When you tell someone you've had a mastectomy, they're immediately uncomfortable. The word mastectomy conjures images of sliced up chests, so it's common for people to squirm and blurt out something awkward or insincere. For me, the response was usually "at least you get a free boob job!"
I honestly heard this over and over; but didn't really know how to respond at the time. Having a mastectomy is not a free boob job. It's just not. And to add insult to injury, my mastectomy and reconstruction certainly wasn't free because I opted to go with private surgeons, rather than the unknowns of the public health system - so for a lot of women there's also quite often a hefty bill at the end of it!
THE EMOTIONAL TOLL.
While I'm definitely not intending to offend or minimise the emotions experienced by someone who has undergone a cosmetic breast augmentation procedure, I do tend to think that the emotional toll experienced throughout a mastectomy and reconstruction journey just can't be compared. Even if you don't feel particularly defined by your breasts, even if you feel womanly in other ways...there's something very confronting about going in for a mastectomy knowing that 'your girls' will no longer be as you recall them; and there's a decent chance that you won't recognise them (or even particularly like them) at all.
Reconstruction is a more complicated procedure than a standard augmentation and can sometimes require several surgeries. With a cosmetic breast augmentation, the surgeon isn't removing every skerrick of your breast tissue in an effort to reduce your risk of a potentially life-threatening disease. And with a mastectomy, that's exactly what it happening! It took my oncologist several hours to remove my breast tissue, and I had small (post-breastfeeding) boobs. The surgeons attempt to remove every cell, although there are no guarantees.
If you imagine your boob as a pillow in a pillowcase, and you're after a fuller pillow - a breast augmentation is like opening the pillow slip and adding an extra pillow in until it's filled to the desired look & feel. A mastectomy & reconstruction is like taking the pillow (and every stray bit of down or fluff) out of the case, maybe changing the size of the case & then putting in a new pillow (either implant or your own tissue from elsewhere on your body) until you have a 'pillow like substitute'. It's a major disruption to the body, which entails drains (small plastic tubes inserted temporarily into the area where your breast tissue was to collect fluid), and can involve follow up surgeries depending on the way your surgeon operates.
NIPPLES, OR NIPPLE-LESS, THAT IS THE QUESTION….
While I personally opted for a nipple sparing mastectomy (I was able to keep my nipples), it's a case by case discussion & decision. The advantage of removing the areola and nipple as part of the mastectomy is that you no longer have to worry about the small possibility of cancer affecting any remaining tissue left behind the nipple. Personally, one of my nips nearly didn't make it through alive in the aftermath of the procedure because the direct blood flow is hindered and supply has to come from further afield. While I'm happy to have my nipples intact, advances in nipple tattooing means that women who opted to have theirs removed can still achieve a super realistic & 3D looking nipple.
BREASTFEED NO MORE
While it is possible for women who have had a breast augmentation to breastfeed, implants can affect a mother's capacity to produce a full milk supply, depending on the type of surgery they've had, and whether any milk ducts were damaged. But it's technically still physically possible. As I touched on earlier, a mastectomy involves the removal of ALL breast tissue, glands, milk ducts - the whole shebang! So while I thought this would be obvious, you'd be surprised who many people still ask whether I can breastfeed after a mastectomy & reconstruction. I calmly explain why I would never be able to breastfeed again - all the while in my head I'm screaming “You can’t get milk out of silicone!”
Side note: funnily enough, I've even had people ask whether it affects my ability to have babies...(?) Last time I checked, boobs aren't a crucial step in the conception stage. Haha.
CAN('T) STOP THE FEELING
Speaking of all things boudoir - when you remove breast tissue during a mastectomy, it causes nerve damage that takes away feeling in the chest and breasts. The nipple and areola, if spared, seem to recapture the least feeling because they're farthest from the chest wall. A little bit of feeling might return over time, but your breasts won't ever feel remotely close to the way they felt before surgery. However, with a breast augmentation procedure, nerves are less likely to be damaged so sensation & sensitivity should remain the same.
WHAT’S COLD AND BUMPY?
If you choose an implant based reconstruction, they literally sit underneath a thin envelope of skin with a matrix holding it in place. This means there is no cushioning on top of the implant, so ripples and seams in the implant can be visible from time to time, and depending on your position. My foobs don't seem to warm up with my body heat, instead they stay cool like little gel cold-packs strapped to my chest. I am always caught off guard when my arm brushes against my chest and feel the coolness of my boobs...and quite often hear 'Mama, your boobs are so cold!' when one of my kids gives me a cuddle.
Ultimately, everyone’s journey is incredibly unique, and it's best to just not compare these two operations at all. If a friend of yours happens to be going through something similar and you’re fumbling for the right thing to say (trust me, I understand - it's super awks), I urge you not to liken the heart-wrenching decision to a ‘free boob job’, even if you're only saying it in an attempt to lighten the mood.
Perhaps instead you could just let them know that you love and support them regardless of what their girls are made from. If you are sincere and thoughtful, any simple, loving, kind words will be appreciated.
With love & happy boobs (or foobs!)