Saturday, July 11, 2015

The Young and the Breast-less

2012 Bon Voyage to the Ta-Ta's
boobie cakes- complete with marshmallow
nipples and suspicious malt-ball lumps.
Don't get me wrong, I think breasts are great.

They make fabulous accessories,  hold up a sundress, are the personification of womanhood, heck - they can even make food.

And of course the media loves them too.  Each day in our country, breasts are coveted, idolized, regulated, fixated on, demonized and discussed.

America -for the most part- is "a boob guy."

Which is why it often comes as some surprise when I divulge I am happier without them.

Full disclosure - choosing to remain breast-less after cancer treatment wasn't exactly my first choice.  In fact, as I learned about my breast reconstruction options, I would have rated this game plan somewhere between "S" and "V".  But after suffering through excruciating pain and various complications, a surgical site infection landed me back in the hospital a month after my bilateral mastectomy.  Before you can say double-d's, my best-laid-plans made a sharp left turn and the breast reconstruction was urgently reversed.  It was then, lying on a hospital gurney in the twilight moments before anesthesia took hold, that I made the bravest decision of my life - I would not pursue reconstruction in the future.

Knowing what I do now, about complication rates and satisfaction scores, I'm not sure I would have gone down the reconstruction route in the first place.  Ironically, three years after losing my breasts and letting go of "conventional" standards of beauty, I feel more confident than ever.  And I got to that point not through obtaining surgically constructed lumps on my chest, but rather by discovering that I am still me without them.  

Don't get me wrong - I am well aware the decision not to pursue reconstruction is not for everyone.  Many women are very happy with their breast reconstruction results - and that's great (Team boobie - remember?).  But for the ladies out there who are on the fence and finding, as I did, that the "breast-less" camp is a little on the quiet side - this one's for you.

The Perks of Less-than-a-Handful

1.  There are better ways to be served sugar-free jello.  

Hospital food is not all that great and frankly, if you choose breast reconstruction you will be eating a lot of it.

Even in the best case scenario, reconstruction procedures are incredibly complex and are often riddled with complications such as scarring, required revisions and unfortunately in my case - infection.  Before all is said and done, most women who choose reconstruction will require 3-4 major surgeries to complete the job and some women I've known have endured eight or more.   To make matters worse, methods involving implants tends to be a little on the high maintenance side.  Even routine follow up includes frequent MRI and implant change out every 10 years - a fact that is often glossed over by surgeons peddling their wares.

Surgeons are also quick to note there have been many advances made in the field of breast reconstruction - which is true.  Tram-Flap, Lat-Flap or DIEP procedures are the new gold standard in surgically obtained boobie bliss - but also come with their share of risks.  For those of you who may not be fluent in recon-lingo, here's a synopsis (but you can read more about the various procedures here.):

First the latissimus dorsi (back) or abdominus rectus (stomach) muscle is removed and transplanted to the woman's chest.  The muscle is cut into a breast shape, fashioned into a pocket and surgically re-attached.  Later, the pocket is filled with fat obtained from elsewhere on the woman's body such as her butt or abdomen.  Then bing, bang, boom - you've got a couple of boobies.  What could possibly go wrong?

It turns out, a lot - including tissue necrosis, infection, pain syndromes and even death.

And don't get me started on nipples which, in some cases, can be removed and reattached, constructed from tissue grafted from the thigh or even colored in via 3-d tattoo methods.
(Strangely, it was the nipple options that were most distressing to me when I first met with my plastic surgeon.  At one point I just about lost my shit and demanded to see a photo gallery of previous work done by their "nipple artist".  It was not my finest moment - and turned out to be a moot point - but you can read about these shenanigans here.)

Regardless of the reconstruction option chosen, nothing will result in returning the breast(s) stolen cancer and all require logging a whole lot of hospital hours.  Frankly, in the immortal words of Ms. Sweet Brown - Ain't nobody got time for that.

Certainly not this kid.

2.  Options are a good thing.

By some estimates, more than 58% of women who undergo mastectomy will either chose not to
Of course - this would be my egg.
reconstruct or later deconstruct.  And yet, even in the medical world the decision is still treated as an anomaly.  I've heard stories from women who were forced to undergo psychiatric evaluation when they opted out of reconstruction and others who requested a flat chest only to awaken from anesthesia with baggy pockets of loose skin retained -against her wishes- to allow for easier reconstruction if she happened to change her mind in the future.

The audacity of a surgeon who would make such a decision - because a woman couldn't possibly live a valuable existence without the presence of breasts - is astounding to me and fodder for a malpractice suit.  But thankfully, my surgeon respected the decision to stop when I did - even if it was not the route he would have chosen.

Three years out, I feel no reduction in my femininity and am thrilled with the options this route opened up to me - including the ability to choose when, or if, I wear breasts.

It took about a year for nerve pain to quiet enough for me to be comfortable wearing prosthetics and today I do so about half the time.  For those not in "the know" - wearing a prosthetic is sort of like donning a Victoria's Secret water bra - but on crack.  Though they come in just about any size, shape or material you can imagine, the ones I wear most often are silicon and slip easily into a pocket which can be sewn into just about any regular bra or swim suit.

And because I am bilaterally flat and not bound to matching with a contralateral breast, over the last three years I have amassed a collection of boobies which amuses me to no end.  I have work boobs (B cup, regular) and date boobs (C, perky), swim boobs (weighted to avoid an unfortunate "float") and cotton boobs (great for working out).  I have boobs for every occasion and collect the latest models the way some girls do shoes.  But the best part is, depending on what I am wearing, I often opt out of boobs entirely - which is just about the most comfortable thing imaginable.  Puts a whole new spin on "casual Fridays" at the office, doesn't it?

