The Miami Herald

Tough choices over type of surgery

Falling in love while healthy and beautiful is challenging. Falling in love while struggling to love yourself after losing body parts is daunting.

That was my first thought when cancer cornered me into making a decision about the removal of my breasts. I was wearing nothing but a blue hospital gown and jeans. It wasn’t sexy. It was morbid.

“The lump is not small enough to be treated with a lumpectomy,” a breast-conserving surgery, said Dr. Tihesha Wilson, a surgical oncologist at Mercy Hospital in Coconut Grove. “But if you decide to have a mastectomy [surgical breast removal], there would be minimal scarring. A nipple-sparing mastectomy [conserving the areola and nipple] is an option.”

I walked out of Wilson’s office with one thought: “This isn’t happening to me.”

I felt like a huge wave had knocked me off my feet and was now tossing me wildly. As I drowned in tears and tried to catch my breath, I called one my best friends, Jelle Prins, a Dutch guy who has never had boobs.

“All of our bodies are headed for decay,” Prins said. “You have a lot going for you in the beauty department. The scars will tell a story about your inner strength. … There is nothing to think about. This is going to save your life.”

In my world, I told him, not having breasts means not having sex appeal.

“I was born in a country where some teenagers go to great lengths to get breast implants in hopes of attracting a rich cocaine smuggler,” I said. “I live in a city where some women spare no expense for hypnotizing cleavage in the hunt for a sugar daddy. The competition to look good is fierce.”

Prins has always had a way of ending my pity parties.

“You have never been the type of woman to want a rich cocaine smuggler or a sugar daddy,” he said.

We laughed.

As I underwent chemotherapy, I met several breast cancer survivors and saw their scars. I also watched dozens of their journeys on YouTube. Patricia San Pedro, whose documentary on her experience with breast cancer airs on the Discovery Channel Saturday, said she met her boyfriend after losing her breasts.

“The type of guy you want, the one who is going to appreciate you and love you, will not care about the scars,” San Pedro said. “And you have to remember, you are not your breasts. You were born without them.”

I got my 34-Cs when I was 14. They became my favorite body parts when I was 18. And through the years, I have to admit I think my breasts have motivated men’s kindness many times. I couldn’t relate to her detachment.

To complicate things, Dr. Robert DerHagopian, the medical director of the Baptist Health Breast Center, disagreed with Wilson on the nipple-sparing mastectomy.

“There is a debate over nipple-sparing. The breast may remain more cosmetically attractive but there is a risk of recurrence,” DerHagopian said. “I don’t recommend it.”

I accepted my reality at the University of Miami’s Sylvester Comprehensive Center. Dr. Marc E. Lippman, the chairman of the department of medicine, was grabbing my left breast. His fingers were that of a pianist playing Chopin’s Sonata No. 2. He closed my gown when he was done, and I could feel my nipple react to the change in temperature. The things we take for granted, I thought. He washed his hands and sat down. His tone was serious.

“Treatment by breast conservation, lumpectomy, is probably not the right idea, because if you leave breast tissue behind, it will be at risk for additional breast cancer, and in my mind the right treatment for you is going to be a bilateral mastectomy,” Lippman said. “The one on your right side would be in effect prophylactic [preventative], because you don’t have cancer on your right side.”

Experts place the 20-year risk of local recurrence after a mastectomy at 3 to 5 percent, compared to 15 to 20 percent after a lumpectomy.

“Cosmetically you will come out better with a bilateral mastectomy and a reconstruction than having one side and not the other,” Lippman said. “Eventually we would put you back together again.”

I pictured the eight-inch scar across each unnatural breast and the lifeless nipple built over a tattoo meant to mimic an areola. It would take months and at least three surgeries to get there. That is without complications.

I called my best friend, Natasha Hackshaw, and told her jokingly I feared I was going to look like the bride of Frankenstein. She laughed. Then, there was an awkward silence.

“Breast cancer doesn’t kill women who refuse to get mastectomies — their vanity does,” she said.

“This is going to be about you loving yourself enough to do what the doctors recommend. Many women have scars on their breasts now a days. You will have to try to love yourself as much as we love you.”




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