Replacing things lost.

February 26, 2009 6:04 AM

Amy DePaul writes about the unlikely intersection of breast cancer and breast augmentation. A piece from The Morning News. Warning: article photographic illustration is most likely NSFW.
posted by shadytrees (30 comments total)

Ifinally 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

That is absolutely grotesque. The idea that at a time when the patient is undergoing such an emotionally difficult medical process, dealing with surgery and chemotherapy and thoughts of mortality, when a woman is mentally grappling with the loss of parts of her body and the idea that her flesh has turned traitorous on her, that is when her surgeon wants her to think of herself in terms of sexuality and pleasing others with her appearance? Gaaaah. I'm angry.
posted by Secret Life of Gravy at 6:19 AM on February 26, 2009 [18 favorites]

It's insensitive, to say the least, but then again we're talking about a surgeon here. He has this big proverbial hammer, and everything looks like a nail. Many women do indeed choose to go larger after reconstruction, but there are many better ways of talking about the desired result. You can make it clear that the patient can choose no reconstruction (some do choose this), reconstruction to your current size and shape, or a change in size and/or shape. The surgeon really ought to have presented this information in a neutral way, but as I said, he is, after all, a surgeon, and is therefore somewhere between an ogre and Norman Bates with regard to his capacity for empathy.
posted by Mister_A at 6:41 AM on February 26, 2009 [1 favorite]

FWIW, that's a pretty tasteful illustration that clearly alludes to mastectomy, and I can't imagine it getting anyone in trouble even if they were reading this from a high school computer lab.

"...this process could permanently reshape the shape of your ribs."

Just... wow.
posted by hermitosis at 6:54 AM on February 26, 2009

I've known many women who have had breast cancer and breast reconstruction has become a routine part of the treatment, although when my aunt had breast cancer 20 years ago reconstruction was still considered a luxury. Most of the big-breasted women I've known want to go smaller. My mother-in-law, for one, wanted to go down two sizes (from a full C to an A) so she could go without a bra, but her doctor talked her out of it. A life time of having big breasts can leave you with a negative opinion on the subject-- I would certainly trade in my D cups given a chance.
posted by Secret Life of Gravy at 6:55 AM on February 26, 2009 [1 favorite]

There were also medical considerations, including thin skin that an implant might wear through in a rare phenomenon called extrusion,

I've never heard of this but it sounds horrifying.
posted by Secret Life of Gravy at 6:56 AM on February 26, 2009

For the record, insurance now must cover reconstruction if the patient elects to have it performed, which I think is wonderful.
posted by Mister_A at 7:02 AM on February 26, 2009

In the US. I do not know the story in other countries.
posted by Mister_A at 7:02 AM on February 26, 2009

Have any of you ever had breast cancer? One of my relatives did, and she ended up having a radical bilateral mastectomy. It's easy to say that you aren't thinking of yourself sexually at that time, but try dealing with the fact that one of your external sexual characteristics, one that had been with you since puberty, will be absolutely gone after a traumatic surgery and often brutal followup treatment. Many, many women with breast cancer mourn the loss of their breasts and feel less feminine because of it, especially if they only lose one. In a perfect world, of course that wouldn't be the case, but we don't live in a perfect world.

My relative chose to have augmentation, and yes, she chose to go bigger. Why not? She's officially considered cured -- more than five years since her mastectomy -- and she's still happy with her choice. Also, breast cancer patients are usually able to have silicone rather than saline implants, thus the end result looks more natural.
posted by sugarfish at 7:16 AM on February 26, 2009 [1 favorite]

Thanks for this. A great and interesting article. I idly wondered how many men with testicular cancer are asked these questions....
posted by anotherpanacea at 7:20 AM on February 26, 2009

A friend had a double mastectomy and reconstruction when she was in her twenties. She had decided to stick with B cups, but while the implants were being inserted she heard the doctor say "There's plenty of room, let's go with C's." She was awake enough to hear him but not conscious enough to do anything about it, so C's are what she got.
posted by The corpse in the library at 7:28 AM on February 26, 2009 [2 favorites]

then he mentioned that I might want to mull this matter some more and perhaps confer with my husband on the decision

