Up Front
Fierce Attachment
going to die sooner than they think? “We’ll need to do more
testing,” she answered impassively.
And that is what we did. More testing. The mammogram
gave way to the sonogram, which gave way to the biopsy,
which gave way to the MRI. It was like hitting the plus sign
on Google Maps over and over, getting closer and closer to
the target. Soon we would be able to read the writing on the
garbage cans next to the back door. Initially, my surgeon had
assured me I could get a lumpectomy and keep the breast,
but as the results of the testing got grimmer, the prognosis
changed. My tumors may have been tiny—more lentil than
pea—but they were numerous. Four, to be exact. In the end,
it was an Alice in Wonderland moment: “Off with her breast!”
T
he night before my mastectomy, I stood naked
in front of the bathroom mirror and held my
right breast in my hand, like an old friend in
need of comfort. Goodbye, I told it, thanking
it for its years of service. Like every sentient
woman in the First World, I have spent stupid hours be-
moaning my physical flaws, but in all that
time I could never think of anything bad
to say about my breasts. Not too big, not
too small. Not too droopy. During sex,
they were a pleasant erogenous zone,
and when it came time to breastfeed,
they performed yeoman’s duty. I’d al-
ways thought men were a bit silly in their
worship of breasts, but actually they are
right. Breasts are wonderfully springy,
joyful things. I had so much to be grateful
for, but, of course, I only realized all that on
the cusp of its loss.
The problem with breast reconstruc-
tion after cancer is that you have to make
your decision in the midst of all these other traumatic life
and death decisions. Only after discussing the possibilities
o f chemotherapy, radiation, mastectomy, and statistical
outcomes for survival are you asked to consider reconstruc-
tion, at which point you’re thinking, Who cares? What’s a
breast compared with a life? On the other hand (assuming
treatment is successful), you will have the rest of your life to
live with that void on your chest, so you really do have to pay
attention. Plus, reconstruction is the one area where you ac-
tually get to make your own choice, as opposed to treatment,
where only a fool would decline to follow standard protocol
(don’t get me started on alternative medicine).
My options for reconstruction were (1) do nothing; (2) get
an implant; (3) undergo a six-hour DIEP-flap (deep inferior
epigastric perforator) surgery, in which a plastic surgeon re-
moves flesh from the abdomen, assuming you have sufficient
excess (not a problem!), and then painstakingly reconnects
the blood vessels from your abdomen to the blood vessels in
your chest, trying as best as possible to match the shape of
the remaining breast.
I considered declining reconstruction—I like the idea of
being that indifferent to convention. On the Internet, you
can see lots of pictures of women who made this decision.
They look proud, defiant, and like they could run an Iron-
man. That’s not me. I hate being the center of attention. If
I had only one breast, anytime I wore anything formfitting,
people would notice the lopsidedness. I was lucky not to
need chemo, not just because I wasn’t going to have toxic
chemicals dripped through my veins but also because I
would not have to endure the sad face of strangers con-
templating my bald head and its attendant message: “This
person may be dead soon.” I know because I can’t help
making the same sad face when I share an elevator with
those bald people at Memorial Sloan Kettering, the hospital
where I was treated.
I was tempted by the idea of reconstructing the breast
with my existing flesh by doing the DIEP-flap operation.
The result would be soft and warm, like my own body, but,
as with all the options, it would still initially be numb, like
a lobotomized cousin who comes for dinner every night.
Once the nerve endings are cut during the mastectomy, full,
normal sensation never comes back. Shaving under your
arm will forever after be a guessing game—you know a
blade is scraping your flesh, but you can’t
feel a thing. After DIEP surgery, you also
need to spend three or four days in the
hospital, the cost of which can run into
the hundreds of thousands of dollars
(although insurance pays for it, thanks to
the Women’s Health and Cancer Rights
Act of 1998). In a world where people
are dying for lack of basic medical care, I
could not fathom so much trouble just so
I could have a soft breast. So, the silicone
implant. But only one. There is a growing
trend for women with low-risk cancer
(Stage 1 and under) in a single breast to
opt for a double mastectomy with recon-
struction. In 2002, 4 percent of diagnosed women chose
this option; in 2012, 13 percent of women did. The thinking
is, they’ll never have to worry about cancer again and will
get a great rack to boot. In reality, the risk of developing
cancer in the healthy breast remains the same as if you have
never had cancer. And as for the myth of the “great rack,”
read on. If I had been tempted, a conversation with a friend
of a friend put an end to that. “I can’t tell you how much I
regret giving up that healthy breast,” she confided. “It was
probably the biggest mistake of my life.”
Each option, it turned out, was its own political minefield.
Not long after I made my plan, I ran into an acquaintance
who’d had a mastectomy but decided not to reconstruct her
A-cup breast. After hearing about her diagnosis, I had lent her
all the breast cancer books in my library, but when I told her
I’d been diagnosed and opted for the implant she said, “Re-
ally? I didn’t think you were the type.” Meow! “Unlike you,”
I answered, “I actually have breasts.” Not my finest moment.
When I met with my plastic surgeon to discuss the op-
eration, he explained there were two shapes of implants to
choose from—round or teardrop. “I want the teardrop,” I
told him confidently, imagining the fake-looking hockey-
puck boobs on strippers’ chests. I looked at U P F R O N T> 4 8
I looked down at
my handsome
doctor’s polished
Italian loafers and
panicked. A man
I did not know
was going to choose
my new breast?
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VOGUE JUNE 2017
VOGUE.COM