Why I’m having a prophylactic mastectomy

It has occurred to me in the last few days that with my more recent lack of daily posting here, I have not bothered to explain my decision for my upcoming surgery.

I will warn you now: this post contains information regarding the impact of breast cancer on my sexuality. If you don’t want these details, look away. 😉

When I was diagnosed with cancer, I was doing everything I could to avoid having a mastectomy. The initial lumpectomy was recommended, actually, because the mammogram showed a tumor well within the size range for a lumpectomy. Had the tumor actually been that size, a lumpectomy would have sufficed for surgery, although I still would have had chemo and I would have had radiation.

The lumpectomy, though, turned into a partial mastectomy and the follow-up surgery then became more complicated. It was the recommendation of my surgeon and a second opinion to have a mastectomy. While my surgeon and oncologist were completely on the fence in terms of a double mastectomy – they both clearly outlined options in both directions, without advising me one way or the other – my plastic surgeon advocated for a double mastectomy.

The surgeon and oncologist were trying hard to balance quality of life issues and future advances in medicine against research showing that at my age, my risk for a contralateral recurrence was extremely high – over 80 percent during my lifetime. The plastic surgeon was more concerned, of course, about my cosmetic outcome, which was best served by a double mastectomy.

I was at a loss. The very concept of losing one breast – let alone both – was mind-boggling. My breasts – my REAL breasts – were important for me for two very critical reasons: breastfeeding and sex. They were also important to me for cosmetic reasons, but there are ways around that concern.

All through my cancer treatment, I had my eye on having more children. I was wanting to start trying to get pregnant just before I was diagnosed. When treatment derailed those plans, I was hell-bent on trying to salvage my fertility and tried every reasonable (and maybe some unreasonable) ways to try to salvage my ability to breastfeed. The breastfeeding experience with my daughter was one of the best parts of early motherhood for me and I wanted to do it again.

And then, there was sex. My breasts were a focal point of my sex life. They felt good. They looked good. And my partner liked them a lot.

But as I got closer to the mastectomy, I started to feel more and more concern for having one fake breast and one real. And after chemo ended, my concern for recurrence started growing. It was as if I felt the cancer could not get to me as long as I had chemo.

So, I asked if I could have a double mastectomy, but my insurance company took their time replying and I didn’t receive approval before the scheduled surgery. Then, I was faced with the decision to turn around and do it immediately, or wait. I chose to wait, thinking in the back of my head that this was my opportunity to have another baby before a second mastectomy.

Of course, within six months, my marriage was at the beginning of the end. (I started to write just then that it was “on the rocks,” but the reality is, it had been on the rocks for a very long time – I just didn’t know it.) After we separated and after he made it clear he wasn’t coming back, I decided I needed to get the surgery done so I could be as done with “cancer treatment” as possible.

My only two “hold out” reasons for saving the breast were gone by then. I knew I would not be having more children without him. I am an extremely cautious person when it comes to big life decisions – buying a house, buying a car, love, marriage, having children. I knew and still know that if I remarry – a concept I find completely unimaginable – that it will be years away and I will be past childbearing age. So, I’ve come to accept that having biological children is likely out of the picture for me.

On the upside, though, I’ve also since learned that breasts do not need to be the focal point of my sex life. A friend who had a double mastectomy once referred to her breasts as “the center of pleasure.” That’s almost exactly the way I thought of mine. But I’ve learned that’s no longer true for me. The center of pleasure is in our minds. And, with a willing partner, I’ve discovered far more sensitive areas of my body then my breasts ever were anyway! Since the mastectomy, in fact, my other breast has become hugely unimportant to me. Too much attention paid to it and it just reminds me of what I’ve lost.

I actually am ok discussing this topic with anyone who is interested, particularly with women facing this decision. But I feel for the sake of this particular audience, I have to limit the conversation. If you want to contact me off-blog, please do. I’ve been told I’m very open on this topic and I think I am. If it helps you to talk about it, I will.

So, that brings me to now. Having a mastectomy for fun.


Ok, not for fun, but for preventative measures. And to help with cosmetic results.

In the time since my first mastectomy, I have yet to find someone who had implants placed who was a D cup. It doesn’t seem likely, actually, since I believe the largest implants are 800cc and my saline implant was filled to 1100cc. I do know people with D cup reconstruction, but they had a different and more invasive type of reconstruction than implants.

But this overfilled implant seems to be causing me back problems. So, my option then becomes: reduce the size of the implant, which requires then a reduction to the other side – either a reduction surgery or a mastectomy with a matching size implant.

I figure if I’m going to the risk of surgery, it might as well be a mastectomy. Get rid of the majority of the cancer risk and improve my cosmetic outcome.

So, here we go!

Author: rosie

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