Goldilocks and the three boobs

One of my friends recently asked how I was getting along with my new boob.  To be honest, I haven’t given it that much thought over the last couple of months.  So much has happened in such a short period of time.  When I was diagnosed with breast cancer in June this year I was offered three options: wire-guided lumpectomy, mastectomy or bi-lateral mastectomy.  The long history of early onset, aggressive breast cancer in my family beggars belief so I was initially of the view that bilateral mastectomy was the only way to forward. I simply didn’t want to provide my body with any further opportunities to let me down.  I’d seen that happen to my Mother and my Aunt and they both died before reaching the age of 50 – no age at all.  Although bilateral mastectomy with immediate reconstruction is a long and complex operation, leaving any unnecessary opportunities for the cancer to return was my main concern.

As more information about the tumour came to light through histology, MRI  and focused ultrasound scans the importance of having it removed, recovering quickly and progressing to chemotherapy took centre stage. I was warned that by opting for bilateral mastectomy, I faced a 20 – 25% risk of developing an infection in the left, healthy side since surgery itself presents an infection risk and immediate reconstruction adds extra complications.  I was given the chance to go away and think about the options over an early July weekend.  I thought long and hard.  The possibility that undetected cancer might be lurking in my seemingly healthy breast worried me a good deal. On the other hand, facing a potentially significant delay in my adjuvant treatment due to any unnecessary infection made me very nervous. I also wondered what kind of mess my chest and my mind would be in if an infection occurred and seriously damaged the reconstruction. In the end the hard facts –  my tumour was very aggressive, hormone receptor negative, HER2+ and here – made me opt for mastectomy, not bilateral mastectomy.  I worked on the basis that I needed to deal with the cancer we knew about and any other cancer that might be lurking around would be taken care of with chemotherapy.

But it doesn’t end here, Goldilocks had more choices to make.  As well as deciding which amputation to have – mastectomy is amputation of the breast – I had to decide which reconstruction to have.  Again I was presented with three options: Diep flap, Latimus dorsi flap or silicon.   I’d always thought of silicon breasts as unnatural and awkward and I didn’t like the thought of foreign materials sitting inside my body. I discounted this option almost immediately.  I was advised Latimus dorsi flap was a fairly complex procedure that would involve moving the Latimus dorsi muscle from my back through a tunnel under my arm and around to my chest. This process would produce a more natural result but could leave me with a weakness in my back and visible scars on my back and front.  Similarly, the Diep flap would be a long and complex surgery moving fat and its supporting blood supply from my abdomen up to my chest.  There would be a long scar across my stomach as well as the scar on my chest but I would end up with a flat tummy and a new breast if I chose this procedure.   Decisions, decisions.

In spite of the complexity and the scale of the operation, I told my consultant I wanted Diep flap.  I was prepared to put myself through extreme make-over style surgery.  But my ideas on my ideal new boob were short-lived because my consultant told me there was insufficient fat on my abdomen to make the new breast.  Fec! Mentally I’d prepared myself for this leviathan of a procedure but stupidly I hadn’t  considered that I might need a plan B. Double-fec!  I needed to give the consultant an answer and I only had two remaining choices. Latimus dorsi with a potential weakening of my back or silicon and the necessary weakening of my resolve.   I chose silicon.  The option I most wanted to avoid. The one I thought would leave me looking unnatural and awkward. The option that meant I would have something foreign inside me as a long-term reminder of my run-in with breast cancer.

So my friend’s question “how are you getting along with your new boob?” is a timely one.

My new boob and I get along just fine, in fact I love my new boob!  I love its shape, its size, its position.  I love the fact that I have one very faint scar instead of multiple scars all over my body.  I love that it will never head south, it’s self-supporting and it doesn’t try jumping out of my T-shirt when I go for a run.  The option I least wanted to pursue has turned out to be the perfect option.  I’m so immensely grateful to my oncoplastic surgeon who is as much an artist as she is a doctor. We’ve already agreed to make another date once chemo is through.  I’ll gladly let her take the other breast in exchange for a perfect silicon replacement.  It’s the next part of my mission to kick cancer into touch.