When I first met with my plastic surgeon, I felt he was just a little too gung-ho. About everything. He was (is) very young, and so new to the staff of a well-respected plastic surgery group (it's his first real job) that he did not even have his name on their sign on the front door. Not Doogie Howser young, but still. I did not want to know the answer to the question of whether or not I was going to be his first patient to pay for a boob job. I am sure that he spent hundreds of hours in his internships and surgical residencies, and completed all of the necessary medical training to cut me up and sew me back together.
After I was diagnosed with breast cancer, I was mentally prepared to have a double mastectomy and have zero reconstruction. I don't really NEED these orbs of fat anymore. For much of my life I really felt like they were just in the way. As a tall woman I can honestly say that I have never worn a bra that really felt good - the straps were always too short. Once I have worn a bra enough and washed and dried it enough to stretch out the elastic straps, then it usually became tolerable.
My oncology surgeon was very confidant that I would be able to have a lumpectomy, but because of the location of the tumor, I was going to lose the entire nipple areola complex (NAC). When I discussed this with the plastic surgeon, the first option he discussed was a double mastectomy, skin expanders, and artificial implants. I told him I didn't want implants. He asked me why and I just explained that I just didn't want something artificial permanently installed in my body for primarily cosmetic reasons. If I needed a pacemaker, I would agree to that artificial implant. Boobs? I just don't think I need them.
He explained the psychological effect that the loss of breasts might have on a patient - maybe not right after surgery, but perhaps down the road some day. I told him I understood that might happen with some women, and hypothetically it might with me as well, but I really didn't think it would. I was okay with the very slight chance of having a double mastectomy. He reminded me that I was still very young and that perhaps if I was 80, he could see choosing no reconstruction, but he was genuinely a little confused by my firm stance. I explained that it was more about the artificial aspect and less about the fake boobs aspect.
I pointed out that I was a cancer patient that never had a port put in for my chemo, and even though my forearms weren't happy, there was just something about having a port that weirded me out. That would have only been for six months. I just couldn't even think about having something artificial inside of me forever. Ew.
He completely understood me and respected my wishes. We reached a happy middle ground, but I told him I wouldn't be doing a nipple reconstruction. My main reason behind not wanting one is that the "new" nipple would basically be erect all the time. I don't wear tight clothes, but some of it is clingy enough that you can tell when my nipples are hard. Just a t-shirt will show that. I didn't want to have the "new" nipple be at attention all the time and the other one at ease. I wanted them to be the same - like before - before cancer! He told me that I could always have nipple reconstruction surgery at any time in the future that I felt like it.
On the day of my breast surgery, with my mother-in-law as my witness in the pre-surgery area, I talked with the oncology surgeon and the plastic surgeon again and went over what we were doing: after the tumor was removed from my left breast and some reconstruction was done on that side, the plastic surgeon was going to do a slight reduction on my right breast and make them both a natural shape. Since I wasn't very large to begin with (DD), he didn't have much to work with for the reduction. One thing he did do during surgery that we did not discuss in advance was use breast tissue from my right breast to rebuild my left breast. I was very happy with the results.
Since the right breast became smaller, he moved the NAC up higher on my right breast. My left breast is "bald" except for the circular disc of flesh he removed from the bottom of my left breast and placed where a potential NAC could go in the future. Again, in my immediate post-surgery visits I reminded him that I wasn't going to have nipple reconstruction. He said he knew that, he just went ahead and placed the "disc" there so that if I changed my mind in the future, it would be an easier and less invasive surgery later.
It has been about four and a half months since surgery. Surprisingly to me, my right nipple is erect all the time. So, when I am wearing a t-shirt or other light-weight material, you can see that my right nipple is hard and the left is not.
The last time I met with my plastic surgeon I told him I wanted to talk about nipple reconstruction. His eyebrows went up, but astutely didn't bring up the fact that I said I wasn't going to do this. He talked about the procedure, the risks, the results, the recovery, etc. We talked about how soon we would do this - in about another couple of months. Then he mentioned how long I would have to wait to get it tattooed and I said, "Oh, I'm not getting it tattooed. I know I said I wasn't going to do nipple reconstruction either. But my right nipple has convinced me that it needs a mate on the left side."
He just looked at me and smiled.
