Celebrity Plastic Surgery, News, Gossip

By Lillie Shockney, RN., BS., MAS
Director of Education and Outreach
The Johns Hopkins Breast Center

I was diagnosed with breast cancer in 1992 at age 38. Our daughter, Laura, was twelve. When I told her that I had breast cancer and needed to have a mastectomy, she was distressed. She was worried that her mommy might die. Even more troubling, Laura was upset that my giving birth to her may in some way caused the cancer. She was somewhat relieved, however, when I explained that I had multi-focal disease in Stage I. Giving birth to her at age 26 actually should have helped reduce my risk. I went on to explain that because of my other medical conditions I wouldn’t be permitted to have reconstruction surgery. Instead, I would wear a breast prosthesis and mastectomy bra. She bluntly replied, “That’s okay, Mommy. Your breast is so valuable, it can’t be replaced anyway.” I sat in silence staring at a face that was so much wiser than its years. She was just beginning to learn about the importance of breasts, having been fitted for her first training bra just days earlier. That was when I went bra shopping with her for the first time; actually, for the only time.

I underwent transformation surgery in July of 1992. That’s what my husband called it and is the term I have since adopted. I use that phrase when I am with patients whom I have the privilege to spend time with at Johns Hopkins while they are undergoing breast cancer surgery. Al, my husband, told me “the surgeon’s mission is to transform you from a victim into a breast cancer survivor. You are exchanging your breast for another chance at life and that is a fair trade.” He was right. It was initially hard, however, to look down and see my left foot and toes. It was a sight I hadn’t seen since I was 12 years old. I developed early and, by adulthood, was large busted like my grandmother: 44D. Certainly, part of my self image was tied to my chest. Laura wrote me a poem to remind me of who I am inside and the importance of focusing on my psychological well being. I took pride in realizing that we had reared her well. This is Laura’s poem. She had my husband bring it to the hospital and read it to me as soon as I had awakened from my breast cancer surgery:

Appearance

Nobody’s perfect
Just look at me
But if you really think about it
Who wants to be

Beauty and glamour
Are nice to get
But it’s what’s inside that counts
You must never forget

I hope you understand
What I’ve been trying to say
I hope you get well soon
And I love you more each day.
Love,
Laura

Six weeks after surgery I was fitted for my breast prosthesis. I was appreciative of how natural they had become. I remembered how unnatural and poor-fitting they were in the early 1970’s when I first saw them on patients as a student nurse. I decided to name her. After all, she would become my bosom buddy. I would take her everywhere I go, so she deserved a name. I selected the name “Betty Boob.” My silhouette was whole again and I stood tall once more, all 5’2” of me. I was growing more confident week by week and month by month about my appearance and sexual being. I sent out adoption notices to my best friends to let them know I had gotten Betty. One friend mailed her a gift—a ceramic Christmas ornament in the shape of a baby bottle. Inscribed on it was “Betty Boob’s 1st Christmas, 1992.” It is displayed in our living room year round.

A year later I had a lumpectomy of my remaining breast. Just 11 months after, at age 30, I had another bad mammogram. Betty Boob got a roommate, Bobbie Sue. I chose to have several sets of breast prostheses since I could now be whatever size I wanted to be - an advantage of a bilateral mastectomy patient. Losing the second breast was emotionally harder. I fretted about the impact this loss may have on our sex life and on my self image once again. Laura, now 14, said she was glad it had happened because she worried everyday that the cancer would return and we wouldn’t catch it in time. We had though - Stage 0 this time. A mastectomy, however, was still the surgical recommendation. Again, I mentioned reconstruction options but my history of life threatening complications from general anesthesia (a rare but deadly condition) hadn’t changed. I resolved to be a breastless woman, thankful to be a survivor, and who had a loving husband. That was my focus— surviving this disease was the priority. Nothing else was important. “It doesn’t matter. Just let me live. I have a child to raise. I must be here for her.” Any thing else would just be gravy. To validate my womanhood and my husband’s love for me, he took me away to the Pocono Mountains (where the honeymooners go) for a long weekend. He said, “I’ve read before when you lose one of your senses like your sense of sight or sense of smell. Your other senses become more intensified. Maybe the same thing happens to your erotic zones. I intend to prove this hypothesis in the next 48 hours.” And he did!

Since 1983, I have worked in a nursing position at Johns Hopkins. After several years of volunteering in the Johns Hopkins Breast Center, I formally joined the faculty as the Director of Education and Outreach in 1997. I had known for some time that I was meant to get this disease. It redirected my nursing career path in line with taking care of other women who ended up wearing the same type of bra I did. I take care of women from all walks of life and all stages of the disease. I counsel patients about their surgical options and discuss with them the pro’s and con’s to assist them with their decision-making. This is of course, if they are fortunate enough to be in a situation to make choices. Most women today can make such health decisions. This also means that I see the surgical outcomes of women post lumpectomy, mastectomy, and mastectomy with reconstruction.