I like breasts as much as the next guy but correct me if I'm wrong isn't it the woman's choice here? Also if someone who I loved had breast cancer making her look sexy again wouldn't be my number 1 priority. Yeah piece of her would be missing but I would have to hope my marriage wouldn't be based off of boobs. Plus the whole You have a terrible disease and will lose your natural breasts but don't worry we'll give you fake ones if you want should automatically make that doctor a candidate for apathetic asshole of the year award.
posted by Mastercheddaar at 7:30 AM on February 26, 2009 [2 favorites]

while the implants were being inserted she heard the doctor say "There's plenty of room, let's go with C's."

I hope she sued the hell out of him, then.
posted by AdamCSnider at 7:31 AM on February 26, 2009 [10 favorites]

My relative chose to have augmentation, and yes, she chose to go bigger. Why not? She's officially considered cured -- more than five years since her mastectomy -- and she's still happy with her choice.

Nobody is arguing that breast cancer patients should not have the option to go bigger ifthey desire it-- what we-- and the article-- are arguing is that women should not feel pressured to go bigger just because they can. If you opt for reconstruction it should not automatically mean you are opting for big, fake breasts. Yes, many women faced with the choice will opt to go larger-- perhaps because they have always wanted bigger breasts. What about those who have always wanted smaller?
posted by Secret Life of Gravy at 8:16 AM on February 26, 2009

That is absolutely grotesque.

Did you see the part where the doctor "explained early on that no one has to undergo reconstruction"? Telling her that she has time to think over such a life-changing decision (and, yes, that she may want to discuss her decision with her husband in private) seems like responsible medical advice to me.
posted by and hosted from Uranus at 8:20 AM on February 26, 2009

Metafilter: based off of boobs

sorry I had to
posted by jckll at 8:27 AM on February 26, 2009

Did you see the part where the doctor "explained early on that no one has to undergo reconstruction"?

And did you see the part where she told him she was certain she wanted to reconstruct?

That decision was made. And her decision was to reconstruct her breasts to their original size. Advising a patient that she may want to increase her breast size, and to check with her husband before deciding not to, is not medical advice in any way.
posted by peep at 8:31 AM on February 26, 2009 [3 favorites]

Thanks for posting this. My wife is going through this right now and I'm glad her plastic surgeon has been very supportive of what she wanted. Really, that has been true for all her doctors -- and you see a lot of them when you are diagnosed with cancer. I can't imagine what it would be like to be dealing with doctors who aren't supportive at the same time you're dealing with cancer.
posted by maurice at 9:17 AM on February 26, 2009

AdamCSnider: "I hope she sued the hell out of him, then."

She didn't. There were several people she could've sued in regard to her cancer, but I believe she didn't think it would be worth the stress. She's more of the "flag and move on" type of person, so she reported various doctors to various departments and got on with her life.
posted by The corpse in the library at 9:46 AM on February 26, 2009

Insensitive, yes. Practical and efficient, also yes.

The surgeon deals with all kinds of people, from the vacuous to the brilliant. Probably a hell of a lot more of the former than the latter.

Don't like his question? Just answer the damn question, say you don't want to move to a larger size, thank you. Did he insult you? No. It was a question. People choose to be offended. She chose to be offended, she inferred that he was suggesting she was "too small", when what he really implied was that he thought she would want to upsize. Generally a fair assumption, since 95% of his patients who get replacements probably do upsize. She's the one who assumes that his implication was pejorative.

Sometimes, it's just a goddamn question.
posted by Xoebe at 9:50 AM on February 26, 2009 [6 favorites]

“Oh no!” Dr. Ward replied. “You’re an attractive, large-breasted girl—you can’t go with anything smaller than a C.”

