Size matters?

I met my plastic surgeon. Words I never imagined I’d write. Or think. He passed the ‘human’ test with flying colours.

He greeted me by name, smiled and looked me in the eye. Tick.

He shook Lilah and Adam’s hands and learned their names. Tick.

He asked permission for every touch and apologised for the strange squeezes and tugs of my flesh. Tick.

He gave me all my options without prejudice and answered my many questions. Tick.

But now I have too many options and no perfect one, so Big Decisions will have to be made. I wanted my new boobs made out of my flesh and not implants. He poked and pinched my body in various different places. Not enough flesh on the thigh or back and not quite enough tummy fat for two boobs at the size I would prefer. Boy, did I feel like a plucked chicken on the chopping block being sized up for the best cuts. And never before have I wished more for a fatter belly.

Before my body changed for pregnancy, my boobs were consistently a size D cup. This is the shape my body wants to be without babies and ice cream. My surgeon doesn’t think he can make the new ones bigger than a B cup. A dramatic shift from the F cups they are now.

He also told me the bilateral mastectomy (both boobs off) is not statistically a guarantee the cancer won’t return. It’s more likely my bad boob will get me in the end, not my healthy one. Stats I could find (it’s very hard to find stats that represent your exact situation) say that there’s a 0.7% risk of contralateral breast cancer, a new cancer in the healthy boob. So the risk of keeping the healthy boob is fairly small. If he did a breast reduction on the healthy boob instead to match the reconstructed breast, half the breast tissue would be taken out so that risk would be halved.

The alternative option is to do the single mastectomy on the bad boob and reconstruct it from my tummy fat. There is enough for one boob at D cup. Then he’d reduce the healthy boob at the same time to match the size of the new one. I get the risk halved from the healthy boob and matching D cup breasts. But there is still that tiny, tiny risk.

And ultimately why am I risking it? For bigger boobs? For vanity?

Big questions.

There is the consideration that I have no clue how I will actually feel when I see my new size B boobs and they will be markedly out of proportion to the rest of my body. I will be looking at them for the rest of my life so I have to consider how that will feel. If I can’t accept them, the psychological stress is a far higher risk factor for cancer returning than any small benefit from getting rid of the healthy boob.

So it’s small boobs, 0.35% lowered risk, possible psychological distress.


Proportional boobs, 0.35% higher risk, less stress.

One week to decide.

16 thoughts on “Size matters?

  1. Sam

    Heidi, What makes you Happy? Do you want to spend all your days psychological stressed? This is a terrible way to live…..I’m 7 years into one of those. If you can reduce the stress and be happier within for the end result but a slighter risk, is this worth your Happy and your family’s happiness? I cannot answer that for you, but this is my thought.

  2. Brenda

    I’m glad your plastic surgeon passed the human test, and I’m thankful mine did as well – as it has made this whole journey that much more doable. His office assistant is lovely as well – she’s the one who did all the nude photos, which is a whole other surreal experience!

    I guess I lucked out having some (okay – a lot!) of extra tummy padding to spare. I also have some love handles and such that can be tapped at a later date for some additional tweaking if need be. I know in my case it just made sense to go for the bilateral since I had questionable lesions on both sides prior to this. I figured if I was going to do this, I was only going to do it once. I’m certainly glad I did! I don’t think I’d want to do it again… 🙂

    This is a HUGE decision – and one that you need to really mull over. If you want to chat at any time, you know you can always message or video chat me. xo

  3. Heidi

    It’s a tough one. A decision informed by risk, uncertainty and unpredictable feelings. I totally want to avoid stress Sam. But it’s hard to know if that stress will even exist as I have no idea how I will react to my new body. Brenda, my healthy boob have never shown any signs of being a problem so it’s a tricky one. And I certainly don’t want to go through this again. A conundrum.

  4. Gill rItchie

    A week is no time at all, if I can help at all, just ask, I will try to give neutral feedback. Factor in scanxiety with keeping the good boob, having not had that I don’t know how much of an issue it is, it may be tiny so not part of the decision making process. Try to remember, we are more than just our boobs, they don’t have to be perfect or ideal for us to love our bodies as a whole xxxxx

  5. Heidi

    Yes scanxiety is definitely another thing to consider. The plastic surgeon seems to have a slight bias for the breast reduction option because of course he wants what he thinks will give the best result for his part of it. The breast care team agreed quickly with my request for a double MX so I need more feedback from them. Seems all the professionals may have differing views. Urgh.

