I have been putting off writing this post about my implant exchange surgery for about 6 months. It took me some time to adjust to the results of my ever changing body and process my feelings associated with this stage. Now that I am a ways out, I can look back with more clarity and share my experience in a way that may help others prepare for this stage of reconstruction process.
I last wrote about the breast reconstruction process in my posts about the expanders and prosthetic nipples. The expanders were like cement blobs on my chest, that kept me from ever sleeping comfortably. By the 9th month of living with the expanders, I had come to love them (in appearance only). They were perky and round and had settled just enough to look semi-normal in clothing. As my husband would said, I looked like a sexy fem-bot.
Just when I had finally come to terms with my appearance with the expanders, it was time for my exchange – the surgery where the plastic surgeon (PS) swaps the expanders for implants and rebuilds and scar tissue pocket. I felt like I was well prepared for this surgery and had set realistic expectations. I was an informed and educated patient and I thought I was ready for this next stage.Right before my surgery, Natrelle came out with a new FDA approved “overfilled” silicone implant. The “overfilled” feature helps prevent rippling, a common concern for thin women following reconstruction. I was very excited about this new option and was looking forward to the surgery and moving on with my life.
For reference, my expanders were filled to the maximum capacity with 860cc of saline (60cc more than the largest implant – 800cc). This photo was taken the day before surgery, my last chance to play with my magnetic abilities.
I knew that the results would not perfect, but I was optimistic. My PS warned me that the implants would look more natural and thus less perky and round. She also warned me that I may need multiple revisions to get the desired cosmetic outcome. While I accepted this reality, I still held out hope subconsciously that I would love the initial results. For so long I had looked forward to this stage of the process as the icing on the cake, the final step in reconstructing my body and finding love for myself. I couldn’t have been more wrong.
Prior to the surgery I told my surgeon that my goals were size and cleavage. The largest implant is an 800cc, so she selected a variety of sizes from 700cc-800cc and she would see what looked best once we were in the OR. That entire cart of implants is just for me!
In order to create cleavage, my plastic surgeon revised the implant pocket by tightening the skin and scar tissue on each side in order to push the cavity towards the center. This is my simplistic explanation and obviously the process is much more complicated. Here I am all marked up for surgery.
The surgery itself was a breeze compared to my other surgeries, which involved multiple complications. My PS knew how to proactively treat my blood disorder now and everything went off without a hitch. When I woke up from the surgery, my first concern was size haha. It turned out, she was able to use a 750cc implant. While I was disappointed it wasn’t 800cc, I tried to trust her judgement. A larger implant that was too large for my chest width would have looked unnatural. When I got home and looked at my chest, I was very happy. The implants looked amazing, though they were quite swollen and I experienced a bad rash from the iodine. The best part was, I even had a little cleavage. I finally felt like a woman again.
I could finally move and sleep without discomfort – so long rock hard implants.
The pain was significantly less than my other surgeries and I returned to work within a few days. I did have to abide by the 5lb weight restriction for 1 months and I quickly learned how many everyday actions require pulling, pushing and lifting over 5lbs. Who knew how hard it is to open a large door without using your chest muscles.
So, you might be wondering what went wrong. It seems like everything went smoothly and that I was happy with the results. Well, that happiness quickly faded. Even though I thought I was prepared for the results and the stage of the process, I was wrong. I underestimated how hard it would be to adjust to yet another bodily change. I had been holding out hope that everything would be perfect and I would be done with this reconstruction nightmare. I wanted to go back to being “normal”, fitting into everyday clothes and not having to feel like a cancer patient. Unfortunately, this surgery was not a magic pill to erase the last year and a half and make me look and feel like a “normal” woman again.
As the surgery began to heal, the swelling went down and the size and shape of my reconstructed breasts began to look different. They were smaller, less perky and lacked the smooth round shape I had come to love with the expanders. I was devastated. I had so much riding on the success of this surgery and I felt an immense sense of disappointment. I would text nightly with another breastie who had surgery at the same time. We were both unhappy with the results and commiserated about our disappointment. I tried to focus on what went well, but I was so unhappy with my body that I sunk into a depression.
To an outsider looking in, it may seem like everything looked fine, but I was crushed. Nothing prepared me for this emotional adjustment and the pressure I had put on myself to be happy with this stage of the process. I stopped looking at my body and covered up in large sweaters and scarves, anything to take the focus away from my chest. Looking at my chest, constantly brought me to tears. The only thing that brought me comfort was counting down the months until we could discuss revisions and my next surgery to “fix” things.
At the 3 months checkpoint, things had improved slightly, but my surgeon wanted to wait another few months before talking about fat grafting and revisions. My stitches hadn’t fully dissolved and she felt the with time things would settle further improving the cosmetic appearance. She was also concerned about my bleeding risk as compared to the necessity of the revisions. I left this appointment in tears, disappointed once again. I had spent the last three months waiting for this moment, the next stage, hoping that would bring me some happiness and closure. Now I had to wait even longer.
As the months passed, I thought about my implants less and less. I adjusted to the look of them in the mirror and I worked tireless on my self compassion practice. I continued my lose dose anti-anxiety/depression meds, I began meditating (as part of a clinical study), and I focused on my art. I also began to work out with more intensity, hoping to take some control back. Just like with the expanders, over time I began to accept my appearance and realize I would never look like the societal view of a normal woman again. Expecting that my reconstructed body would ever fit in that box, was unrealistic. As I began to accept this reality, the disappointment faded and I found happiness in the positive aspects of my surgery and my growing strength and confidence.
Now, I am 6 months out from surgery and while I still have some aspects of my breasts that need to be revised, the urgency has dissipated. I decided I want to take the summer to enjoy the sunshine and have some fun. I will have the next surgery in late August at which point they will remove extra skin from the inner corners, remove extra fat from the top left side (where my port was) and graft fat from my stomach to the front/bottom of my breasts to make the appearance more full and round. For now, I try to focus less on my imperfections and continue my work on self-acceptance.
I share my experience, because many people (doctors included) do not understand the emotional challenges associated with reconstruction. While many doctors try to help set realistic expectations for the physical appearance and recover, they fail to address the emotional adjustment period and how to cope with your reaction. Ninety percent of the women I have spoken to who underwent reconstruction are unhappy with the results initially. If I had known this going in, I may have been better prepared to cope with my sadness and disappointment.
With so many people comparing our reconstruction to an elective breast surgery, we internalize the pressure for the results to be perfect and for our bodies to be “fixed”. We forget that our bodies are a work in progress and we fail to give ourselves the time to be sad. It is a slow process adjusting to a new appearance and as breast cancer survivors, we have to go through this process multiple times. Each stage of reconstruction brings with it new challenges.
I have tried to change my focus work on rebuilding a loving relationship with my new bodies. Over time I trust that I will get there, and for now I celebrate my growth — each step of the way. I hope you will too. Take a moment to stop and look in the mirror and celebrate your body, imperfections and all. You are strong, you are resilient and you are beautiful.
If you have any questions about the implant exchange process, please feel free to reach out to me at firstname.lastname@example.org. I would be glad to answer your questions or share more specifics about my experience. I will definitely follow up with more information about my fat grafting/revision experience after my surgery in August.