by bl

14 years ago I had a conversation with someone who needed a mastectomy. I asked if she was going to have a reconstruction. She said no, as she didn’t want a lump of silicone inside her, as there had been recent adverse publicity about implants leaking and possible side effects. I said I thought she was wise and would do the same in her circumstances.

Over the next 10 years I saw the effect this had on her, her husband and their marriage. She did not get the support she needed from her husband, which in turn made her feel less of a woman and it created huge problems resulting in a nasty and bitter divorce. Now I realise this is not going to happen to everyone, but when I was diagnosed and told I needed a mastectomy, it did make me think about how I might feel about my body after losing a breast and whether it would affect my relationship with my husband if I lost confidence in my own appearance. I thought my husband would be alright whatever decision I made, but how could I be sure? We all know how we would like to behave in such circumstances,
but can any of us really be sure how it will affect us until it happens?

I also had a friend who had a mastectomy and was never offered reconstruction. She is quite happy as she is, but sometimes, depending on what she was wearing, it was apparent that she had a prosthesis and I felt that was not for me. After much soul searching I decided that I was not prepared to take the risk. My self esteem has never been great and I was not going to jeopardise my marriage.

I was adamant I was not going to have an implant. I don’t learn, do I? A DIEP was out of the question, as I had a laparotomy in my twenties and was advised it was too big a risk of necrosis. I was told that any other reconstruction would need an implant as well to give me enough volume, which I found hard to believe. I thought I had more than enough fat to make half a dozen breasts. I was advised that the LD flap with implant would be my best option. After a lot of research, asking others opinions and reading about a breast surgeon who had breast cancer herself and decided against the LD flap in case it affected her right arm and her capability to operate, I had concerns that it might leave a residual weakness in my right arm and was not prepared to take that risk, as I had arthritic knees and relied on my arms to get me up off the floor and out the bath. That left me with the option of an implant.

The surgeon reassured me that implants had improved significantly. They were now made from a cohesive gel and even if they ruptured they would not leak like the early ones did. He advised I could go for an implant and if I wanted it removed or the LD flap later I could always have that done.

I had my mastectomy and immediate reconstruction with expander later replaced with a silicone implant and I have no regrets. Yes there are occasions when I wish I had a tissue reconstruction, but I know that given the same circumstances I would make the same decision again. My implant is not perfect. It doesn’t move like a natural breast, but in a bra it’s hard to tell the difference. Bras have been a bit of a problem in that I need a padded seam free one to accommodate both my natural breast and the implant. I don’t think of my implant as a breast. It’s not my breast and never will be. It’s a prosthesis that is under my skin, but I’m quite happy with that; it doesn’t bother me. I’m not going to waste my life wishing for what was. Comparing it with a prosthetic limb I know which I would rather have.

Having said all this I think it is very important that we all make our own decisions about what is right for us. There is no right or wrong decision. We are all individuals and even if we may not always agree with someone else’s decision we should still respect it; they will have had their ownreasons for making it. It can be a whirlwind of emotions when you arefirst confronted with the possibility of a reconstruction so make sure youask plenty of questions, ask to see pictures, how many has your surgeon done, what is his success rate, can you talk to any of his patients for their experiences? What can you realistically expect from reconstruction? Will it be like your natural breast, what scars you will have etc etc. Your Breast Care Nurse or Surgeon should be able to put you in touch with others who have had different reconstructions so don’t be afraid to ask and good luck with whatever you decide.