In 1997, after much effort, a federal bill was finally passed to ensure insurance coverage of breast reconstruction as a consequence of breast cancer. I provided testimony to get this bill passed and felt really good about that. In 1998, I held a special fundraiser with proceeds from the event going to cover expenses for Dr. Maurice Nahabedian (fondly known by his patients as Dr. Mo). The purpose of his trip to Europe was to learn a new breast reconstruction method called DIEP flap - deep inferior epigastric perforator. This procedure involves taking tummy tissue and fat but leaving preserved all the muscles. This is accomplished by stripping out of the muscle tiny perforators and reconnecting those blood vessels up in the chest area. This procedure, therefore, is a true transplant. The tummy tissue and fat are molded into a breast and serves as an amazing Memorex version of a woman’s breast. This technique requires learning how to do microvascular surgery. I was thrilled that our patients had a new state-of-the-art option available for them. This new surgery lifted restrictions we previously needed to recommend to women having the traditional TRAM flap procedure (TRAM flap uses the abdominal muscles to reconstruct a breast). As years went by, the surgical outcomes of skin sparing mastectomy with DIEP flap reconstruction became even more impressive to me. Many women reported nerve regeneration. Although different than breast sensation, they did have some feeling restored to their new breasts. Fascinating.

Each year I saw my various oncology doctors. For the first few years I mentioned that I still wanted reconstruction one day. Then, at some point in time, I stopped asking, expecting the doctor(s) to bring it up to me. No one did. “How are you doing?” they’d ask. – “Fine,” I’d say. “Any problems?” they’d reply. “No, not really,” I’d tell them.

We brought on board a new medical director for the Breast Center in March 2002. He was a surgical oncologist who specialized in breast cancer. Having a reputation as a skillful surgeon, he was academically talented and was a wonderful leader and team player. Patients adored him and this was well known. His name was Ted Tsangaris. I saw newly diagnosed patients with him just as I had with our previous medical director. I quickly began learning his routine. For women needing mastectomy surgery, he encouraged consultations with our plastic surgery team to discuss reconstruction options. At first, I worried he was being too forceful about discussing reconstruction options. I soon realized he did have the patient’s best interest in mind. He told me when we discussed this privately that “when a woman is diagnosed with breast cancer, all she can focus on is survival. ‘Let me live. I don’t care if I have breasts or not.’ She probably does care, though. She is born with two breasts and has the right to have two breasts if medically it is safe for her to do so and doesn’t impact her treatment and outcome. Therefore, she should see the plastic surgeon and talk about reconstruction options.” At that moment, I realized that I had yearned to have breasts again but was doing as most of our patients do - I was waiting for my doctors to bring it up to me; not me mention it again to them. The last time I had brought it up to my doctor was in 1998 when I mentioned that Mo was traveling to Europe to learn how to do DIEP flap reconstruction. The response was, “That sounds interesting. Good for him.” What I wanted to hear was, “Is this something you want to possibly pursue for yourself?” I didn’t hear those words, though. And frankly, why should I? I am one of the most assertive women you’ll ever meet. I am down right aggressive when it comes to making sure that our patients needs and desires are addressed and heard. So, no doubt, my doctors expected me to take the initiative and speak up. But I didn’t because I was functioning as a patient and there was, ironically enough, no Lillie Shockney to be my patient advocate and have my desires heard and taken seriously. How ironic.

Wanting DIEP flap reconstruction didn’t mean that I had overcome my anesthesia problems that had prevented me from pursuing anything in 1992. My anesthesia problem had continued to be a problem that I had to work around. (Implants didn’t interest me either.) I wasn’t an ideal candidate for reconstruction anyway, having had multiple abdominal surgeries, as well, making the traditional TRAM flap a bit tricky. I had had five previous abdominal surgeries prior to my diagnosis of breast cancer. Three out of five times I had respiratory arrests immediately following the operation, either in the recovery room or out on the nursing units. No one liked putting me to sleep and no nurse wanted the responsibility to take care of me during this phase of recovery. My father has had similar problems, though not quite as severe. In April 2002, he needed a total knee replacement and I spent a great deal of time with anesthesiology to try to decipher what would be safe to give him so his surgery would go well. He had a six-hour procedure and sailed through it, spending the night in the ICU for precautionary reasons only. This opened the door to discussing with anesthesiology my personal history and what options they may be now able to offer me. A friend on the anesthesia team carefully reviewed my records and determined that sodium pentathol and phenergan given in combination may be the culprit to cause my respiratory system to crash. Propafol would be a good alternative with a 15 second half-life, and an overnight stay in the ICU for observation. Now suddenly, choice had been restored to me. I didn’t have the choice in 1992 or 1994 to do reconstruction with my mastectomy surgeries. I only had desire. I met with Mo Nahabedian and told him I wanted to be evaluated for DIEP flap reconstruction. After examining me and talking with me about my personal situation, he felt I was an excellent candidate.

My brain went into overdrive now. Was it okay for me to pursue this? Did I deserve this opportunity? Was it too late? (I always told my patients it was never too late and that they have the right to be anatomically whole; a woman has the right to choose what is best for her. It was necessary for her to not focus on anything but herself and what she really wanted.) But I was struggling with giving myself permission to pursue it. Who would take care of patients while I would be on medical leave? This haunted me. I rarely took off blocks of time because of this chronic problem - feeling guilty if I had let a patient down while I was away, no matter what the reason.

