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Reconstructing Hope

Knowing I had to interview two women about their experiences of breast cancer and reconstruction, I needed to imagine myself in their position. Of course that is a long, long way from knowing the reality. I assume women's reactions will vary enormously depending on their nature and life experiences up to that point. There is no way to list in textbook fashion the feelings and stages of coping.

From the self-consciousness of the teenage years to the pleasure of a breast being caressed, from the fullness of pregnancy and the sensation of a baby feeding to the stretching and sagging as the years go by, women may love their breasts or hate them.

Breasts are also culturally inscribed. From the moment they start developing in teenagers, breasts signify woman-hood. They are sexually or maternally charged identifiers. Statuettes of fertility goddesses from ancient cultures always feature prominent breasts.

Would a mastectomy represent an attack on a woman's sexuality, her maternal capability or her self-esteem? What would it be like to wake up without breasts? What are the options?

Many women decide to get on with life in a body without breasts. Perhaps some experience a sense of liberation from societal norms or a deepening appreciation of what it is to be human. With or without a reconstruction, the initial physical change demands that a woman traverse a complex emotional landscape. Adapting clothing and wearing prostheses are presentation options that may help with the daily adjustments.

Sue with family

Sue McMillan and Robbi Neal have both been faced with mastectomy and have chosen to undergo breast reconstruction surgery.

They are both aged near 40, married with children and live busy lives in country Victoria. That, apart from their breast cancer and positive reconstruction experiences with Geelong plastic surgeon Dr Ian Holten, is about all they have in common. Dr Holten says that many doctors underestimate the importance of breast reconstruction. "They emphasise the removal of the cancer and the life saving, but can overlook the psychological impact of losing a breast."

Sue, aged 39, lives in Warrnambool with her husband and four children whose ages range from seven to 12. Being confronted with breast cancer last year plunged her to emotional depths. "Finding out I had breast cancer created a primal fear within me - the opposite of the kind of primal joy a mother feels when she gives birth," Sue recalls.

Being a theatre nurse, she knew it was possible to undergo reconstruction straight after a mastectomy - but decided to wait. "Losing a breast is an absolute death of part of your body and you have to grieve it," she adds.

She wondered how her husband would react and how other men would see her new body. "When I lost my breast, I lost some of my female confidence and I couldn't relax," Sue says. "I felt vulnerable and others were probably aware that I didn't feel comfortable."

With her husband's support during the postoperative phase, their relationship deepened and strengthened. Before reconstruction she wore a prosthesis, which she describes as a "lifesaver" as it fitted into her normal bras and she could wear fitted tops.

Robbi, 43, lives in Ballarat with her husband and their five children, aged from five to 22. Her breast cancer diagnosis three years ago prompted her to start writing about her life so her children could understand her experiences. She wrote the first 12,000 words over two consecutive Saturdays and entered them into a writer’s competition (the 2003 Varuna-Harper Collins manuscript award) - and won. Her book, with the working title of "The God of Messy Things," is being developed with an editor and is earmarked for publication next year.

Robbi's family history is dotted with cancers, and hardship had been no stranger in the years before her diagnosis, but she has an incredible life force. "When I was told I had breast cancer, all I could think was that I wanted the cancer out of my body. My youngest child was only three and I had too much to live for," she says.

Her journey forwards has not been easy though. After undergoing chemotherapy, both breasts were removed and then radiation treatment followed. "I felt terrible without my breasts from the minute they were removed," says Robbi. "I'd walk around crunched over and felt uncomfortable being naked. I didn't want to be seen. I felt I'd lost part of what identified me as a woman."

Robbi found wearing prostheses hot and itchy, and she felt depressed taking them off at night and having to confront her appearance. Her postoperative experience led her towards breast reconstruction, whereas Sue had considered that possibility from the outset.

Robbi

Deciding to go ahead with reconstruction is an acknowledgment that breasts matter to you. They make a difference to how you see yourself and how you feel others see you. Reconstruction requires yet more surgery and this fact must be faced after the previous trauma of the mastectomy. But reconstruction can be a positive way of putting the disease behind you and physically reclaiming your body.

Sue waited a year before undergoing breast reconstruction surgery and by that stage felt excited by the prospect. She knew her breasts would be uneven and the new breast would sit higher. "Already I feel like my inner self-esteem and confidence are back," Sue explains. "I'm grateful to be alive, but I feel that the reconstruction has given me my femininity back. I've already bought a new dress - with a low back and shoestring straps - that I look forward to wearing to the Christmas party this year. Watch out! I'll soon be heading out on the dance floor, feeling beautiful, whole and complete."

When Robbi decided to undergo a reconstruction she visited several plastic surgeons to find the doctor she felt most comfortable to trust with such an important procedure. The next challenge was addressing her own expectations. "I really hoped I'd get these lovely 20 year-old's pert breasts (it would be a nice reward after what I'd been through), but Dr Holten was supportive and explained this was an unrealistic expectation."

Her actual reconstruction has happened in stages. The first stage involved taking fat out of her stomach and making it into two breasts, during an operation that lasted just short of 12 hours. Recovery was slow and uncomfortable, and it was a few weeks before the bandages were removed. A few months later, it was clear that one breast was larger than the other so Robbi went back for more surgery to have the larger breast made smaller. The next stage of the reconstruction, in September, will involve inserting a small implant into the right breast, and Dr Holten may possibly recreate her nipples.

"Every time I go back I look better than the time before, so every time I feel better about myself," says Robbi. "I've had a full hysterectomy that threw me into early menopause - but you can't see any of that. When I wore prostheses, I was conscious every minute of the day that I didn't have breasts. Since the reconstruction, I forget that I had my breasts removed. It's a good feeling."

Breast Reconstruction Surgery Surgery Information Guide

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