A l'Agrandissement du Temps Perdu*

caryatid*Or, On the Enlargement of Things Lost.

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!

0 thoughts on “A l'Agrandissement du Temps Perdu*

  1. I had no idea. And it’s something we should know. Thank you for posting this. As for the surgeon’s question and assumptions about the desirability of augmentation, I thought it was outrageous before I read how much pain was involved. Having read that, I wonder that the surgeon wouldn’t discourage it, rather than bring it up. It reminds me of foot-binding.


  2. (shouldn’t it be ‘choses perdu’? or something? )

    I have thought about this over and over, as my mother had a lumpectomy at my age, and several friends have had much more severe cancer — one died of a relapse, which ended up metastasizing and reached her brain.

    I’ve thought about plastic surgery in the abstract for years … liposuction sounds useful. Making my face a bit more symmetrical … And every time, I think, “why would I submit my body to surgery when I don’t need it?” The idea seems too alien for me to consider. I can’t see any reason I’d ever have elective plastic surgery — just reconstructive stuff in case of injury.

    The two run together when I think of mastectomies. I have to say, I’m not one of the brave women who would choose no reconstruction. I want to look as much as possible as I did before the surgery, should that ever happen. And if that means popping a C-cup bag of saline in, that’s what it is. Having read this, it sounds like the sensible thing would be to go down a size if you can — less pain. But to me, we’re talking reconstruction — replacing what’s been lost, at least to the eye. I imagine I would always feel that I was missing a part of me, and going through extra pain to end up not even looking like the me before the surgery? It would make me feel even more like my body wasn’t *me*.


  3. The title was a play on Marcel Proust’s A La Recherche du Temps Perdu (Remembrance of Things Past). I’ll admit the translation is a little wonky–but I didn’t want to change the “Temps” since I changed the “Recherche” part.


  4. One of my good friends married this guy a few years ago who I, frankly, despise. While they were engaged she had considered getting a reduction because she is petite but has a DD cup size. This leads of course to back pain, etc. Her fiance didn’t care for this idea, so she said one day, “Well, Steve doesn’t like the idea, and he told me I shouldn’t do it.” Needless to say I was furious with Steve for not encouraging her to do something that would make her feel better. He’s done other things too that have convinced me that he really only sees her as a possession, but she of course can’t see it because of the love goggles.

    Thinking about this now fills me again with rage. Full on. Rage.

    Anyway, I appreciate this post, and I think it would be a great source to point doubters to, when they argue that our society is not hyper-sexualized. Thanks for posting.


  5. THE–I actually had another paragraph in the draft of this post (since deleted) about how the only women I know who have had surgery on their breasts (except for breast cancer surgeries) have been women who had breast reductions. Their backs were killing them, and their breasts hampered their athletic abilities and movement. Not a one regrets the reduction, and in fact, one has told me that she wished she had gone smaller.

    Maybe I just hang with an unusually small-breasted, athletic crowd of women, or maybe we’re just more into the notion that our bodies should work for us, we don’t work for our bodies. This is why that Dr. Ray plastic surgery show (and most everything else on TV) really irritates me–if you watch that stuff, you’d think that there wasn’t a single woman or group of women in America who were happy with their bodies and enjoyed them.

    And, BTW: Steve sounds like a real prize!


  6. Once, long ago, I worked as a paper shuffler in a big DC law firm, and one of the things I worked on involved the major manufacturer of silicon breast implants. My job was very basic (see these two big piles of paper? make sure they’re identical), but after seeing that stuff I have never been able to think of breast enhancement (or even skin grafting, since implants were often used to stretch healthy skin to provide extra for grafting elsewhere) as anything other than major surgery, with a host of potential side effects and things that could go wrong, even beyond the allegations/evidence of the problems with silicon. Even though I was basically looking at pictures of boobs all day, that was probably the least sexy job I’ve ever had.

    Also, it’s amazing how bad some doctors (especially specialists and surgeons) are at understanding and respecting patients’ emotional/psychological concerns. The doctor in this case had to find out what the patient wanted from the surgery, but “How big ya wanna go? That’s all? Ya sure?” really, really isn’t the way to get there, even if his experience says that most people end up augmenting.


  7. Recently in my area a commercial has been running for a group of plastic surgeons. It is so unbelievably sexist I almost can’t believe they are putting it on air. It shows many groups of guys whistling and cat calling and the tag line is “Don’t you wish you’d done this sooner?” They do not show the woman. After reading this entry, I am going to call that group and level my protest at their ad. Thanks for getting the juices roiled!


  8. This is nuts. Speechless. The hub should have nothing to do with it, it goes without saying. Does the surgical team get paid by the square centimeter of new surfase area?


  9. Who is this clown, and how insensitive does one have to be to spam a post about breast cancer?

    Your choice, Historiann, whether or not to delete the post above mine… I’d rather delete the person, but I don’t have that power.


  10. A good friend of mine had a double mastectomy, followed by reconstruction. I don’t have to read it, I’ve seen it. Having seen, I decided I couldn’t “reconstruct,” if it happened to me. Having my chest muscles where they belong is more important to me than my breasts are.

    “A l’agrandissement des tetons perdus” would keep a t-word in there; with “temps,” I expected a time-management post.


  11. The offending post to which cgeye refers has been deleted. (It looked like some strange autospam sent here because of trigger words in the post. Very obnoxious, but nothing personal, I think.)


  12. While I completely agree that the doctor referred to is insanely unethical, I think there may be more to this story. The doctor’s surprised reaction points to the fact that DePaul’s choice isn’t very common. To me, this is the crucial part of the story.A doctor cannot be blamed for the fact that unfortunately most women do seem to be unhappy with their bodies. It is quite likely that this doctor is simply mirroring the reality she/he comes across. So the question is, could it be possible that women deliberately choose to augment their breasts at this specific time? Perhaps they interpret it as an act of optimism. They avoid dealing with thoughts about death by focusing on life. What better way than by fantasizing about their “improved” future?


  13. It’s the way the doctor said maybe you’d like to confer with your husband that tips me off to the super utter weirdness in this story. He doesn’t think of her as autonomous and he does think of her as property.

    But I know some husbands who have boasted of saying exactly this: I will pay for your surgery (whatever it is) but I insist you also get breast augmentation along with it.


  14. Pingback: Sexuality and cancer surgeries: what’s mine is yours, apparently : Historiann : History and sexual politics, 1492 to the present

  15. When my grandmother, a widow, was diagnosed with breast cancer, she learned she would need a mastectomy. She sat in her doctor’s office, stunned and mourning the pending loss of her breast, as he tried to console her.

    “Don’t worry,” the doctor said, “at least you aren’t married any longer, so no one else will see them. Besides, they are so small already that you won’t be losing much.”

    The real message here? Breasts are only for the benefit of husbands, and only if they are large.


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