When I told my husband what I was considering, he became very concerned. “It sounds risky. I don’t want anything to happen to you. I’ve nearly lost you before. Aren’t we okay? I think we have a great sex life. Don’t you? Am I doing something wrong?” I assured him that we were fine. Now I was being offered options – to choose or not to choose reconstruction. I wanted to do it. When I pressed him about this he agreed that he, too, missed my breasts. I prayed about this for many days. What should I do? Is it okay to pursue this? Am I being selfish? I was leaving church one evening and asked God to please give me a sign that it was okay to proceed with the reconstruction surgery. As I arrived to my car and turned on the ignition, playing on the car radio was the song “Sexual Healing.” The first full verse I heard was, “You’re my medicine, come on and let me in. I can’t wait for you to operate.” It was the sign I needed, rational or not! I drove home and announced to my husband that I was going to get on the OR schedule for 6 months from then to do the reconstruction surgery over the Christmas holidays. This would give me 6 months to plan out my work schedule and hopefully recruit help from our survivor volunteer team to pinch-hit for me. Yes, I’m a planner. I wanted to decipher a plan that would have me away from patients the shortest period of time and help ensure those who were diagnosed and treated while I was out would have someone there with them filling my role. I kept my plans a secret from everyone but my husband. A month later I told our daughter, then 22. She worried about the surgery, telling me, “Mom, you look fine as you are.” I had a heart-to-heart with her explaining that just as she enjoys her cleavage now, I missed having my own. I waited until September to tell my parents, who were quite stunned by the news. Dad asked, “Are you doing one or two?” I told him, “Dad, I might do one big one right in the middle - Ms Uni-boob.” He was overwhelmed with everything and simply said supportively, “Okay.”

As the weeks approached to my surgery date, December 5th, 2002, I felt like I was preparing for the birth of a baby. So I began to refer to my future new breasts as ‘the girls.’ “The girls are being delivered December 5th. We will bring them home from the hospital on December 9th.” I started looking at bra ads in the newspaper again. I hadn’t done that for years - ten years to be exact.

I went public with my decision to do delayed reconstruction at the beginning of November, announcing it at our Survivor Retreat and received applause and support for my decision. And just as Mo predicted, breast cancer survivors who had had mastectomies without reconstruction in the past began calling, requesting evaluations for “the same surgery Lillie is having.” I was clearly clueless until then of the impact my own previous breast cancer surgery had had on other women and their decision to have or not have reconstruction.

As I showered the morning of my surgery, I rubbed the bar of soap across my chest for the last time. I had always said that when I looked down in the shower, I didn’t see that my breasts were gone - I saw that the cancer was gone. I realized that soon I would be seeing two healthy surgically created breasts that would be cancer free and remain that way for life, hopefully. Wow. I also realized that every person taking care of me, from checking me in at the registration desk to putting me to sleep, operating on me, and caring for me post op all knew me, worked with me, and several were my closest friends. What an extraordinary journey I was taking with them. I had asked Ted Tsangaris to be with me while I was put to sleep, feeling this would be my most nervous period. He agreed to do so, but exceeded my expectations as a dear friend by serving as Mo’s first assistant in the OR, helping throughout my surgery from beginning to end. The surgery lasted more than 12 hours. Laurel Moore, also a dear friend, was my anesthesiologist who, ironically enough, was with me for my first mastectomy. I requested to listen to the song Sexual Healing as I went under anesthesia.

Once asleep, I knew that my hospital gown would be lifted up to my neck exposing nearly every inch of my body. I prepared typed signs to wear, which were taped to my chest and abdomen - some comic relief for the OR staff. Over my right mastectomy incision it said, “Mo, please super size me.” Over my left mastectomy incision it said, “I’m here for a front end realignment.” And over my navel it said, “Dear Santa, thanks for bringing me cleavage for Christmas.” Undoubtedly the signage brought a laugh to the OR team. I hoped it would reduce their stress a bit as they began working on one of their own Hopkins’ family members. I also realized that this would be for me yet another form of transformation surgery.

With the exception of initial laryngeal edema that was quickly under control in the ICU and sciatica that had flared up from being on the OR table longer than anticipated, I did well and awakened in the ICU with family at my side. Mo and Ted spent the night at the hospital to be doubly sure I did fine and that the circulation to my new breasts continued. (Wouldn’t you know it - a woman’s fantasy is to have two men to sleep with whose focus is on her breasts and I looked like crap and felt like hell. Oh well.)

A Doppler was used hourly to listen to the blood supply in each of my new breasts. It reminded me of listening to a baby’s heartbeat in utero. Wawoosh. Wawoosh. My mother heard a different sound though—wow, wow, wow. She said, “That’s the sound I hear them saying because they are so happy to be here!” I went home on day four with six drains that would stay in for a week. My tummy was flay and tight and initially, if I tried to stand up too suddenly, I felt like my vagina was bungee jumping off my chin. This feeling subsided as a few more days passed.

The day my drains came out and I was able to get in the shower without tubes and devices in my way, I took a bar of soap and slowly washed my new breasts with tears streaming down my face. It was a profound moment. The girls and I were home and doing fine (and they were each capable of holding a bar of soap under their mammary fold.)

Anxious to be back with patients, I returned to work early - at four weeks post-op. Al and I resumed sex at five weeks. (Yes, a little ahead of doctor’s recommendation of six weeks.) We quickly turned into a pair of honeymooners, test-driving my new body often. He told his brother, “I feel like I’m sleeping with another woman and have my wife’s permission.”

