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Nicola Pulling in her Toronto home on July 10, 2014. Pulling had breast reconstruction surgery after having one breast removed due to cancer. (Chris Young For The Globe and Mail)
Nicola Pulling in her Toronto home on July 10, 2014. Pulling had breast reconstruction surgery after having one breast removed due to cancer. (Chris Young For The Globe and Mail)

PERSONAL ESSAY

Reconstructive breast surgery makes woman feel ‘more beautiful than I’d felt in years’ Add to ...

I’m in the drawing room.

My hospital gown is tied around my hip bones so the surgeon can get a good look at my mastectomy scar, my one breast and my lower belly.

She crouches down and takes the cap off the marker. While her surgical team looks on, she draws a blue road map on my torso.

In a few minutes I’ll be in Operating Room #10, dedicated, the sign says, to “Plastics”, and the surgeon will begin moving my belly fat up to the space formerly known as my left breast. She calls it DIEP flap breast reconstruction. I call it my reduce, reuse, recycle program.

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Right up to the moment I get on the table, before I’ve noticed how cold it is in there, when they put the compression stockings on my legs to prevent blood clots, put the mask over my face, as my eyes close, part of me is screaming silently, “What the hell am I doing? And why the hell am I doing it?” I breathe in deeply.

I’m tall, slim and small breasted. I was that prepubescent girl who never needed a training bra, the last girl in Grade 8 to get a real one. My boobs never entered my psyche as one of my “features” – never made it to the mythical billboard advertising “Me”.

Me did not equal Boobs.

I was on a research trip in Cleveland years ago, spending the weekend in the racing pit of Jacques Villeneuve’s IndyCar team. It was pretty cool. But after four days of inhaling ethanol, testosterone and words like torque, shaft and cockpit, I needed an extreme feminine antidote. I needed Victoria’s Secret.

I tend to feel somewhat alien in those places. Whenever I found myself in the dressing room, trying something lacy, padded and underwired – I started laughing. I looked like I was trying too hard. I’ve never been able to pull off sexy if I was aware I was trying. Sexy, like goodness, is innate; if you put it on, it goes rancid in its falseness.

The salesgirl offered to measure me. I’d heard the stats: 80 bazillion women suffer life in the wrong bra size. “I’m a 34B. Have always been a 34B. Will always be a 34B,” I said.

She got the tape. I looked off to the distance, drawing my posture skyward, filling my lungs – kind of like those Soviet memorials to the women who harvest wheat, looking off to the future, confident Stalin wouldn’t let them starve.

“I’ve got good news and bad news,” I seem to remember her saying. “You’re a 36, not a 34. But you’re an A cup, not B cup.” So, I was wider in the back and smaller in the boobs than I thought. I could get a job harvesting wheat.

I bought a bra and panty set from the girl anyway. My breasts receded into the background of my life.

Then, in 2007, a moment of reckoning. I was diagnosed with invasive ductal carcinoma in my left breast. It was discovered on my first mammogram. I was 44.

My breasts rudely re-asserted their presence. I had to reconsider what they meant to me, existentially. Breasts are fraught with meaning – they’re sexual, they feed and nourish, they make halter tops look good. Me still did not equal Boobs. But they were part of my whole.

I sobbed in the shower the morning of my surgery. As I scrubbed my skin with the antibacterial soap they gave me, I felt the impending loss of a piece of me. The morning after the operation, the surgeon’s fellow came and took off the bandage. And there it was – a flat space where my small breast had been. Two hours and one night in hospital. Done.

At first I did nothing. I needed to feel wounded. It didn’t matter anyway – I had chemo to get through, then radiation. I lost my hair, my eyebrows, my eyelashes, even my pubic hair. I was a freak on the outside – I saw it in the fear that flashed across some faces.

Then I got a prosthetic. In public, I looked whole again. But I was conscious that when I wore any tank top, or V-neck, someone might see not only the prosthetic but also the flat space beneath it, where my cleavage, such as it was, used to be. My arm would reflexively hold my top in. My shoulders curved inward.

