Warning: I talk openly and honestly about my consultation for reconstruction post-mastectomy (read: boob job). I find the process and information fascinating and want to share it with you all, however, conversations about my boobs might make you uncomfortable. You’ve been warned.

After the meeting with my breast surgeon (the one doing the mastectomy), I was left with a checklist of tests and appointments that I needed to accomplish before treatment could start. I was determined to get it all accomplished as quickly as possible, so when the scheduler called and said, “plastics can get you in with the doctor at 4:30 today, if you can make that work.” I jumped at the appointment.

When I arrived at the “Plastics” Group office for my appointment, it was 4 p.m. on a Friday afternoon. The waiting room was empty and you could tell they added me to the end of the schedule, as the week was winding down. As I sat, waiting to be called back, the receptionist would banter and talk with each patient as they left – some of them bald, all of them with boobs. As they filed out, I wondered where they were in their reconstruction journey. Were they just starting like me?

I was jolted back alert from my introspection when the nurse called my name and I was escorted down a long hallway to an exam room. She handed me a gown and asked me to “strip from the waist up with the gown open in the front”. At this point, I had become all-too-familiar with these instructions and this gown – a short-sleeve number that is a delightful color of 1985 mauve and hits just above your hips like you’re a 25 year-old instagram influencer in a trendy crop-top. In the last week, I had slid a gown on like this, no less than 5 times.

As I sat on the exam table waiting for the doctor, I closed my eyes, began to breathe deeply, and chant a mantra I had be using to manage my anxiety since my diagnosis, “Have faith. Trust God. All joy.” Over and over again, “Have faith. Trust God. All joy.” I was jolted back alert, when the doctor entered with a nurse and introduced himself. The doctor, a shorter, older gentleman, reminded me of an older Rick Moranis from Honey I Shrunk the Kids. He carried an old-school digital camera, in a leather case with him, like a dad at Disney World with the kids for the first time. He asked me a bunch of questions about my health history and then instructed me to open the gown, put my arms down, and let the gown fall down to my wrists.

I was officially uncomfortable.

I tend to make jokes when I’m uncomfortable and strongly considered making a comment like, “Doctor we just met,” but decided against it.

The doc then proceeded to pull out a measuring tape, like one a seamstress would use, and measure my breasts – nipple to bottom, nipple to top, side to side, top to bottom, size of the nipple – each time shouting measurements back to the nurse as she feverishly wrote them down. Then, he asked me to close the gown, stand up, and stand up against the blank white wall at the back of the exam room. As I stood up against the wall, he said, “okay now open the gown and let it fall back to your wrists again,” as he pulled out the digital camera and proceeded to snap photos of me from variety of angles.

I am certain that I have never been more uncomfortable in my life.

Until it got worse.

The doctor then instructed me to pull my pants down to my bikini line as he took another set of photos from a variety of angles. I was not ready for this. As all of this is occurring, the nurse is just standing there jotting down everything the doctor is saying as I’m dying a slow, painful death of mortification on the inside.

After he was done, he asked me to cover back up and take a seat in a chair next to the exam table. The doctor pulled up a stool and sat down as the nurse closed up my file and left the room. The doctor then began to describe the two recommended options for reconstruction:

One: Using your own tissue. As he described it, they essentially make an “old-school c-section” incision across your abdomen and remove tissue from your belly to replace the tissue that was removed at mastectomy. The benefit is that it is your own tissue and not something like silicone in your body. It is a more difficult surgery with a more difficult recovery. The downside is that the breasts would age like normal breast tissue would over time. The doctor then said to me, “You’re not a candidate for this though, as you do not have enough fat on your belly.”

I looked at him as said, “That’s the nicest thing anyone has every said to me. Could you write that down?” He chuckled as I thought to myself, “I could kiss him right now, but I’m topless and that feels inappropriate.” [jokes].

Two: Implants. The second option, is more familiar – a silicone or saline implant. These implants would be placed at a date after the mastectomy, over the muscle. They used to do under the muscle to help hold the weight of the implant, but they looked less natural because they move with a woman’s arm movements. Now they place them over the muscle, just under the skin, with the help of cadaver skin (read: sanitized skin from dead people) to hold the implant in.

This option would include a “delayed-immediate reconstruction” during the mastectomy. Since I am not scheduled to have radiation, they can place a “balloon-like” tissue expander in after they remove my breast tissue. Then starting at two-weeks post-op, they begin inflating the expander incrementally until it is at the correct size. This allows me to avoid the painful re-stretching of skin that can occur when they don’t insert the expander at mastectomy. After my tissue is allowed to heal and my treatment is complete, they will go in and replace the expander with a silicone or saline implant.

After we discussed my reconstruction options, we then discussed topics that no one dreams of talking about with strangers – much less your closest friends – like the shape, size, color, and proportion of my nipples to my overall breast and if I would like to keep my nipples or have them removed. This is something I’ve never thought about and felt wholly unprepared to make a decision on. After being largely uncomfortable with the discussion of my nipples and the pressure to make a decision, the doctor shared, “most women are happier with their reconstruction when they have their nipples removed”. Okay done. Remove them. We then discussed nipple tattoos as an option post-recovery to replace my absent nipples. I don’t have strong feelings either way, but if you’re feeling brave, Google image search “post-mastectomy nipple tattoos”, you’ll be amazed (NSFW).

Then we talked about my breast size. In my discomfort, I said, “well my husband would like them to be bigger,” to which he chuckled. As it turns out, however, you really can’t go bigger and you really can’t go smaller (except maybe a 1/2 size). Okay cool. As they are. Fine.

As the conversation went on, it became clear to me why he took the pictures and measurements, and I slowly felt at ease. It was clear he was a professional and his ultimate goal was to make something that is pretty traumatic for most women, as easy as possible. That his ultimate goal was to get you as close to “original” as possible.

As I left, I felt a sense of calm about the reconstruction process; still totally mortified, but calm with a sense of humor about the whole thing. I know the mastectomy and reconstruction is a long road and its absolutely no cake walk, but I have a sense of what the process will be like and I honestly appreciate the level of choice and control I have in the matter. I get to order up the boobs I want, nipples and all. If that’s the positive of getting breast cancer, I’ll take it.

As I got into my car, I chuckled to myself about the whole thing, and smiled as I remembered my mantra: “All JOY.” (and then promptly group called my girlfriends to tell them all about what. just. happened.)

All joy.