Our daughter took me bra shopping - an event that should have been videotaped. Three hours of laughter and twice a few tears. She went through the department store bra sections like Grant went through Richmond, and proceeded to show me what a bra can do for a woman’s breasts today: lift them up, push them together, pull them apart, add a cup size, deepen cleavage - you name it and there is a bra that could do it. And the color choices were amazing. My last experience with bras before mastectomy bras was wearing a Cross Your Heart minimizer bra I had ordered from a catalog. Now I’d be wearing bras that had names, color, and designer configurations that really should come with an operator’s manual. Not to mention the role reversal of my daughter, now 23, fitting her mother for a bra. (I also privately ordered a few items from Frederick’s of Hollywood, too.)

In April, I had my nipple reconstruction done. It was a 22-minute operation with a local anesthetic. I actually had it done between morning and afternoon clinic. For this procedure, my husband had gotten me pink sequenced pasties to wear to mark where I wanted my nipples to go. To prevent prematurely flattening the nipple, it is recommended to not wear a bra for a while. This resulted in me looking like the ‘erotic oncology nurse.’ So I bought callus cushions at the drug store that look like small flat donuts, perfect for sticking over the nipple to protect them. By stacking them and sticking them on, 2 deep, they were level with the tip of the new nipple and fit fine inside a soft cup bra. Great! (Of course without my bra on, my breasts looked like they were going scuba diving, having their goggles already on.)

This summer I’ll have the areola tattooed. I can hardly wait. It’s been four months and I still surprise myself when I look in the mirror. I still smile with joy in the shower every morning when the girls and I get wet and soapy. And perhaps I am even more pleased than most women would be because I have mourned the loss of my breasts, was resolved I would never have them again and was given the gift of choice at long last - to choose or not to choose reconstruction. Was it worth the wait? You betcha. In my case, waiting gave me the opportunity to experience a newer method of reconstruction superior to the traditional flap reconstruction still done throughout most of the country. This newer method along with free flaps has become the standard for Hopkins’ patients and it is a wonderful improvement that has been made over the last decade.

What did I do with Betty Boob and Bobbie Sue, my breast prostheses? I wanted to select someone very special to receive them. I took my time in selecting a patient who would be having bilateral mastectomies without reconstruction. The patient I selected didn’t undergo reconstruction since she had no time for recovery, having 5 young children she was raising, none of which were even her own. (They were born with a variety of medical complications since their mothers were heroin addicts.) She had outpatient mastectomies so that she could get back to the children as soon as possible. She was large busted like myself. She came to the clinic post-op, hunched over wearing a large sweatshirt with her cotton batting breast forms underneath. She was clearly lacking self-confidence in her appearance. I presented her with my breast prostheses and mastectomy bras and properly fit her to ensure they would work for her. She literally wore them out of the Breast Center like a child wearing new shoes from the shoe store. She stood tall and confident again and said, “I think I might be able to catch a man with these.” She hugged me tight for giving her this special gift of an important piece of me - from an important time in my life - my bosom buddies. I realized at that moment as we were embracing that my new breasts were actually hugging my old prosthetic breasts. It was as if my old girls were perhaps saying, “Welcome to Lillie’s. We know you will enjoy your stay. We did. She is full of life and love and energy like no one else we know. You will meet many newly diagnosed women with breast cancer just as we have over the last decade. She will utilize you as she did us - giving women hope and reminding them that this is a disease that is emotionally charged and tests our psyches. We’ll come by to visit periodically with our new owner. Again, welcome.”

Remember that women have the right to choose. It is a personal choice whether to do breast reconstruction or not. It can be done usually at the time of (skin sparing) mastectomy surgery, but also can be done later if necessary or desired. Sometimes we simply have to be reminded that choice is a woman’s right.

Relevant Links

Visit the Mastectomy, Lumpectomy & Breast Reconstruction Shop and find breast cancer surgery bras, camisoles, and swimsuits, and a wide variety of natural breast forms (breast prosthesis) in all shapes, styles, and sizes, and related accessories.

Chat with women and survivors on the Mastectomy Message Board.

This article was reprinted by permission from www.thebreastcaresite.com, which is devoted to addressing the general needs of all who have been touched by breast cancer, including newly diagnosed patients and long time survivors, as well as their friends, family members and coworkers. Breastcaresite.com’s specific mission focuses on providing breast cancer survivors with accurate information about everything from post-surgery options and products to information about insurance and intimacy issues.

 

Tags: breast cancer, breast reconstruction, mastectomy, plastic surgery, prosthesis

• (0)

