In an essay about breast reconstruction after a double mastectomy, “Replacing Things Lost,” Amy DePaul offers a fascinating glimpse into the technology of breast reconstruction and the cultural expectations that go with it. She writes that in her first meeting with the plastic surgeon, he asked her, “What is your current bra and cup size, and what would you like to move up to?” as though it were self-evident that she would want to emerge Phoenix-like from a mastectomy with larger breasts:
No, I thought. No, he didn’t just imply that I am an obvious candidate for breast augmentation, though some might argue that I was. I looked at my doctor and then my husband, both of whom studiously avoided eye contact with me. . . .
I finally managed to stammer a response to the bra inquiry (“It’s 34, um, A”) and said that no, I’d pass on the augmentation. My answer seemed to surprise my doctor (“Oh” was all he could say at first), and then he mentioned that I might want to mull this matter some more and perhaps confer with my husband on the decision. But my mind was pretty much made up that day in the office. The inescapable fact is that I resist any attempts by others to “improve” me. My husband, for the record, never tried to talk me into augmenting. He is a very intelligent man.
The surgeon’s interest in the husband’s opinion is rather disturbing for several reasons. First of all, who cares what a husband wants, really? Secondly, the surgeon’s question suggests that he has met several husbands who see breast cancer as an opportunity to trade up in terms of their wives’ breast size. But really, what kind of a husband would say, “Gee honey, why not go for the C-cup funbags?” That’s like saying, “I’m really sorry about the cancer and the surgeries and the chemo and the fearing you won’t live to see our children grow up and all, but what am I going to get out of it?” Super-duper extra classy! I’m trying–and failing–to come up with a reverse scenario in which a wife or female partner would suggest that her male partner’s illness was an opportunity to make him more attractive to her. How about this: “Honey, I’m sorry about the brain tumor, but since your head will be shaved and prepped and you’ll be laid up a while afterwards, what do you say about finally getting those hair implants?”
DePaul goes on to relate more of the technical details of reconstruction and augmentation. As it turns out, “rebuilding a breast or breasts after they have been removed in a mastectomy can allow you options for expansion. Hard to figure—you lose much of the skin and virtually all the internal contents of your breast, and yet you can, in some cases, end up bigger than you started.” Sounds great, right? Um, well–not when you know what augmentation after mastectomy requires: “reconstruction. . . . involves prolonged, torturous skin stretching, and anyone seeking to augment will face an even greater degree of pain and discomfort, something I’ve learned many women are willing to do,” even amidst the pain, misery, and fear of being treated for cancer. Breast augmentation, she writes, is the most popular kind of elective plastic surgery in the country today, which she says is a large part of the problem:
[I]t’s the culture of augmentation that inspires many breast cancer patients’ remarkable commitment to larger breasts in the face of increased pain and suffering. In addition to extreme skin stretching, the pangs of reconstruction (made worse by further stretching to enlarge) include immense pressure on the rib cage, muscle spasms across the chest, restricted arm movement and nerve pain over weeks or months, and sometimes overlapping with chemotherapy. Reconstruction thus revives the eternal question: How much are breasts worth, and how big do you need to be?
Indeed. How much pain do you have to endure for simply having been born with a female body, especially one that has been disobedient suffered disease? DePaul’s discussion of the disturbing details of reconstruction and augmentation are must-reads, especially for those of you who have women in your lives who have faced breast cancer. Until I read DePaul’s article, I had no idea what reconstruction entailed, and she describes the process and its results for her in striking detail:
When it came to the expansion challenge, I threw in the towel as quickly as I could, which meant that I didn’t suffer as long or as acutely as many women. This small blessing I owe at least in part to my husband, whose deferral to me on this issue freed me up to follow my own wishes. Instead of trying to persuade me to augment, my husband left me to make up my own mind. When pressed, he said with characteristic bluntness that large implants would not look right on me. Whether he believed it or not doesn’t matter; I’m just glad he said it, and with conviction. He also agreed with me that basic reconstruction was well worth doing.
In reflecting on her choices and experiences, DePaul writes, “I still find disfigurement hard, and I feel the loss of my right, normal body every day. I sometimes catch a glance in the mirror after a shower and think sadly, ‘Really?’ At these times, no, I don’t think I look very good, though that is the fault of cancer and not a lack of skill on the part of the plastic surgeon.”
Go read the whole thing. And come back to discuss!