He explains reconstruction: At the time of the mastectomy, he would put an expander, made of silicone, under the muscles of my chest. You couldn’t put it directly under the skin, as you would with breast augmentation, because all the breast tissue is gone, and there would be nothing to serve as a cushion between the implant and the skin. Over a four-to-six-week period, a saline solution would be injected into the implant, enlarging it. The muscles on top of the implant would stretch, as in pregnancy, but, as in pregnancy, you couldn't stretch them all at once. After two or three months, after the tissue around the implant had “settled down,” there would be a second operation and a permanent prosthesis would replace the expander. If you’re having chemotherapy, you have to wait longer because chemotherapy usually brings down the white-blood-cell count, increasing the risk of infection. Finally, in the case of large-breasted women like myself, there would be a third operation, a reduction of the healthy breast, to make it match the first and to build a nipple for the reconstructed breast.
To somebody who is terrified of general anesthesia, this is awful—I’m looking at three extra operations, not one. Then the doctor shows us the pictures and it’s worse: a color Polaroid of a woman whose breast looks like a halved grapefruit. The shape is perfectly round; a thick red scar runs from one side to the other; the woman has no nipple and no areola.
“I can’t walk around for six months looking like that,” I say. “It’s like a nuclear catastrophe.”
Then I feel terrible.
“What I mean is, it just sort of throws me, the idea of walking around like that with no nipple. I’m sure when it’s all finished it looks really nice,” I say.
The doctor shows us more Polaroids, including women with their finished breasts, who look much better. He says there are implants he can use for a more natural look, but while they have the same texture, all breast tissue is different, so my breasts may not feel the same. His patients say, however, that after a while they are not aware of the implant—it just becomes their breast. He’s a lovely guy. It’s running on two-thirty; we were booked at the last minute, and I’m sure he hasn’t had any lunch, but he acts like he has all the time in the world.
We leave. I know now, I tell Herb, I don’t want reconstruction. There is no way I am going to do those things to my body.
I also realize something else.
“You know how we’re always saying we miss things,” I say. “We weren’t around for Paris in the twenties; we weren’t reporters in New York in the forties; I had tickets to Woodstock, too much mud, I didn’t go. It just hit me: All these stories about breast cancer—for this trend I’m right on time.”
(This is the first of two installments.)