Tumorous: Plastic Fantastic

After her mastectomy, Juliet Disparte gets breast implants — a process that reveals just how shallow she is.

Illustration by Rebecca Elves

A month after my unilateral mastectomy (in which one of my breasts was removed), I began the weird and painful process of reconstructing my breasts.

My cancer surgeon had given me a list of plastic surgeons in the area who specialized in breast reconstruction, though there was one in particular she recommended. He was, as she said, “an artist, with an artist’s ego.” His bedside manner left a bit to be desired, she warned, but he was the best plastic surgeon in the city and easily as talented as any plastic surgeon in Los Angeles, the Kingdom of Fake Tits, where I briefly considered going for my reconstruction surgery.

Once I had recovered from my mastectomy and solidified my treatment plan with my oncologist, I made my first visit to the plastic surgeon’s office, also known as the place where I discovered exactly how shallow I really am.

My plastic surgeon was tall, handsome, not too old, and blunt — but in a charmingly sardonic sort of way. He took me into his office and explained the reconstruction process. There are a few different ways to reconstruct a breast. One very common method is to give the patient a tummy tuck, then use the excess skin and fat from that procedure to create a new breast. This option was out of the question for me, mainly because I did not have enough skin and fat in my abdomen to accommodate a tummy tuck.

The only real reconstruction option available to me, other than no reconstruction at all, was a three-step process, in which a tissue expander is first placed under the skin of the breast that was removed, and gradually injected with saline solution to stretch the skin to the desired size. Then a standard saline or silicone breast implant is placed in the healthy breast to match the side with the expander. (I did not have to have the other breast enlarged, but it is easier to enlarge both breasts to a new size than to reconstruct a breast to match an existing size.) Finally, four months after the expander has been filled to its desired size, the expander is replaced with a breast implant to match the healthy side.

I’ve read about women — celebrities, mainly — who have compressed the mastectomy and reconstruction into one marathon surgery. None of my doctors advocated this approach because the risk of complications like infection and bleeding is much higher.

My plastic surgeon explained all of this in that first visit, aided by photographs of past patients. The photographs, which might best be described as “torture porn lite,” showed women in the various stages of reconstruction. Although my tolerance for medical terminology and icky situations had risen considerably in the previous three months, I wrestled with nausea while looking at these pictures of women’s mutilated bodies. My heart broke for this awful club of women whose bodies were beat up by grueling cancer surgeries and radiation. Thankfully, my plastic surgeon wound his way around to the “after” pictures — photographs of beautifully reconstructed breasts that were almost impossible to distinguish from healthy breasts, other than the scars.

Then we went into an examination room, and I took off my shirt so the plastic surgeon could assess my breasts. He used a permanent marker to draw a series of bisecting lines and arcs across my torso, measuring the width of my rib cage and my remaining breast, all as a means of determining the proper size and placement of my expander.

Standing there with graphs and charts drawn on my chest, my plastic surgeon finally asked the million-dollar question: how big did I want to my new breasts to be? I had looked forward to this moment for months, and I’d mentally debated the answer a hundred times in the weeks leading up to this appointment. I’d spent a fair amount of time on the internet “researching” the size of Gisele’s breasts. (For those interested, the online consensus is split between whether they are Bs or Cs.) As someone with naturally tiny breasts, I was excited about the prospect of coming out of this nightmare with gargantuan jugs, like a sick sort of consolation prize. I didn’t buy into society’s idea that bigger breasts are more beautiful, but finding bras and dresses that fit me was really tough at times, and, hey, why the hell not? But on the other hand, losing a breast had made me realize that I actually loved my tiny tits. They worked on my body, they actually looked pretty great under tight t-shirts, and they were, well, mine. How sad and ironic that losing one of my breasts was the thing that helped me come to terms with my 32AAs.

So here is what I told my plastic surgeon: I wanted my breasts to be as big as they could be, without looking like a porn star or a cartoon. He chuckled and said that was the best answer I could have given, and one he didn’t hear very often. In my case, he guessed, I’d be able to go up to a B cup at most, and that was all right with me.

A month later, I went in for my first reconstruction procedure, to have the expander put in. I was surprised to discover that many plastic surgeries take place in the plastic surgeon’s office rather than a hospital. It felt like I was going in to get my teeth cleaned or something, though of course I was considerably more nervous. The surgery took about an hour, and I remember coming out of my anesthetic fog sometime during the car ride home. I had worn a zip-up hoodie to the plastic surgeon’s office, and on the way home I’m told I tried unzipping it several times, to the point where my husband had to hold my arms at my sides to stop me from exposing myself to all of Seattle. I guess I was pretty excited to have something resembling normal breasts again, after two months of a lopsided, freakishly flat chest.

But it would be a few days before I had a chance to appreciate my new look. The night after having my expander put in was hands down the most painful and unpleasant night of my life. It turns out that the chest muscles underneath the breast that had been removed had gotten pretty used to their solitude in there, and putting in the expander caused them to seize up and spasm uncontrollably. I’d been given Vicodin and Valium for the pain and the muscle spasms, but aside from making me sleepy and dull, they didn’t help much. I remember waking up that night at 3 a.m. in total agony, my entire body wracked with uncontrollable tremors. It felt like someone had bashed my ribcage with a sledgehammer. I called out for my husband, who rushed to get the painkillers and Valium down my throat. I lay there for 20 minutes, waiting for the chemicals to hit my bloodstream, trying not to make things worse by panicking. My head started buzzing from the Valium, and then I was asleep.

A couple of weeks later, I went in for my first “fill,” in which saline is injected into the expander to enlarge it. It was a very weird experience, to watch someone stick a big syringe into my boob — which I couldn’t feel, because my breast no longer had any nerve endings in it — and slowly inflate it. I had a total of two fills, and by the time I was done, my new boob was approximately a B cup, just as my plastic surgeon had predicted.

The final two surgeries in the reconstruction process were a breeze. I’d gotten used to the heavenly leaden feeling that washed over me as I sunk down into anesthesia, and I’d gotten used to my post-surgical routine of playing video games and watching The Office while taking half a Vicodin every two hours. Aside from that first night after getting my expander put in, I found plastic surgery to be shockingly easy and relatively painless. I wondered if I would have gotten implants, if I hadn’t gotten cancer and if I’d known just how mild the unpleasantness of plastic surgery really is. Moreover, the implants do feel pretty realistic — that urban legend likening augmented breasts to a ripe grapefruit is, in my experience, false. Other than the scars, I don’t think anyone would be able to tell my breasts are fake.

One thing I still struggle with, and may for a long time to come, is the scarring. My left breast has a 5-inch long scar from the mastectomy, from my armpit to my nipple; my right breast (“the healthy one”) has a 3-inch scar on the underside from where the implant went in. I’ve heard people say that scars are interesting, that scars tell a story, that my scars make me a survivor, blah blah blah…but I hate them. I hope that over time I’ll be able to view my scars as an inextricable part of myself, but for now I just avoid looking at them.

Six weeks after my final reconstruction surgery, I did something I hadn’t done for more than eight months: I walked into a Victoria’s Secret and I bought some new bras. In the end, my breasts didn’t turn out as big as I’d hoped they’d be, and I mentally scolded myself every time I caught myself wishing they were bigger. The fact was, I was lucky to be alive.

Illustration by Rebecca Elves

Juliet Disparte lives in Seattle, where she works with books and goes to the doctor. For more about her adventures as a cancer patient, visit her blog, Tumorous. Follow her on Twitter.