Georgia native, Sharon Ludvigsen had no idea she would have to deal with breast cancer in her lifetime. Although both she and her mother had fibrocystic disease, she always felt it was nothing serious, and that she would probably spend her life being somewhat inconvenienced, but certainly not dealing with anything life threatening.And then about 10 years ago a mammogram showed that she was no longer dealing with fibrocystic disease. She remembers feeling really shocked to discover she had breast cancer. She’d been having regular mammograms, so the spot was very tiny, but it was still breast cancer! Sharon still talks glowingly about her doctor and attributes her attitude about surviving to Dr. Stephen Auda. She feels fortunate to have developed a relationship with him that allows her to feel completely confident in the decisions they make about her treatment. She had no qualms about choosing a lumpectomy and radiation when she was originally diagnosed, and still feels it was the right choice at that time. When she had a recurrence in October of 2006 here choices were much different. Since the cancer had reappeared in the same breast it required she have a mastectomy followed by chemotherapy. A PET scan showed the cancer hadn’t spread anywhere else, and as Sharon recounts, “That morning when I got up I just knew it would be good news, so when my doctor told me the cancer hadn’t spread, I was relieved, but I wasn’t surprised. A lot of people have added me to their prayers, so I know I’ve had that help. There are miracles all the time – I feel like I’m one!”Sharon had lost a brother to lung cancer when he was only 38 years old, and that was really the only person she’d known who had undergone chemo, so she was really concerned because he’d had such a hard time of it. Surprisingly, although she did lose her hair, she never got sick, which she knows is a real blessing! When asked how having breast cancer twice has changed her outlook, Sharon first talks about her three daughters, saying, “I stay on my daughters all the time about making sure they are paying attention to their bodies. I make sure that Kim, Teresa, and Michelle realize they are at greater risk because I’ve had cancer. I don’t want them to live in fear, but I do want them to make sure they take the proper care of themselves.”She continues, “I’m not one of those women who need to have a breast to feel good about themselves. I want to see my grandchildren grow up, that’s what I think is much more important. I didn’t want reconstructive surgery – I’m fine without my breast. It certainly doesn’t define who I am. I also try not to spend much time worrying about whether or not I’m going to die from breast cancer. Some people can’t believe my attitude, it’s not that I’m nonchalant, I just figure why worry about something until you have to. Of course I was worried that the cancer showed up again, but I have so much faith in my doctor I knew he’d take care of me!” “One of the things I really like about Dr. Auda is his willingness not just to explain what is going on to me – but to take the time to talk to my whole family, if they have questions. With this second diagnosis, after I had my surgery, I think half of the waiting room was my family. He took the time to really talk to them which made me feel better. He’s a wonderful doctor!”“I’m lucky to still have my mother alive. That lady is in better shape than I’ll ever be. I have more gray hair than she does, which I don’t think is fair! People can’t believe she’s almost 78 years old, because she’s still such a firecracker! She’ll tell you in a second what she thinks, and I think that’s what keeps her going. Because she had already lost a son to cancer, mom had a particularly difficult time dealing with my second diagnosis. I tried to calm her worries by keeping her laughing, because otherwise she was crying! She was so afraid she was going to lose another child. I felt so bad for her, but I knew that we had to keep our sense of humor to get us through! I told everyone whatever God has planned for me is what will happen. I can’t live in fear every day – I wouldn’t be a whole person that way. My husband lost his leg in an accident several years ago, so we joke about him having one leg and my having one breast – and what a pair we make! I really do feel that attitude can make a difference, perhaps not in the outcome, but in our day-to-day lives while we are dealing with the disease.”Breast cancer has taught Sharon a few other valuable lessons as well. “I’ve taken care of everyone my whole life. I wasn’t stopping to think about myself. When this came up I began thinking about taking care of myself. I’ve always been a worrywart about my family and friends. Sharon never came first. I never thought she needed anything. When this happened I saw all of the support I had – you really know your true friends and who really loves you during a time like this. I began to realize that I also needed to love and take care of myself just as fervently as they do!“When asked what she would tell another woman who has recently been diagnosed with breast cancer, Sharon says, “The only thing I could do would be to tell her my experience, and to try not to be negative. Always try to look on the bright side, because the more you worry the more stress you feel. This is something we just have to go through and hopefully it will come out for the best. You’ve got to have faith. Even with my problems I always look around and see someone in worse shape than I am. I don’t feel sorry for myself.“ Life is good for the Ludvigsons these days. Married to husband Robert for 39 years, Sharon feels the two compliment each other well, and they really enjoy having the family all together. “We’re Southerners so we really love our food”, says Sharon, “We have get-togethers and cook outs all the time. If there is a holiday there is always something going on.“ “All of my family lives in Georgia, so we are able to stay close. Even when I was going through chemo I had everyone over to the house for Christmas. I have a little house but managed to have about 70 people gather for the holidays. I didn’t have to lift a finger ‘cause my kids are so good! I have 10 grandchildren: Misty, Amber, Cory, Dylan, Devin, Clayton, Ryan, Trey, Morgan, and Dawson. Range in age from 26 to 2. The little one Ryan is a rounder – and I know he comes by that honestly! When you’ve got friends and family there isn’t anything you can’t handle because you’re never alone!” Chat with women and survivors on the Mastectomy Message Board. This article was reprinted by permission from www.thebreastcaresite.com, which is devoted to addressing the general needs of all who have been touched by breast cancer, including newly diagnosed patients and long time survivors, as well as their friends, family members and coworkers. Breastcaresite.com’s specific mission focuses on providing breast cancer survivors with accurate information about everything from post-surgery options and products to information about insurance and intimacy issues.

Tags: bras, breast cancer, breast form, mastectomy, prosthesis

• (0)

It’s tough being a woman. Images of women’s faces and bodies are used to sell everything from cars to holidays. The ‘personal care’ industry, with its make-up, firming lotions and slimming products, seems determined on making us dissatisfied with what nature gave us. With physical beauty – judged by ridiculously artificial standards of perfection – prized in the media above all other personal attributes, it is no wonder we often feel we are falling short of the ideal.When a woman experiences a sudden transformation in appearance, such as breast surgery, these feelings are accentuated, and it can be a real struggle to regain confidence. After all, the choice of body-altering surgery has in most cases been forced upon her to save her own life. Dealing with the issue of self image is a key stage in the process of recovery.

Less a woman?

