Image - Francoise -- TRAM-flap reconstruction

Age 38 at diagnosis (1990)
Age 45 in photo (1997)
Age 48 in lymphedema photo (2000)

In November 1990 I had a right breast biopsy which proved positive for intraductal carcinoma. That Christmas Eve I had a left breast biopsy which proved negative. And that New Year's Eve I had a right modified radical mastectomy immediately followed by a TRAM-flap reconstruction. The pathology report indicated intraductal carcinoma in situ with deep margins of resection. So I had radiation therapy to my reconstructed breast and chest wall—4500 rads in twenty-five daily fractions over five weeks.

When I was first diagnosed I began to search through medical journals for photographs of a combined mastectomy and breast reconstruction operation relatively similar to the one I was considering. Eventually I found some outdated ones. I also found some photographs of a reconstructed breast that had developed necrosis (had become infected). Based on these photographs I felt I had a realistic understanding of the seriousness of this operation and I was ready to make my own decision. I expected my body to look odd, funky, perhaps even traumatized, but not vulgar or grotesque. I believed then and I believe now that my body is beautiful despite any alteration made by man or nature.

I did have a concern before my surgery which involved lovemaking. Due to a mastectomy I knew I would not have sensation in my right breast or nipple and I would possibly lose sensation in my left breast and nipple due to a biopsy. For me, this sensation enhances lovemaking. My husband Denny and I discussed this concern. Then we decided to search for new pleasure sensations after the life crisis was over. But in the back of my mind I remained apprehensive that a change of this nature would take some adjusting to. Even so, I did not discuss this with my doctor since our main priority was to concentrate on saving my life. After my recovery I found that I retained normal sensation in my left breast/nipple area.

Right modified radical mastectomy, immediate
TRAM-flap reconstruction, chest wall radiation,
later lymphedema

My body looks better than I expected after all this surgery. My scars are much lighter now, except for the one resulting from a benign cyst removal. It still appears red in the middle of my chest after two years. This cyst removal occurred after radiation to that skin area which now is more sensitive to trauma. But it's still not that noticeable. In fact, not much appears out of the ordinary when I wear my favorite sailing or gardening outfit—an athletic bra, shorts and a straw hat. You don't even notice a missing nipple.

The transplanted tissue from my abdomen to my breast area has no feeling. However, it stays as warm as the rest of my body and is just as smooth. I am content with my body image except for one quirky thing—my navel is not centered. I can't believe this bothers me, but it does. Perhaps if I had known it would be off-center I would have prepared myself mentally and it would not bother me now. Emotionally, I'm hurt that it was not discussed in advance. My advice to you is, if you want a centered navel, ask for it in advance. Despite my navel musings you can see from looking at my photographs that I have not had my navel relocated. I guess my funky navel is now a part of me!

Partner's observations:

If I had been asked about concerns about physical appearance in the weeks prior to surgery, I think I would have said something like, "I don't care, just make sure she survives this horror." I did do one thing regarding physical appearance; the night before the operation I asked if we could videotape her nude from the waist up while she talked about the operation to come and her expectations. We did this in our bedroom. The camera was my accomplice in capturing a bittersweet, intimate image: my beautiful wife of twenty years, my high-school sweetheart, my best friend, innocently putting the best light on a painful time to come—both physically and emotionally.

Right modified radical mastectomy, immediate
TRAM-flap reconstruction, chest wall radiation,
later lymphedema

As I write this it is six years after the operation. My strongest memories are of... Our mostly fruitless search for photos and descriptions of what to expect the reconstruction to look like and what it would look like if things went badly. Some people want to know, some don't. We wanted to know everything.

The first look at the results of the surgery. Watching the doctor peel back the bandages. The coarse, black stitches against her pale skin. The little mid-breast stitch we couldn't explain: "What happened there, Doctor, did you make a mistake?" "No, that used to be her belly button." Absolutely incredible.

The fading of the scars—and the emotional pain. The angry red scars have faded and so has my anger and my fear. Anger at a world in which the very best blessings in our lives can be assaulted. Fear that we will lose those very best parts of our lives and we will be lost.

Waiting over five years to look at the video tape. I knew my motives included capturing an image of her perfect form before the operation. So if I viewed the tape to see her as she was before the operation, it would be like saying, "Those were the days when life was good." And that's not true. Life is good now.

Update 2000

I am still happy with my decision to have a TRAM-flap reconstruction. My body weight fluctuates maybe seven pounds one way or the other. My reconstructed breast remains roughly the same size it was at the time of reconstruction. Perhaps it shrank a little.


Photos courtesy of Show Me (2nd Edition), A Photo Collection of Breast Cancer Survivors' Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image, published by Penn State Hershey Medical Center in Hershey, PA. This book is now out of print.

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