***Side note: Having a bilateral mastectomy has also lead to great conversations with my kids about boobies not being bean bags and interrogations about where they put my "work boobs" - which should be great material for them when they eventually need therapy as adults.

3.  Decreased Risk.

As much as I'd like to tell you having a bilateral mastectomy instead of a single improved my survival odds after cancer popped up in my right breast - I can't.  Actually, the odds of a new primary tumor in the contralateral breast is pretty small - probably a 3% reduction in risk overall.

What many doctors do not take into consideration is that even when cancer treatment is complete, it's never really over.  If I had chosen to keep my left (cancer-free) breast, I would have been subjected to increased scrutiny and imaging for the rest of my life.  And because of my history, every blip on the monitor would result in more testing and painful biopsies as well as the often understated scan-xiety - not to mention being compelled to complete reconstruction or wearing a prosthetic at all times to maintain symmetry.

In short, I would have been prisoner in my own body, which was something I had absolutely no interest in signing on to.

There is more to living than just survival statistics and I've never regretted my decision.

***Side note: by choosing a bilateral mastectomy I decreased my risk of purple nurple by 100% - and that is no small thing considering who I am married to.

Cancer has taught our family many valuable lessons.
But none quite so poignant as how to stuff a
mastectomy bra full of snacks.

4.  Mastectomy Bras have Untapped Storage Potential.

Speaking of awesome future therapy fodder, here's a little trivia for you:  Granola bars fit nicely into a mastectomy bra.  I know this for a fact because I once filled said mastectomy bra with a variety of snacks and then strapped it to my then 12-year-old daughter as she headed off to DisneyLand with her aunt and uncle.

Don't judge - Disney food is crazy expensive and strategically placed snack items are a great thing to have.  Plus, I just about died laughing when I hugged her good-bye and it made crinkle noises.

Because of this experience, I believe I may have stumbled upon an untapped storage market for mastectomy bras - and I am ready to test out my theory.  And, because I'm a big believer in sharing the life lessons I manage to acquire, I've accumulated a partial list of easily stash-able stuff for your own inspired sneakiness:

Banana chips.
Fruit snacks.
A flask of rum.
Gummy bears.
Ice packs on hot days.
Hand warmers on cold days.
Candy boxes the movie theatre.
Capri Sun juice box.

So, there you go.  The next time you hug me and you think you hear a faint crackle - it's not your imagination.

And yes, I will probably share.

4.  Because - Screw Convention!

Though writing this may cause the editors of Cosmo to inflict a plague of great proportions (think: hipster mullets and shoulder pads) - convention is pretty overrated.

And to be perfectly honest, most people won't see whatever it is you don't like about yourself  because they are far too busy with their own weird hang ups.  So be healthy, love who you are and make peace with your body.

Life is just too short for any other route.


Monday, July 6, 2015

Running In Circles.

Procession of the Unknown Soldier.
Cancer years are a little like dog years - each is filled with enough loss and love, decisions and determination to make up at least seven "normal years".  And in the circles I run with, these years are unfortunately punctuated with more than our share of grief.

The reality is, more than 40,000 deaths are attributed to breast cancer each year, and some of these will be my friends and fellow advocates.  Each and every death inflicts loss - to the families left behind, the breast cancer community and society as a whole.  Each carries with it a shroud of stories and perspectives forever silenced by this insidious disease.

These deaths are a tragic reminder of the importance of advocacy and why we cannot afford to lose focus in our quest to end this disease.

But some losses will inevitably hit closer to home than others.
As far as the eye can see.

When Barbie Ritzco died earlier this year it was a crushing defeat for the breast cancer community.  She was a great woman known for her strength, bravado and a feisty can-do spirit. And though I knew her for only a short time, it was easy to see why she had earned the respect of those who spent time in the trenches alongside her.

Barbie and I bonded over a shared love of tattoos and the decision to forgo reconstruction.  At that time she was the only other young person I'd known who was as vehement about this choice as I was. And when Barbie died it was the first time I fully realized the gravity of the disease we shared.

She was many things to many people, but to me, Barbie represented all of us.  So, last month, while in the DC area for a BCRP panel, I decided to make good on a promise to meet up with the great Warrior Queen the only way I possibly could - at her final resting place in Arlington Cemetery.

At the risk of sounding hyperbolic, Arlington  is much more moving than I could have ever imagined.  The sheer magnitude of those perfectly placed marble tablets standing at attention across endless rolling hills would cause even the most hardened cynic to wipe a tear or two.  

Arlington embodies American sacrifice and honor in a way that is nearly impossible to put into words - though many have tried.  It is also a very real testament to the tragedy of war and life cut down too soon.  

And it was here, amid this reverent landscape that I finally met my friend.

Though the grounds were solemn and steeped in ceremony, as I made my way to Barbie's grave, I didn't feel as sad as I feared I might.  Arlington is something special, and perched high on a wall amid all those brave men and women - the young soldier didn't seem quite so alone.

This, of course, was not the meet-up we should have had - shared drinks and tattooed tales.  But being able to pay my respect in person is something I will always be thankful for. As I gazed upon that marbled wall, I realized that although Barbie's life was far too short, the flame lit through her message and spirit will live on through all she touched.

And perhaps, that is the most any of us can ever hope to accomplish.

Perhaps, this alone, is enough.

Rest at ease, dear Soldier.  For we shall carry your post.