Having fought tooth and nail for a breast reduction, stuff like this makes me want to punch people. "Lots of women would kill to have that size!" Ugggh. Look, I'm not going to make any judgments on what women want to do with their bodies, but it pisses me off to no end when other people try to make those decisions for them. And buying a whole new wardrobe because your old shirts don't fit you is annoying as hell.


"The Myself: Together Again story of delayed breast reconstruction following double mastectomy surgery that appears on these pages was inspired by Debbie, who agreed to have the process photographed so that other young women like her could get an idea of what to expect."

This is NSFW but totally worth your time.
posted by giraffe at 10:05 AM on February 26, 2009 [3 favorites]

Some day, perhaps not in the immediate future, feminism will have its way and a bloke will be lying semi-conscious on the gurney after surgery for testicular cancer and the doctor will be discussing with a colleague how anything less than a handful each is for sissies.
posted by MuffinMan at 10:20 AM on February 26, 2009 [1 favorite]

That decision was made. And her decision was to reconstruct her breasts to their original size. Advising a patient that she may want to increase her breast size, and to check with her husband before deciding not to, is not medical advice in any way.

You have misstated the situation. During a first meeting with the doctor, it was obvious she had not considered the idea of an augmentation. Her first instinct was refusal, and the doctor told her to take some time to think about it.

Further, she didn't need to "check with" her husband - she needed to discuss it with him. If I go out and get a giant tattoo of a penis on my forehead, that's certainly my decision, but it doesn't mean that it's helpful to leave my partner out of the discussion. No one is claiming that men should be able to stuff plastic into women's bodies whenever they want, but a healthy relationship should include the ability to discuss such a thing honestly, especially when there's reconstruction happening anyway.

Now, whether or not augmentation is an appropriate thing to discuss with women undergoing mastectomies is another topic altogether, but the fact is that it's a common practice, and the surgeon in question didn't do anything wrong.
posted by TypographicalError at 10:30 AM on February 26, 2009 [2 favorites]

The idea that at a time when the patient is undergoing such an emotionally difficult medical process, dealing with surgery and chemotherapy and thoughts of mortality, when a woman is mentally grappling with the loss of parts of her body and the idea that her flesh has turned traitorous on her, that is when her surgeon wants her to think of herself in terms of sexuality and pleasing others with her appearance?

Let me tell you about my extroverted aunt Denise. After going through one bout of chemotherapy because of breast cancer, we got together for lunch, at the always delicious Paper Moon in Baltimore, in the back room. She had gotten there first and chosen a table in the far back corner, the one furthest from the entrance to the room. When I entered the half filled room, she grabbed her breasts and proudly proclaimed "I still got'em!" to the delight of the room.

So no, it's not completely strange that a person might be thinking of their looks at time like that. YMMV.
posted by Brandon Blatcher at 12:28 PM on February 26, 2009

The surgeon deals with all kinds of people, from the vacuous to the brilliant. Probably a hell of a lot more of the former than the latter.

Generally a fair assumption, since 95% of his patients who get replacements probably do upsize. She's the one who assumes that his implication was pejorative.

Maybe I'm just reading too much into this (likely), but the implication that wanting larger breasts makes one vacuous really bothers me, as does the assumption that 95% of women want larger breasts.

...if someone who I loved had breast cancer making her look sexy again wouldn't be my number 1 priority. ... Plus the whole You have a terrible disease and will lose your natural breasts but don't worry we'll give you fake ones if you want should automatically make that doctor a candidate for apathetic asshole of the year award.