In her book, No Less a Woman – Femininity, Sexuality and Breast Cancer, Deborah Hobler Kahane has this to say about the hurdles that women face following breast surgery. “Confronted with the possibility of losing her life, the removal of her breast and resulting disfigurement, a breast cancer patient faces a devastating experience. Perhaps one of the most painful parts of the experience is the belief that a woman with breast cancer is ‘less a woman’ and will somehow be rejected by loved ones or future suitors. This stereotype evolved from our culture linking a woman’s identity to her attractiveness, her femininity to her breasts and body.”

Like so many women with breast cancer, when Deborah herself was diagnosed she was terrified about having a life-threatening illness, but thanks to her work with breast cancer patients she knew she would get through it. “I knew from my own experience that the majority of women carried on with their lives as normal. Living with their partners, raising their children, some dating and most still sexually active. Breast cancer had not ended their capacity for sexual intimacy, nor did they feel their femininity had diminished.”

Many AMOENA Life readers felt that their confidence took a knock immediately after surgery. Says Rosemary: “I’ve never felt particularly glamorous, but my hair and my breasts were always my best features and I made the most of them. Before my operation I thought I would be able to handle the loss of a breast. I was surprised how difficult it was. My husband has been absolutely fabulous but the difficult times are summer holidays, parties and dressing up. When I get undressed at night and take my bra off and the prosthesis comes too, my stomach turns.”

Nan agrees. “During each stage of the surgery, chemo and radiation I have tried to keep up with my ‘appearance’ but, somehow, after a mastectomy it is entirely different dealing with what to wear and a great deal of your self confidence goes. This, I know, compared to survival is really irrelevant, but a bit of self esteem goes a long way.”

So how can you help yourself to a better body image?

Take a look

Some women find the first look at their surgery scars extremely traumatic. “I was absolutely horrified when I first looked in the mirror, as it looked so abnormal,” says Theresa. “I still find it difficult to look – although when I have my prosthesis in I don’t always know which one is the ‘falsie’.”

Yet confronting their scars is one of the first steps women can take to re-establish their body image, says Deborah Hobler Kahane. “The first look is never easy, but for most women who have a mastectomy the worst scar scenarios they imagine do not materialise. Many women I have spoken to had not seen a mastectomy scar prior to surgery and were expecting to find ‘a big hole in their chest’. Fortunately, instead of a huge scar, most women are pleasantly surprised to see only a thin pencil line of stitches. Show the scar to those close to you – husband, family, friends etc. With the support of others you will quickly learn that you still look OK.”

This advice worked well for nearly all the readers we talked to. “Everyone was wonderful, especially my husband and 18-year-old daughter who said ‘You haven’t lost a breast, mom, you’ve lost a cancer’,” says Rosemary.

Sandra remembers thinking her scar looked very neat: “Just as though the surgeon had drawn a line across my chest. I was pleased that the cancer had gone and I remember saying to my daughter when she asked if I minded having my breast removed, ‘if you had a bad tooth which was causing you pain, you’d have it removed – this is very much the same’”.

Letting go

Accepting the loss of your breast and letting go of your old body image is also an important part of the move towards accepting your changed body and developing a healthy body image. “The loss is more difficult for some women than others, and depends on how you felt about your breasts prior to surgery and the role they play in your body image and sexual life,” says Deborah Hobler Kahane.

During this phase it can be helpful to meet other women who have been through a similar experience, and who can show you that you can feel good about yourself and the way you look again – it just takes time.

Deborah quotes Susie, whose ‘breast buddy’ was an inspiration to her. “She was an attractive forty-year-old woman who was very comfortable with her one breast and her sexuality. I didn’t look at her as a one-breasted lady. I looked at her as a pleasant, warm witty woman whose style was feminine.”

Reality check

Finally, you need to decide for yourself what femininity, or being a woman, really means to you – it’s a fundamental part of you, not something that can be surgically removed. If you continually tell yourself you’ll never feel good about your body again, you are preventing yourself from ever recovering a positive body image. Femininity does not reside solely in a woman’s breasts.

Carol says that the loss of a breast doesn’t bother her, or make her feel less feminine: “I was swimming within weeks, wearing a special swimsuit with a swim form. My breast form was carefully matched to my right breast – I look normal. No one looking at me would think I only had one breast.”

And femininity is an intrinsic part of being female; it is not something that can be diminished by a mastectomy. Deborah Hobler Kahane quotes Francois Giraud, the Swiss French journalist and politician who felt it was absurd to suggest that a woman could simply lose her femininity: “As though femininity is something you lose the way you lose a purse. The question of breast cancer and lost femininity is based on an outdated social attitude that equates a woman’s femininity almost exclusively with her breasts.” says Deborah.

As one of the women quoted in Deborah’s book sagely commented: “Many women are acting out of the culture’s commercial notion of what it means to be feminine. With nothing better to do than shave our legs, put on make-up and do our hair, women with breast cancer feel that they are not worthy and that nobody will ever pay attention to them.”

Almost everyone we spoke to believes that society places too much emphasis on the importance of breasts. “There is no escape in the media,” said reader Pauline. “Every day you open a newspaper and see stars in stunning low cut dresses, and advertisements for plastic surgery.” Diane agrees: “The pressure to have a perfect body, hair and skin is enormous. Fashion dictates how we all look instead of allowing self-expression.”