In private, I had more support and loving than I could wish for. My husband never made me feel less or different. This was the man who shaved my head the day my hair started falling out. He loved my body. He thought I was sexy. And he showed it. But over time, I found my boob, my chest area, off-limits. I built a barrier around my sexual self. I didn’t feel desirable. I stopped thinking about being beautiful. That wasn’t part of me anymore.

To the outside world I was fine. I pooh-poohed any notion of reconstruction, saying it’s pure vanity… that boobs are highly overrated. I think I was digging in my heels against being medicalized again. I just wanted to be left alone.

But gradually the incessant doctors’ appointments faded. My hair came back – on my head as curly as a poodle, my eyebrows like caterpillars. I got to the point where I actually cut my hair short again. And dyed it. And I realized... I was healing. Life was normalizing. I decided it was time to at least check out my reconstruction options. No one made me, I was just finally willing to look up and beyond this place.

I signed up for two different group sessions at two different hospitals. We sipped coffee and ate cookies while they explained to a group of hardy survivors – some newly de-breasted, others more than a decade out – how all this works.

You can have implants – saline or silicone. This takes months because first they surgically implant a tissue expander, which is a fancy balloon that they slowly, over six months, fill with saline through a syringe. Once the skin has stretched, you go back into surgery to have the implant inserted. They last up to 20 years – then might need to be replaced.

If you’re not a fan of implants, or have had radiation, which stiffens the skin and takes implants off the option list, you could opt for a TRAM flap, where they migrate muscle and fat from either your back or your stomach under the skin and up onto the chest wall. You sacrifice some strength where the muscle has been removed.

I’m not sure about the other women, but I was working hard to keep the astonished look off my face. Seriously, decades of breast reconstruction and this is what we have to show for it?

The second info session also offered the DIEP flap. I knew two women who had had the procedure and were thrilled with it. You pay up front – the surgeon takes skin, fat and blood vessels and reconnects them microscopically to the chest. It takes eight hours. Once the procedure is done, it is done. No tissue expanders, no sacrifice of back or stomach muscles, and it’s my own tissue. My very own frankenbreast.

After months of waiting, I finally got the consultation at the beginning of April. I doubted I had enough belly fat to build even an A cup. But, as the surgeon squeezed my belly between her two hands, she said it was just possible and that I could have the procedure within a couple of months. I was, she said, a textbook case. I was suddenly giddy. Up from my murky depths came an excitement and a truth that I was willing to embrace: Tank tops for the summer. I signed the consent. Just like that.

So that’s how I ended up in the drawing room. Still battling with why I needed to go through this but listening to a quiet instinct that said I deeply, deeply wanted to be whole on the outside. And yes that offends my feminist self. Deal.

I woke up from surgery late in the afternoon. I pulled the gown open, looked down and there was a new mound on the left. It looked good. Though, as the surgeon promised, I felt like I’d been hit by a truck.

When she came by later, the surgeon pointed to an extra scar on my newborn boob. “That’s your belly button,” she said. Great, I thought, I am officially Ms. Potato Head. The skin she had taken included my belly button, so she cut me a new one. They had to jackknife me in the OR to sew me up because she had taken every scrap of belly fat she could find.

So I am now not only Ms. Potato Head, but Ms. Potato Head with abs of steel.

It may take two hours and one night in hospital to take breasts off, but it takes eight hours and three days in hospital to backfill. And a morphine pump. And hospital food. My pain level was low (unless I sneezed) and I came home a couple of days later, bent over but walking. Three drainage tubes came out a few days after that. And now I’m walking upright and my life is back.

I feel like I’ve resigned from a club I never wanted to join. I threw out my prosthetic and the grandma–like mastectomy bras. I’ve pulled out clothes that I had thrust to the back of the closet. I used to put on a special nightie once in a while and rip it off as soon as I saw my image in the mirror. A few weeks ago I pulled it on, and a stupid, happy grin covered my face. I felt ignited – more beautiful than I’d felt in years. I walked out and showed my husband. He looked at my face (well, I hope he looked at more than that), and he teared up.

It was my birthday the week after I got home. For the first time in our relationship, my husband bought me a gift certificate. Unbelievably, from Victoria’s Secret. In the card he wrote, “For when you rediscover what I’ve known about you all along.” I’m standing a little taller now, drawing in my breath. And living for beauty. Mine.

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