I don't read this as apathy, I read it as the surgeon doing his job. The patient will have her body for the rest of her life, and feeling comfortable about and happy with that body (including feeling sexy) is an important part of life, at least for most people I know. I agree it's a sensitive issue that isn't always handled well, but that doesn't mean it should just be side-stepped.
posted by !Jim at 12:31 PM on February 26, 2009

The decision shouldn't be side-stepped, but neither should the patient feel pressured to have larger breasts, nor even to have reconstruction done at all. Describe for her, as completely and as neutrally as possible, the options that are available. Do not assume that you know what she wants to do or, worse yet, what she "ought" to do.
posted by Mister_A at 1:08 PM on February 26, 2009 [1 favorite]

As someone who has gone through this - it's a question that has to be asked. You are losing your boobs. You are building new ones. How do you want them to look? The best time to begin breast reconstruction is during the same surgery where your breasts are removed. So you need to decide then. You can wait - but that means an additional surgery.

So get over it people. Breast cancer ain't pretty or easy. Blessings to all of us who have so far survived.
posted by trii at 3:51 PM on February 26, 2009

The decision shouldn't be side-stepped, but neither should the patient feel pressured to have larger breasts, nor even to have reconstruction done at all.

My mother had a double mastectomy a couple of years ago, when her cancer came back something like... 7 years after her lumpectomy. Originally, the surgeon left a lot of extra skin because he thought she might want to go for reconstruction later and it would make that easier. Well, she has never wanted reconstruction at all. The surgeon I guess thought he knew better than she did what she wanted.

The extra skin became a problem, and she had various areas that didn't drain well (that she had to go in and have drained repeatedly with a needle), and overall the result was not what she wanted. She ended up getting another surgery about a year later that removed all the extra skin, improved the drainage, and worked out well for her.

Having no boobs certainly hasn't slowed her down one bit. She doesn't miss having to wear a bra. She doesn't have a significant other, so there's no one to feel aggrieved that she doesn't have breasts for them to play with. And as a bonus, her cat can perch on her belly and lean against her chest with nothing in the way, which they both enjoy very much.

Personally I wouldn't go for reconstruction either. Having a big squishy, blobby foreign object embedded in my body would be horrific to me, much worse than having no breasts at all. Plus there's the whole association of breast implants with the vapid and vain, which would bother me even though it would be for plastic not cosmetic reasons.
posted by marble at 5:12 PM on February 26, 2009

Advising a patient that she may want to increase her breast size, and to check with her husband before deciding not to, is not medical advice in any way.

Yes, but generally plastic surgeons are not solely, or even mostly in the business of medicine. They are in the business first and foremost of cosmetic surgery. While I'm sure that there are some plastic surgeons who focus on reconstruction, the industry as a whole does at least twice as many cosmetic procedures yearly. Being upset with this guy is like going to a car wash and complaining that they tried to up sell you detailing services.
posted by BrotherCaine at 8:23 PM on February 26, 2009

I'm pretty shocked at how much defense there is of the surgeon. Augmenting causes significant additional pain and the possibility of damage. How on earth is it advisable to encourage a longer and more complicated recovery time? Especially after surgery, chemo, radiation?

You have misstated the situation. During a first meeting with the doctor, it was obvious she had not considered the idea of an augmentation. Her first instinct was refusal, and the doctor told her to take some time to think about it.

I'm not seeing this. Her difficulty in imagining herself in the plastic surgeon's office is because she was shocked by the diagnosis, but she intended to reconstruct from the get-go.

"I was still reeling from my breast cancer diagnosis when I began preparing for my mastectomy and reconstruction."

"A chatty and energetic sort, he explained early on that no one has to undergo reconstruction, which I appreciated, but that if I wanted to, he would help me determine my options. I told him I was certain I wanted to reconstruct."

posted by desuetude at 9:43 PM on February 26, 2009

I'm pretty shocked at how much defense there is of the surgeon.

If her oncologist had told her to think about larger breasts, I'd be handing out torches and pitchforks as well. But if she goes to a plastic surgeon, she's essentially decided that aesthetic considerations are as important a part of the recovery process as medical considerations. At that point, why shouldn't he ask her to reflect on what exactly she wants? He'd be remiss not to.

I will agree that the quote she attributes to him is not the best way he could ask her to take time to consider her decision.
posted by BrotherCaine at 10:50 PM on February 26, 2009