, and the introduction of Tamoxifen into my daily diet, my child-bearing and breast feeding days have gradually faded into the past as well.
But I still have my skin; albeit traumatized and diminished somewhat and sensory nerve damaged by all the snipping and stretching and scarring, it’s still mine. And tomorrow, it will go into service again, lending itself to a nipple sculpture of the most lovely variety (a girl can hope, can’t she?). I am most grateful. My new girl will soon sport a new nipple, constructed to match my right nipple in placement and size, though Dr. Pitts has warned me that the original projection will be impossible to equal. Sweater-button nipple, indeed.
I’ll have to wait another two months for my tattooing, the color that will render my new nipple and areola rosy-cheeked and life-like.
For now, I’m trying not to think about tomorrow’s surgery, but how to do my homework. For weeks, I’ve put off trying on those little nipple placements that Dr. Pitts’ office sent, but procrastination will only get you so far. As much as I’d just rather blow it off, I know that I should at least make some effort to figure out where my new nipple should go. It just seems so damn strange...
…As does telling people that I’m off to get my new nipple. And what to do, what to do if I should be running late tomorrow, find myself speeding along Route 2 only to be stopped by a state trooper? “Oh, gee, I’m sorry officer, but I’m in a rush. I’m getting my new nipple today, and I’m late!”
The whole thing is so bizarre that I have more than once thought that perhaps I don’t really need a nipple, after all, and can dispense with these surgical oddities. I've gotten quite used to my new nipple-less left girl, the deft surgical strokes running a residual, diagonal track of pink scarred tissue across the white smooth mound of skin, the bare, unfinished quality that speaks of stories and truths instead of deception and disguise. And after all, you can buy nipple prostheses in all different shapes, sizes and colors, even ones that can be customized to match your other nipple, made in the moulding room (not to be confused with the moldy room) in the hospital. Just stick it on, and you’re good to go. Heading to the pool for a swim? Just stick on your nipple underneath your suit and no one will know the difference! Planning on wearing that slinky dress to the party that shows every little bump and curve? Simply stick and go!
As fun (or creepy) as the stick-on silicone nipples sound, I’d rather not to have to bother. When I decided to reconstruct my breast, I signed on for the whole spiel—expander, implant, nipple, tattoo, all. I can’t stop now. I just wouldn’t be done.
And besides, going in for surgery to get a new nipple is a great distraction away from the fact that I turn 43 tomorrow, that yet another year has gone by and I still don’t know what I want to be when I grow-up, that another birthday has come and gone and I am no closer to figuring all this out than last year. Perhaps, though, I have learned a few new tricks this past year. After all, on Friday I met my fear head on in the mammography studio at MGH, made peace with the clampdown, and relished the feeling at being told that “everything looked clear.” Six months out and cancer-free. I’ll take it in baby steps, celebrate the small victories, and try to find the light in each day. Time to do my homework. XO, L.
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