  6. sokari

    Wow – I ditto Sam but agree there is no ‘stress free option’ here except to say we know that stress is a negative on our bodies. All I can say is after 15 years I was diagnosed with two lumps in my healthy breast both were removed. Of course thats no litmus test for anyone else but it can happen. I was told that after 5 years you are given an all clear whatever that means, well it didnt mean much in the end. The upside is that once you do have a diagnosis, you will get regular mamo’s maybe even every 6 months so early detection is the key here.

    I remember asking my oncologist whether having breast cancer followed by chemo and amputation guarantees it will never return in other breast or anywhere else for that matter and the answer was “we dont know”. There is so much ‘they dont know’ that is hard to figure out the right choice so all we can do is try to do what gives us the least stress. I wish you had more than a week to think things through.

  7. LInda

    Hi Heidi! I´ve been reading and cheering you on silently. Now when it’s time to comment on new boobs I’m pitching in! I’d say go for the D cup on both sides, with one reconstructed and one slightly reduced. I think it’s worth it to feel as much as possible like yourself.
    Reading and sending you the best of wishes from Mexico!

  8. Heidi

    Yeh Sokari it’s really hard to make a solid decision based on whatifs. And there is so much that isn’t known still. Thanks Linda for silent and vocal cheerleading. It’s always helpful to know I have both. And I feel myself inching towards the bigger boobs. Mostly because I realise I want to keep my life and identity as intact as possible. I had lots of healthy realisations about changing my habits and getting on a better, stress reducing track. And I don’t want to lose that. Maybe I’m clinging onto the boobs I used to have as a symbolic way to keep my life as it is now. I think I’ll get some more opinions from the oncologist and mastectomy surgeon and ponder it again.

  9. Heidi

    Yeh Donna you’d think it would be less traumatic a surgery but apparently it’s not. Plus the downside is that if I do end up having the other boob off later I have to go through all this again. And they can’t do it from tummy fat next time so they’ll be completely different kinds of boob reconstructions. More conundrums!

  10. Heidi

    Anyway I have a week to decide. In the meantime they are going ahead to book me in for a date for surgery. It will have to be by 21st September. And I will be having a CT scan to map my blood vessels and arteries.

  11. Karen

    Hello my darling. I am really glad that your plastic surgeon is a good guy, and relates well to you, Adam and Lilah. That is so important, and a real relief. I am also glad that you are feeling your way through this decision. It’s really interesting reading the thread of comments, and I’m sure you must gain some insight from your own reaction to each of the comments. Would it be helpful to write down a list of statements for and against each option and just gently see how they make you feel? I can see that it’s a very complex decision and not one that any other person’s single view can solve, but maybe with the combination of all the different standpoints that your friends have written above, you can come to something that feels like a solid basis for a decision. Also, as you say, including comments from the different medical professionals you are consulting. Do you have any contact with women who have been through the mastectomy to help understand the sort of responses people do have after the surgery? The other good thing about writing it down, is that you will have it afterwards to remind yourself of the process you took to make the decision. Sending you lots and lots of love, Karen xxxxxxx

  12. Heidi

    Karen that is exactly the thing I am doing now. Making a pros and cons list for each option and adding everyone’s input into that. I’m meeting my mastectomy surgeon tomorrow and I’ll try to talk to the oncologist too this week. If I get a sniff from them that the double is good for health reasons, then I think that will swing it towards the small boobs option. At the moment I am edging that way too. Because what this is all about is staying alive, being here. If I get that intention focused, all the other stuff can be absorbed and accepted.

  13. Heidi

    After spending the morning only thinking about new boobies, I’ve realised I dismissed quite a good option out of hand.. Implants. Half the recovery time, no extra wound, less chance of infection, no extra surgeries except replacement in ten years (that’s only an hour job, nothing major), pick the size I want, lifetime of perkiness (not a huge thing for me), no risky fat cells in the danger zone (fat produces oestrogen). So I’m edging towards it. Except I didn’t get all the info because I dismissed it out of hand. I’ll have to rectify that at the meeting next Wednesday. More options, more options..

  14. Karen Grant

    Oh wow! Yes, there was so much to think about, that option must have got lost in the blur. Well done, amazing woman for giving yourself space to work through all these possibilities and see how they feel. Sending you so much love and hoping the meeting today has gone well. LOVE LOVE LOVE xxxxxxxxx

  15. Lisa

    Your comments about psychological stress were what I zeroed in on while reading your post. Being a cancer survivor means the stress of the unknown is a constant companion. Will the cancer come back? What do I do? What if I’m not doing enough? Will the cancer come back? And so on and so on. If you can find a way to help minimize the psychological stress, then that’s the path to take.

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