"self-image (n.)
The conception that one has of oneself, including an
assessment of qualities and personal worth." - Dictionary.com
During the course of our lives, this assessment changes depending on what we are going through at the time. Body-image plays a big part in this assessment, and for many breast cancer survivors it is the only one we can focus on. Many of us grew up playing with Barbie and Ken dolls, and that was our introduction to society's idea of the perfect body type.
Over the past few decades the doll has evolved to represent other cultures and even promotes that children can be anything they want to be. However, the body type has remained relatively the same and so has our thinking. They came up with tall, petite and curvy Barbie, yet she still has a slim waistline and healthy sized bust.
After a breast cancer diagnosis and mastectomy (of either one or both breasts) many of us begin to feel that we are no longer feminine or attractive. Looking in the mirror becomes so painful for me at times, I just stand there and cry! I adored my breasts, let me just put that out there. They were perfect. Then immediately following that comes the question of "What do I wear?" I try on a dozen tops, tossing each next one to the floor in anger because they make me look lopsided or weird. I now have no cleavage so v-necks or low-cut anything are out of the question because if I lean over even a little bit my scar becomes visible. I also try to hide the scar from the port that was in my upper chest. I end up in the homely, baggy t-shirt or sweatshirt that sort of masks my chest. I make sure every top I wear has a busy print to take the viewers eyes away from my lopsided chest.
Oh sure, after surgery they give you this prosthetic breast that slips into a panel in a special bra to make your figure even. What they do not understand, is that without an actual breast to hold that side of the bra in place, the material moves all over the place, rubbing against my scar which is still 70% numb and that is extremely uncomfortable. All the adjusting and fidgeting just draws even more attention to my chest. I also had 15 lymphnodes removed in that armpit and I am at high risk of developing lymphedema in that arm so having anything that restrictive around my torso is not a very good idea. Add to that the compression sleeve I am supposed to wear, I feel so bound up it drives me insane.
In 2015 the Breast Cancer Patient Education Act was passed requiring that all doctors involved with diagnosing and treating breast cancer inform their patients about their breast reconstruction options and mandatory insurance coverage before treatment begins. Most women have breast reconstruction after a mastectomy. Some decide not to have this reconstructive surgery because they have had enough pain and down time for recovery that they simply do not wish to go through all of that again. Others, like myself, are unable to get reconstruction for one reason or another. For me, it was my insurance.
The Women's Health and Cancer Rights Act of 1998 mandates that all insurance carriers must cover the cost of breast reconstruction after a mastectomy or lumpectomy. What it does NOT do is mandate that all doctors must accept that insurance. Doctors are allowed to pick and choose what insurance they will accept or not accept, turning away certain patients based on what insurance they carry. Breast reconstruction is done by a plastic surgeon, not the surgeon who originally does the actual mastectomy. There are literally no plastic surgeons in my state that accept my insurance for this reconstruction. They want thousands of dollars in cash. I just went through an entire year of breast cancer treatment. What cash do they think I have??
The normal process for this procedure is that after the mastectomy itself, a plastic surgeon is present to take over and perform the reconstruction. If this is not possible for whatever reason, the original surgeon will attempt to leave plenty of skin available for a tissue expander to be placed there until reconstruction can be done. In my case, my surgeon could not find a plastic surgeon who would accept my insurance, and there was no guarantee I would find one any time soon, so she attempted to leave enough skin just in case, but did not put in the tissue expander. I then finished my second round of chemotherapy and finally radiation. At this point, reconstruction becomes less and less advisable because after radiation the skin has a lesser chance of healing from another surgery. Now that extra skin is an eyesore and makes wearing a bra even more uncomfortable.
Three years later I have still not found one plastic surgeon who would accept my insurance, either here in my state or in several other states I have had friends check on for me. Is there not one out there that has any sympathy for a breast cancer survivor? Why did they become plastic surgeons in the first place? To help us all look and feel better? Or was it the money? If the Women's Health and Cancer Rights Act of 1998 forces insurance companies to pay for this surgery, why would none of these surgeons accept it?? This makes absolutely no sense to me.
I think back to a question my original surgeon asked me before the surgery. "Do you want to remove just the diseased breast, or both of them to be safe?" At that time I had been promised reconstruction so why would I remove both? I was told they could build up the breast to the same size as my existing one, and even work on the healthy one to make them both perky again! I was about to buy a t-shirt that said "Of course they're fake, the real ones tried to kill me!" You can only imagine the huge let down and blow to my self-image. I am now trying to just be OK with my scars and lopsidedness.
Had I removed both at least my chest would be even now...
Things are, however, looking up. Thanks to websites like Leave Me Breastless that provide fashion ideas for survivors who have chosen not to have reconstruction, we now have some advice on how to buy and wear clothing to help restore some semblance of a healthy self-image. I am still working on that.
© Image copyright Janis Harner 2017
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