Delayed Fixes

When I was diagnosed with breast cancer fourteen years ago, being inundated with endless doctor appointments was one of my biggest concerns. Cancer should have been the main priority, but life keeps marching on and cancer and its many necessary appointments are time consuming. When I was making surgery decisions, one goal was to have the least disruptions. Lumpectomy plus radiation versus mastectomy was at the top of my pros and cons list. Somehow a three day post flap hospital stay was the winner and felt easier to fit into my life than thirty individual radiation appointments.

The biggest goal of a flap procedure is to have the flap survive. The surgeon knows that minor fixes can happen later to improve the shape of the breast mound. Whenever I pictured these minor fixes, I pictured surgery with general anesthesia. A three phase plan for reconstruction was a concept I had heard about, yet my surgeon never discussed it explicitly. I would simply follow up with some regularity and then return to my regularly scheduled life when I had healed.

Thirteen years after cancer, my babies more grown and independent, I decided to look into fixing up my body. Naturally, I scheduled an appointment with my former plastic surgeon. Learning that fat grafting can occur as an outpatient procedure without general anesthesia was a happy surprise for me. Having fixes at this point in my life was a choice. Whenever I saw information about the reconstruction process, it always included a nipple as the final step. I too wanted to feel more finished, though I had an indentation that I felt needed to be addressed first.

Armed with new information, I scheduled fat grafting. Like many experience, one round of fat grafting was not enough. The decision to sign up for liposuction is not a small one and needs careful consideration and planning for downtime. Liposuction bruising in the deepest shades of black and blue is on a level which I had never seen before. A different option would have been to add a small implant, but I chose not to go this route.

Finally after three rounds of fat grafting, filling in the small dent and increasing the overall size of the breast mound, I had my nipple appointment. In many ways, it seems superficial to go back, take time, and endure pain for what may seem to be simply cosmetic reasons. However, I knew it was more than that. Years ago, I was fitted with a partial prosthesis. This prosthesis had a tiny bump on it mimicking a nipple. When looking in the mirror at Thelma’s, I could hardly believe I saw two nipples peeking through my bra. My eyes and brain immediately appreciated the symmetry that had been lost for so long. Even I would have told you that it didn’t matter, but that would be a lie. Although only as a fleeting thought, I have felt a pang of self consciousness in a locker room or at a doctor visit, always knowing the missing nipple would stand out, but only figuratively. In my nightshirt and in an unpadded swim top, I was consciously and subconsciously aware of the difference.

The surgical addition of a nipple was a straightforward procedure. Lidocaine was used, but the sensation on the breast mound is still mostly absent. As the four injections went in, I could not even feel the first two and wondered if they would be necessary at all. The second set did elicit a brief twinge of acknowledgement. After some surgical magic, the nipple was created, photographed (by my request), and bandaged. This was one of my easiest procedures. Fortunately, I don’t feel overly anxious about procedures and can tolerate having them without systemic drugs. After this appointment, I was able to drive myself home. In the days that followed, my main complaint was fatigue. Pain was not registered at all, though occasionally I was aware of a minor aching.

The next step is always to wait. Waiting is such a large part of the cancer experience. At this point I needed to wait to heal. After about three months I was eligible for an areola and nipple tattoo. I looked forward to this final step and was very hopeful along with my brain, that the appearance of two nipples would be noted and then fade away into the sense of normalcy I have long sought.