For Deborah Vlock, a double mastectomy led to unexpected chances for reinvention.
The first time I tried on a pair of falsies, I was 35 and built like a string bean. I asked for a pair of B cups because I'd spent 20 years not enjoying my premastectomy Ds, which I still associated with high school chubbiness. My husband, who had put DDs on his wish list, was clearly going to be disappointed.
The falsies—or, as the salesclerk called them, "breast forms"—were petal pink and felt oddly like Jell-O shots. Each one culminated in a bee-stung nipple that wasn't nearly as large as the real thing, but might, with any luck, make a tentative showing under a clingy T-shirt.
I had come to the lingerie shop to take care of some unfinished business. Two years earlier, I'd submitted to genetic testing in the hopes that I didn't have the same breast cancer gene as my older sister. She'd died from the disease at 36, leaving a husband and three children under the age of 11. When I learned I'd inherited the genetic mutation and my doctors suggested a bilateral prophylactic mastectomy, I weighed my options and chose the least lousy of them. I was 35, with a husband and baby of my own. I'd get rid of the damned Ds. I needed to live.
The worst part of relinquishing my breasts was the postsurgical pain, which exceeds even the pain of childbirth because the doctor doesn't place something lovely in your arms that helps you forget. The second-worst part was losing an important piece of anatomical evidence that I am, in fact, a woman.
Yet I never seriously considered reconstruction. Recovering from the primary operation was going to be hard enough, with a toddler at home and a husband working long hours. In any case, I quickly discovered that breasts are hardly a requirement for a happy life. Who but a breastless woman would have guessed? Who, beyond carpenters and mathematicians, could have imagined the pleasures of the flat plane? But pleasures there were: painless jogging, prone sleeping, blouses without popped buttons.
It was only as I ventured further into middle age—when I began to grow a tummy that needed balance up top if I was to maintain my dignity—that I opened my heart, and the cups of my bra, to the falsies.
Since my first encounter with those B cups, I've owned five sets. I could have had double that number by now, because, according to my insurance company, I'm entitled to a new pair each year. To me this seems an extravagance, as a typical set of breast forms will last about three years before splitting their skins—that is, unless your toddler notices them on the bedroom floor while you're trying to read the paper and takes a bite out of one.
Not that babies are the only ones. One day, while on pair number three, I was showering when our dog, Noo Noo, crept into the bathroom, then streaked out as if he were running from the law. When I dried off and reached for my bra, I saw the reason for his guilty flight: One of the falsies was missing. I found Noo Noo under the dining room table, a pale gibbous-moon-like thing hanging from his teeth, then chased him through the house until he dropped it. My right breast had two puncture wounds above the nipple, which I patched with silver duct tape. It took a year and a half until I found the time to go into the city for a new pair, but the duct tape held just fine. And what did a silver crater on a pink moon matter, anyway?
A few months ago, I finally went for my first pair of C cups. I wasn't so much caving to my husband as trying to keep up with the evolution of my body, which for 12 years has been blossoming at the rate of about three pounds a year. This is not simply the consequence of gluttony, but also the unfortunate fallout from surgical menopause at 38. (The gene mutation—BRCA1—also put me at high risk for ovarian cancer.)
My C cups are nice. But it's not as though I need them. If I've learned anything in the process of losing my real breasts and gaining a whole lot of replacements, it's that there's nothing wrong with large breasts or small breasts, real breasts or constructed breasts, or no breasts at all. In the course of a day, I can swing from flat-chested to busty, throwing on a sweater for a falsies-free morning walk, then strapping them on later under a silk shirt for a date with my husband. What matters most, I have come to understand, is that I have the choice at all.
—Deborah Vlock is a Boston-based writer. She is currently working on a collection of essays.
"Prosthetics are now much lighter weight and have a more natural drape to them," says Jackie Hester, who's logged 14 years as a certified fitter at Reflections Boutique at the Simms/Mann UCLA Center for Integrative Oncology. "Some are triangle shapes or asymmetrical in order to match more women's actual contours." And although Victoria's Secret has yet to heed a change.org petition urging it to start selling mastectomy bras, there are some pretty alternatives on the scene. With thinner straps and lace details, the new generation of prosthesis bras adds fun to function; some companies, like mastectomyshop.com, also sell workout tops. —Sunny Sea Gold
The Angelina Question
When Angelina Jolie announced earlier this year that she'd had a double prophylactic mastectomy and breast reconstruction with implants, all within a whirlwind three months, some people—including doctors—were surprised: For many women, the reconstruction process takes much longer. We asked radiation oncologist Marisa Weiss, MD, founder of breastcancer.org, to walk us through a typical timeline.
Month 1 Right after a mastectomy, in an operation that can take up to four hours per breast, an expander is inserted under the chest muscle to create a pocket for the implant. "The breast tissue is taken out and the skin envelope is left behind so that all a surgeon needs to do is, in effect, put another pillow inside the pillowcase," explains Weiss. Postsurgery, some women are unable to lift anything for two to four weeks.
Months 2–4 Over the course of multiple visits, the expander is filled with saline until the pocket is large enough to accommodate the implant. "It's a quick appointment, but fairly uncomfortable," Weiss says. The injections result in a feeling of tightness and pressure as the skin stretches. The National Cancer Institute estimates that the expansion process can take anywhere from six weeks to six months, depending on the size of the implants and the rate at which they're filled.
Month 5 In a final surgery, the expander is replaced with an implant—often leading to an almost immediate feeling of relief. For women who aren't able to keep their nipples (because the tumor was too close or the nipple itself was cancerous), a different kind of plastic surgery magic comes next: Although restoring nipple sensation is impossible, "some surgeons can use your own skin and a bit of origami action to create a nipplelike bump," Weiss says. "After it's healed, they tattoo color onto it. Alternatively, there are extraordinary three-dimensional tattoos that can make skin look more like the real thing."
Month 6+ Full recovery time varies but, on average, it takes at least five more weeks to recuperate (every hour you were under anesthesia generally requires a week of recovery, says Weiss). Your doctor may recommend arm exercises to prevent stiffness.