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Please Stop Saying a Mastectomy Is a ‘Boob Job’

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Yes, people say this. All. The. Time.

I’ve heard it first-hand and in many second-hand stories from fellow breast cancer survivors.

I know most people who make this comment are doing so to point out the “silver-lining” in a very dark cloud. But it just ends up making the person with breast cancer feel like others really don’t get it. Because a mastectomy is not a boob job. And it’s certainly no consolation prize for having cancer.

I know this because I had a double mastectomy in August 2019. The cancer in my right breast covered a large area, and since I had a small chest, my oncology team recommended a mastectomy.

I chose to also remove my left breast for a double mastectomy and proceed with reconstruction. I did this for many reasons that I won’t go into here, but I can tell you “free” plastic surgery was not at the top of my list.

Now, to be totally transparent, I happen to like aspects of my reconstructed breasts; wearing a bra is optional and the whole “your-baby-sucked-the-life-out-of-you” look is no longer an issue. I’ve even shared these “perks” with others.

But this doesn’t make up for the fact that cancer took my breasts. What I have sitting on my chest now are 100% fake.

I have no nipple, no feeling, no connection. They’re just there now. Which is better than the alternative, but it doesn’t make them real to me..

And since I’m only part way through the reconstruction process, I know there’s still many changes in my future and potential complications to overcome. I have at least one more surgery. Maybe two. So the end result is never certain. This makes me nervous.

I’d take my cancer-free life and my original breasts back in an instant if I could, and I’m willing to bet every breast cancer survivor would say the same.

I am comfortable sharing my experience with friends, family, and anyone who is genuinely interested in learning more about the process. But when we talk, I always remind them reconstruction after a mastectomy is very different than a cosmetic breast augmentation.

When I explain this, people get it and are very respectful. But I know many aren’t aware of the differences. I’m hoping to shed some light on what a mastectomy actually is so the inaccurate comparison to a “boob job” can stop.

A Mastectomy is Cancer Treatment

I know this seems totally obvious, but I feel it needs to be stated: A mastectomy is part of treatment for cancer. The person who is having this surgery is fighting a deadly disease. They are afraid they might die. They would give just about anything to get rid of the cancer lingering in their body. Their hopes are so much higher than getting a boob job.

A Mastectomy Does Not Equal Reconstruction

Many people assume that a mastectomy automatically means reconstruction. But there are situations where a woman is not able to have reconstruction or chooses not to proceed with the process. In these situations, the survivor may choose to wear prosthetic breasts in a mastectomy bra or go au naturel. This is a very personal choice and a heartbreaking outcome of breast cancer treatment.

A Mastectomy is an Amputation

It’s actually more appropriate to think of a mastectomy as an amputation. The procedure removes as much tissue as possible, some surrounding skin, and many times, the nipple. This doesn’t leave much left of the original breast and in most cases, the area loses all sensation. Although breasts can be reconstructed, what’s left is some numb skin to hold the implant or fat transfer. This makes the end result essentially a prosthetic breast.

A Mastectomy Also Involves Lymph Node Removal

Lymph node dissection and removal is an additional part of most mastectomies. This is to check the nodes for cancer activity and to remove the ones that show signs of disease. Some women have a few lymph nodes removed while others have many or all of them taken, which increases the risk for complications and lymphedema. This part of surgery is pretty painful and can cause life-long issues.

A Mastectomy Has a High Rate of Complications

Because this surgery is often done along with other cancer treatments like chemotherapy and radiation, the potential for complications is much higher than in a typical breast cosmetic surgery. Cancer patients often have low immune systems, so infections can start quickly and be very aggressive. Radiation damages the skin, which can cause incisions to split open, enlargers to encapsulate and other serious issues along with additional risk for infection.

A Mastectomy is Not a Choice

With a cosmetic breast augmentation, women are typically choosing surgery to change or enhance a part of their breasts. For women with breast cancer, a mastectomy may be the only reasonable option for surgical treatment. And even the women who “choose” this route aren’t making this decision lightly, and they do so for reasons beyond physical appearance. Remember, this is treatment for cancer.

A Mastectomy is a Loss

Continuing with the point above, women who choose to have plastic surgery on their breasts are likely excited for the end results and anticipate an improved outcome. This is not the case with a mastectomy. The surgery is not meant for enhancement; it’s to remove as much tissue as possible for a disease-free outcome. Women (and their partners) are emotionally and sexually connected to their breasts; it’s a very defining feature and the loss can be traumatic. No matter how talented the surgeon, in the end, reconstructed breasts are still not the same as their original breasts.

A Mastectomy Plus Reconstruction is a Process

There are many different options for reconstruction after a mastectomy, and none of them are a one-and-done situation. The process usually requires at least two surgeries with many woman having three or more. Many women have breast expanders placed after the tissue is removed to stretch their skin before implants or fat transfer can occur. There’s also the option for fat grafting, nipple tattooing and even reconstructing the nipple. These are all separate procedures from the actual breast reconstruction. It can take years from the start of treatment to complete the process.

I was able to start reconstruction during my mastectomy. This means they placed breast expanders during the surgery. After this, I had appointments to fill these expanders with liquid to stretch my skin. Since I had radiation, I have to wait at least six months until my next surgery. The rest of this process will depend on the route I take for reconstruction, so I’m not sure how many more surgeries or procedures I have in front of me.

A Mastectomy is a Reminder

I have a 4-inch scar running across each of my breasts where my nipples used to be. They are a daily reminder of my experience with cancer. Some days this inspires me; it reminds me of the challenges I’ve faced and overcome. Other days, I don’t want to see them. These scars don’t let me escape my reality for very long: every morning when I get dressed, every shower at the end of the day, every time I am intimate with my husband, they are there, bringing my thoughts back to cancer.

I hope this helps you understand that sensitivity is essential when discussing a mastectomy with a breast cancer survivor. Even if a woman is open about her experience, it’s a very personal situation with an infinite amount of possibilities and outcomes. But the one certainty of every mastectomy, is it is not a “free” boob job. Please do not say this to anyone, especially a woman diagnosed with breast cancer. And if you hear someone referring to this surgery as such, kindly tell them they are wrong and direct them to this post.

Follow this journey on From the Fire Blog.

This story originally appeared on From the Fire Blog.

Getty image via Pradit_Ph.

Story image via Nicole Dorian.

Originally published: December 28, 2019
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