Reconstruct or Remodel?

October 14, 2005

The dark shadow of hair appears again on my head, outlining my face, along with fuzzy soft blonde fur along the sides of my face and neck. The crisp shadow my head casts against the kitchen wall in the sunlight pouring through the window makes me think of wheat grass just beginning to sprout. I dare not pluck even one of the sprawling black eyebrows that have finally returned.

“Now you’ve had your surgery, the chemo is behind you, you’re done!” a friend exclaims. “You won’t even think about this three years from now.”

If it were only true. After surgery, once I got over the fear of emptying the drains, once my visiting nurse removed the dressing (I thought the sight of my mangled chest would make me cringe and weep), and once the swelling from surgery went down, I thought I’d be okay. After all, they saved my areola, the pinkish part around the nipple that had fed my baby.

I didn’t look as bad as I had thought. But food began to taste like metal. I could barely eat any of the delicious meals delivered by wonderful friends, although I was glad to see my family eat. My throat hurt. Then I became aware of the expander that had been placed in my chest that would be filled each week with saline to stretch my skin for breast reconstruction. I just knew it was pressing against my esophagus; that the surgeon had misjudged the placement.

I looked into my throat with a mirror in front of a sunlit window. White patches appeared there and my tongue was brown and green. Candida. I knew it. A yeast infection was taking over my throat, the result of chemo and antibiotics. I called the home nurse. I was miserable with allergies and claustrophobia from the inside out. I had to take more drugs that came with a list of side effects such as severe or fatal liver damage. I berated myself for vanity for deciding on reconstruction, since that added more time to this process that I just wanted to be free of.

To reconstruct means to construct again, reestablish, reassemble. But there was a foreign body in my chest that was filled every week. I felt I was being remodeled, like the house we have worked on now for three years. Remodel means to alter the structure, and though I had my own skin, my own areola, I would not have my own flesh and blood inside.

For months we had talked about reconstruction. I interviewed other cancer survivors, some adamant for it, some against. I didn’t know until the morning of the mastectomy whether I would choose to be one-breasted or have what I thought of as an internal prosthesis. Even after several visits to have the expander filled, after blood work showed that the chemo had indeed thrown me into a post-menopausal state (hence my hot hours of pacing followed by cold minutes and constant anxiety over the safety of my daughter driving), after women warning me of dangers of silicone, I wasn’t clear about my decision.

I plague the plastic surgeon with questions. After I describe my horrible week and how I have wanted to claw my skin with my fingernails (that are now really falling off) he looks vaguely disappointed and asks me if I want him to remove the expander. We sit for long minutes without talking. Then I tell him, okay, I’m a physical trainer and I know that the smallest adjustments can mean the difference in whether a body adapts or not. So he fills the expander with less saline and I try another week.

A breast can be reconstructed by using one’s own body. They can tunnel some of the abdominal or latissimus dorsi muscle through the body to the chest. Sounds agonizing and I feel I’ve worked hard to maintain my muscle through these last months. Recuperation is long and there would be no more training for the abs. So where do I go from here?

I take it a day at a time. I have what appear to be two breasts, one is high and hard, one soft and dropped slightly with age. I have to wait, now that the filling is finished, for another less intrusive surgery. The doctor assures me this is not the permanent look.

Many thanks, much love to all the support of this rich community of diverse and caring folks. When my husband spoke of how people had been touched by these articles, I said I thought it was because we are often too considerate to ask questions of those enduring the dreaded disease of cancer, though we are always curious and want to know. I know I have been like that, but knowledge quells fear.