She entered my hospital room looking like a woman on a mission. Without so much as identifying herself or saying good morning, she asked in a demanding tone, “ Why no reconstruction?”
Her uniform and I.D. identified her as a nurse.
I was still on a morphine drip following my bilateral mastectomy the day before and not at my sharpest. Since she hadn’t bothered with any pleasantries such as “how are you”, I decided to return the compliment and give her a brief response, the only one she was going to get from me. “I didn’t get reconstruction, because I didn’t want reconstruction.”
She stared at me in disbelief, saying, “You mean you were told that you had the right to reconstruction, your insurance would cover it, and you didn’t choose to have reconstruction?”
I stared back and responded, “Reconstruction is a choice not a required part of a breast cancer treatment plan.”
With that she left the room.
After she left, I was of two minds. First, I was glad the staff were concerned that every woman having a breast or breasts removed would have been told beforehand that they had the right to reconstruction; they would also be informed that Medicare, Medicaid and most private insurance companies covered the cost of reconstruction.
My second thought… were women, facing breast cancer surgery, being given all the information they needed about the pros and cons of reconstruction to handle their expectations about the process realistically, and to make educated, informed choices?
Throughout the day, I was to have several other staff ask me about my choice not to have reconstruction. They were not rude, as was my first visitor. They got me thinking about the thought process I went through in making my decision about reconstruction.
Having spent years as an American Cancer Society Patient Navigator, I had seen reconstruction successes and reconstruction problems in the patients I met with in the hospitals. I was well aware of the benefits of reconstruction. I was also aware that, if I had reconstruction, my new breasts would have no sensation, there would be scars, and there would be more than one surgery involved to complete the process.
During the years between my surgeries, I played out the “what if”: scenario. What if my cancer came back and I needed a mastectomy or bilateral mastectomy? What would I do?
I reviewed my feeling about my breasts, and what they meant to me. I had the advantage of time to rehearse my decision. Most women have to make the choice about reconstruction soon after hearing they have breast cancer. They make this decision while also having to make dozens of decisions that affect their treatment.
Some of the things I considered before making my decision included:
From a physical standpoint: My general health status, previous surgeries, healing time, additional surgeries to complete the process, potential complications, satisfaction with outcomes…general appearance, lack of feeling in breasts.
From an emotional standpoint: What did my breasts mean to me? I never considered my breasts one of my defining features. They were attractive, but not outstanding. They served the purpose they were intended for…nursing, and that was a long time ago.
I didn’t need breasts to feel attractive or feminine. I was in a committed relationship, with or without reconstruction.
From a practical standpoint:I knew I didn’t need my breasts to look good in clothes. I had been wearing a partial prosthesis since my first breast cancer. A lumpectomy and radiation necessitated using a partial prosthesis to balance my breast in clothes. I spent 10 years between cancers getting annual screenings with all the stress that goes with it. There were a few scares, false alarms that required additional tests and in some instances, biopsies. I wanted cancer behind me. I wanted the least amount surgical down time and the fastest healing time so I could get on with my life.
All things considered, I came to the conclusion that I didn’t need or want reconstruction.When faced with the actual situation of a second primary that required a bilateral mastectomy, my choice was clear…no reconstruction.
The point of my sharing this post…in the end, it is all about choices.