Beauty in itself is not only a highly subjective concept, it is also a double-edged sword. Usually equated with youth, physical beauty is ephemeral and by no means an automatic ticket to love, success and happiness. If a woman invests all her self-worth in her physical attractiveness, she is undermining her personality and building a very unreliable foundation for her existence. After all, we are most often remembered and valued for our actions – not our looks.

Your own personal reality check, then, will aim to discover what you feel about your femininity and how you value yourself – and are valued by others, enabling you to reach into a deeper level of confidence in yourself as a woman.

Swimming against the tide
Many of the women whose stories we have drawn on for this article made their own journey back to self-esteem by going against the dictates of the media and popular concepts of what it means to be a woman, rather than accepting the so-called ideal.

In defiance of media hype and sexual stereotypes, many readers were adamant that surgery was not going to change the way they felt about themselves. Sandra says: “I can still look good. Nobody would ever know that I have had a mastectomy and I won’t let breast cancer stop me from doing anything I want to do. My friends and family still feel the same about me, so why should I feel any different about myself? I have had an illness which I wish I hadn’t had, but these things happen to all sorts of people and I am pleased to have got through it. I am a strong person and can be comfortable the way I am. Advertising promotes perfection, but in reality few people are perfect – we should look at the whole person.”

Julie says, “I have to look down and check sometimes as I can’t tell if I’m wearing a breast form or not.” Julie’s surgery has not changed the way she feels about her body: “When I wear a prosthesis I look as I always did. When I don’t wear it I am proud to show people how normal it can all become to only have one breast.”

And Debbie is determined to brave the beach as she always did. “I feel that I am still an attractive, desirable woman. I am gradually regaining my confidence.”

It is up to you to decide who you are, and to a great extent this will influence how other people perceive you

Make the most of yourself
However hard we try to reject the media’s concept of perfection, personal presentation is important for both men and women and for people of all ages. And learning how to make the best of your looks is an excellent way to boost your self-image.

We asked personal development and image consultant, Judy Fearn, for her advice. Judy found a lump in her breast in April 2000 and had a lumpectomy, removal of her lymph nodes, chemotherapy and radiation, and is currently taking tamoxifen. Aged 50, she is married and has two children in their twenties.

“What is happening on the outside when you have been operated on affects how you feel inside,” she says. “I remember after my surgery the first time I needed to dress up for a meeting. I put on one of my little suits and was discouraged.”

“If you’re feeling less confident, my advice is to ask yourself what you can do about it in practical terms. If you have had a mastectomy, think about trying to get the right angles into your body shape again. Start with the foundations. If you haven’t opted for a reconstruction it is vital to get a good breast form and find the right bra. This really is worth pursuing. Keep trying them on until you find one that works for you. You’ll be amazed at the difference it can make to your silhouette and the way you feel about yourself.

“You may also need to consider taking some of your clothes to a dressmaker who can adapt them to flatter your new shape. And if you prefer to wear casual clothes then try not to hide beneath voluminous shapes and several layers. In fact if you are small you could try a cotton t-shirt much smaller than you would normally wear – this can be much more comfortable than wearing a bra, particularly at first. Alternatively sports bras or even maternity bras can work well. Experimenting with weights of material can also help define your outline.”

“Color is another amazing confidence booster and it really affects the way people perceive you,” says Judy. “I usually wear a lot of black, but I didn’t wear it at all when I was ill. I wore soft pinks and blues which flattered my skin but also made people react differently towards me.”

Hair plays an important part in people’s appearance. “It is vital to remember that, although you may lose your hair if you have chemotherapy, it will always grow back. It is worthwhile exploring wigs, and I would suggest synthetic hair because real hair is heavy and can be hot and uncomfortable. Think of your face shape, too – if you have straight facial lines you should go for a more angular hairstyle, whereas rounded faces need a softer shape. Consider having your hair shorter during treatment. Short hair can look thicker, and if you do lose some it will be less noticeable. If a wig makes your head itchy and uncomfortable there are lots of things you can do with scarves and turbans.”

Light at the end of the tunnel
In the early days after a mastectomy, it’s difficult for many women to believe that there is light at the end of the tunnel.

“Unless you have been through the trauma of breast cancer, it is very difficult to explain to people how you feel about yourself. Personally I found losing my hair far more traumatic than the operation itself. Whereas I would often go out without make-up on, I now find myself making an effort even to go to the supermarket! It is important to me that I look as well as I can, all the time. While my family and very close friends have seen me without my wig, I do find it difficult, as least for the first time, letting others see me with no hair. Their reaction is what worries me more than how I look – after all, this is me now, at least for the next few months.”

Many women said there were significant milestones in their journey back to a positive self-image. “After surgery I felt very unsexy, losing some hair, eyelashes and eyebrows,” says Pauline. “But I decided to treat myself to a new bra and when it arrived I couldn’t wait to try it on. Wow! It looked perfect. It immediately made me feel 100 per cent sexy again and my husband loved it.

“I have recently met so many ladies who are either undergoing surgery or having chemo, and who can’t see a light at the end of the tunnel – just like I used to feel. I want to say to them ‘hey, look at me, you can do this too!’”

Amanda says that since her operation she’s been more determined to make the most of her appearance. “I’ve managed to find fabulous, even sexy underwear and super swimwear. I’ve wanted to prove to myself that I could look good following mastectomy. I now joke with people I know, ‘if you haven’t got it, flaunt it!’” And Denise H’s wobbly confidence was boosted in an unexpected way: “For a short time after surgery I felt apprehensive about going out, thinking that people would notice that I was ‘different’. However, this was short-lived, because following a ‘workman’s’ whistle, I smiled to myself, knowing that what I’d believed for years was indeed true, that it’s a person’s overall appearance that is more important than any specific feature.”

