Post-Surgical Reflections

"We cannot control the outer circumstances in our lives, but we do have the power and ability to rise up to our difficulties and find our strength."

The day after my 38th birthday, I went into menopause.  Surgical menopause.  Four years after healing from cancer, and two years after losing my mother, it was time to put into action the plan that my healthcare team, my husband, and I had decided after my first mastectomy: when I was finished nursing my daughter, I would remove my remaining breast, ovaries, and fallopian tubes.  This was something in my mother’s final weeks that she also asked of me.  She had fought breast cancer.  Her mother had fought ovarian.  Others in our family had similar stories.

Deciding to remove several parts of my body that are disease-free is something that most people find hard to understand.  It’s something that even I, knowing the statistics and risks full well, have struggled with for some time.  It seems that there must be a better way.  I was never counseled to remove my ankle because there was a risk that I could fall and break it.  Yet being a carrier of the BRCA-1 genetic mutation, the risk of breast cancer recurrence or ovarian cancer is so high that it is more likely a question of when cancer would strike in my life than if.

I consider myself incredibly lucky that I was able to have a child post-cancer, and that we were able to nurse with one breast for as long as we did.  My husband and I were considering having another baby, and weighing the risks.  So many friends my age were getting pregnant again, and we longed for another.  Something was different this time, however.  I heard many stories of BRCA positive women going for the same preventative surgeries I was supposed to be going for, and finding cancer.  I was afraid, and felt the need to move forward with the preventative surgeries that had been looming in the back of my mind for so long.  After my first breast imaging, my doctor wanted to do a biopsy of a suspicious area.  I told her it was time.  I didn’t want to jump back into the roller coaster of testing and waiting and worrying every six months.  Things moved along very quickly after that.

In some ways I had more time to process my losses with my first mastectomy.  I had quiet time by the sea, and uninterrupted time to write.  This time I had an active toddler who was used to being with me all of the time.  In the weeks before my surgery, she became sick.  She wanted only her mama, and made sure to remind me that she was the most important priority in my life.  I did not find myself tenderly caressing my breast this time, as I had before my first surgery.  It was my little girl who was asking to “hold the nurser” gently and lovingly as she drifted off to sleep.  She was my sea this time.  Her needs and unconditional love were where I found my center.  It is for my children that I was taking these drastic measures.  This was the best-insured way for me to be around to see them grow up.

A dear friend put together a gathering, in celebration of my upcoming life changes.  It was an incredibly beautiful and uplifting experience that literally filled up my spirit with the strength and courage I needed.  I knew that I needed to connect with my support system.  I began talking about this openly with family, with friends, even with people I didn’t know very well.  Reaching out and being open and persistent with my needs was hard for me to do!  I kept remembering how my mother used to call everyone whenever she would go into the hospital.  I used to think this was strange.  Whenever I had a health issue, it tended to be a quiet, introspective time for me.  I would pull inside, and reach out only later to my closest friends when I was feeling better.  I struggled with the reality that unless I told the people who cared about me what my needs were, there was little chance that they would actually be met.  I came to see how brave my mom was by calling on her loved ones when she needed us most.

In reaching out, we take a tremendous risk.  Our needs may not be met.  Yet in not reaching out there is a greater risk.  Feeling connected to community was very important to me.  My experience of cancer had been lonely and isolating.  I did not want to go through that again.  So I followed my mother’s example and began talking about my upcoming surgeries with people from every aspect of my life.  Another close friend organized a system of meal drop-offs, and even people I didn’t know very well signed up to bring us dinner beginning the day before I was released from the hospital, and for several weeks afterward.  I felt incredibly loved and supported.  This carried me far during a time that I needed it most.

I began to settle into a new phase in my life—of insomnia and hot flashes and speaking my mind a bit more clearly and forcefully than I’ve ever done before!  As I work on harnessing the forceful part, I recognize that it is time to welcome this shift of energy into my life.  To shake off my inhibitions and speak my Truth.  Time to find deeper ways of nurturing and caring for myself, as I have nurtured and cared for my family.

Prior to surgery I met with two plastic surgeons to discuss reconstruction options.  I had decided on a saline implant after I lost my right breast, and I was never happy with it.  None of the other surgical options sat right with me either.  Yet, surprisingly, no one mentioned the option of not reconstructing.  My mother had chosen to stay flat after her mastectomies.  One of my closest friends also declined additional surgeries.  Why hadn’t I considered this as an option for myself before?  I began searching online for images and information.  I found that statistics imply that more women do not opt for reconstruction; however, it certainly appeared as though more women do.

Ultimately, I decided to remove my implant and be flat.  It’s a very personal decision, and each woman faced with it must reach her own conclusions.  For me, I felt that I would be more accepting of my scars than I would of reconstructed breasts from either foreign material or another transplanted part of my body.  My chest would only be seen by my supportive husband and myself.  I could wear prosthetics if I chose, which would look the same to the outside world as if I had reconstructed.  I became aware through an online Facebook forum called “Flat and Fabulous” of a movement of women who had either by choice or by circumstance remained or become flat.  Many of these women choose not to wear breast forms at all.  I found myself inspired and intrigued by these brave and self-accepting women.  Some of these women have altered their style of dress to call attention away from their chest areas.  I have found myself experimenting with scarves and button-down collared shirts when I have had occasion post-surgery to go out of the house.

Whether or not I end up using prosthetics daily, occasionally, or not at all, I am grateful for my process of healing.  While we cannot control the outer circumstances in our lives, we do have the power and ability to rise up to our difficulties and find our strength.  When in the thick of treatment or recovery, strength can be simply reaching out when we need to connect with another soul, or when we need a ride to an appointment or the grocery store.  There is strength in allowing tears to flow as we mourn our losses, and strength in drying them up and going on with another day.  Strength is learning to accept and ultimately love the scars on our bodies; scars which have saved our lives.  Strength lies in finding our beauty again, somewhere deep inside, and mustering the courage to let it shine.