You are who you want to be
Feeling confident in the way you look to others has a lot to do with the way you perceive yourself as a person. And this has as much to do with the ‘inner’ as the ‘outer’ you.

Cathy had a mastectomy and reconstruction using her stomach muscle: “I’ve realized it is still possible to like your body, even with significant scarring – in fact I’m probably happier with my body now because I love my flat tummy (I even had my belly button pierced to celebrate). Also the surgery changed my priorities and I’m more concerned now with how I feel than how I look. I’ve discovered that in order to be happy you need to like yourself, and once you are comfortable with yourself and can be happy, it has a knock-on effect on others.”

Perhaps the last word should go to someone who has helped another person through breast cancer. “Mom has always been beautiful, tall and shapely – and that can be a burden as well as a bonus, particularly as one ages or has to undergo surgery as she did,” says Elizabeth. “But the loss of a breast didn’t in any way change her. Not her loving, generous personality; nor her wise and warm spirit; or the irrepressible sparkle in her eyes. My father and I love her even more than before.”

Chat with women and survivors on the Mastectomy Message Board.

This article was reprinted by permission from www.thebreastcaresite.com, which is devoted to addressing the general needs of all who have been touched by breast cancer, including newly diagnosed patients and long time survivors, as well as their friends, family members and coworkers. Breastcaresite.com’s specific mission focuses on providing breast cancer survivors with accurate information about everything from post-surgery options and products to information about insurance and intimacy issues.

Tags: celebrity, plastic, surgery

• (0)

Women looking for a minimally invasive, virtually scarless breast augmentation may find hope in a new and innovative procedure called Celution that has just gained approval in the European Union. The new plastic surgery technique achieves breast enlargement by injecting a supercharged fat mixture into the patient’s breast. Fat is taken from a woman’s stomach area, buttocks, or thighs using a minor liposuction-like procedure under local anesthetic.

Celution is not yet available in the United States, but it has been approved by the European Union for 2008. The technique will first focus on breast reconstruction for women who have had breast cancer and have undergone a partial mastectomy (breast removal) or lumpectomy. However, breast augmentation through the Celution techinque may be a possibility in the future.

Fat taken from the patient is placed in the Celution system, a device which separates out and concentrates stem cells and regenerative cells. About an hour later, a prescribed dose of regenerative cells are injected into the patient’s breast tissue. “It works by ’supercharging’ the fat cells, which makes them stay where they are injected”, explained Dr. Eric Daniels, senior director of business development for Cytori Therapeutics in San Diego, which developed the Celution technique.

Following the Celution procedure, breasts may enlarge up to two cup sizes over about six months, while also appearing more natural than with traditional breast augmentation procedures. One day, women seeking to increase their bust may be able to go in and have this procedure done during their lunch break, and of course, the bonus is that fat would also be taken from the stomach or thighs while one’s breasts are enlarged. Who could complain about that?

The use of fat injections in reconstructive procedures is not a new breakthrough, as it is commonly used in different cosmetic procedures for many years. Dr. Brian Kinney, a plastic surgeon from Beverly Hills, California and clinical assistant professor of plastic surgery at the University of Southern California, said that, “It’s become common practice for plastic surgeons to use [the patient’s own] fat in filling in defects such as around the eyes, in the nasolabial (nose to mouth) folds, and in the body, especially after liposuction that leads to irregular contours.”

However, breast reconstructions using fat injections have failed in the past because the patient’s body often reabsorbed the fat. With Celution, however, mixing fat-derived stem cells from the Celution system with the patient’s fat has apparently minimized this problem of fat reabsorbing in the body. “The supercharged fat graft survives really well and fills in the volume defect left by partial mastectomy,“ says Kai Pinkernel, Cytori’s Head of Research & Development.

Kinney, who is also past president of the Plastic Surgery Educational Foundation of the American Society of Plastic Surgeons stated that a procedure like Celution could be of benefit to women wanting a regular breast augmentation.

“It would not be surprising in the future — with refinement in technique — that this could be of benefit to women who need augmentation or reconstruction. But it may be many years, and it’s far too early to know before large, well-controlled case-control clinical trials are done and peer-reviewed by other experts,” says Kinney.

While Celution and stem-cell fat techniques of the like hold considerable promise for women seeking a minimally invasive breast augmentation that would not require the insertion of implants, the prospect of a one-hour procedure to achieve an aesthetically pleasing result that rivals a traditional breast enlargement surgery seems unlikely. Doctors believe such a procedure will likely need to take longer than one-hour to achieve desirable breast enhancement results. “Just a few years ago, lots of attention focused on the weekend face lift”, Kinney said. “A lunchtime breast augmentation is equally implausible.” Similary, Mac Hedrick, president of Cytori Therapeutics, said “No one is going to leave for lunch, have the procedure and go back to work like it’s no problem.” Hedrick expects the procedure to take two hours under general anesthesia. Additionally, the Celution technique has the limitation of not being able to increase one’s bust by more than two cup sizes.

Yet even if the procedure would take longer than lunch to perform, many prospective candidates seeking a moderate breast enlargement would likely flock to have a virtually scarless and silicone-free breast augmentation.