Wednesday, July 15, 2020

Flat and Fabulous

 In the years since I first intended to write this, I’ve discovered how hard it is to chronicle the difficulties of someone I greatly admire and respect. I'll start with an apology to Ann (not her real name) for taking so long -- I just didn't know how to explain what she went through while properly acknowledging her and her experiences. Having not gone through what she has, I worried that I couldn’t convey her story in a way that honors her in the way she deserves.

More than artistic perfection, Ann deserves a story.

We met many years ago in Boulder. Ann has since moved, but we used to do some training together as part of a local running group. Anyone who’s met her would agree that she is one of the sweetest ladies in the world. She's smart, funny, adorable, and talented in all kinds of ways. This isn't excessive flattery; it's the truth.

Ann approached me after she had already gone through a bilateral mastectomy to remove cancer. Going through the diagnosis and facing the removal of both breasts was difficult enough, but what occurred afterward compounded Ann’s grave challenges in a way familiar to far too many women.

Endless reconstructive surgery cycle

Life doesn’t go back to normal after breast-cancer treatment ends. The most common treatments are partial or total mastectomy, radiation or chemotherapy, then hormonal treatment, followed by reconstructive surgery, a cosmetic procedure designed to bring back the shape of the breast. Technically, the procedure is not considered cosmetic since the surgery is reconstructive, but it serves no functional purpose. It's important to note that these operations don't bring back sensation to the area, though sometimes sensation eventually returns with or without the procedure. Despite this, most women aren’t encouraged to stay flat.

For Ann, the whole process seemed more like a financial benefit to cosmetic surgeons than a way to restore health and confidence, or to reconnect her to her sense of femininity. Whenever part of the body is surgically removed, a physical and emotional adjustment period always follows. Some in the medical field seem to prey on this vulnerability and rarely offer breast cancer patients emotional support in lieu of a mammoplasty.

Reconstructive surgery is on the rise, but is it because women truly want it or because they are being pushed into it after mastectomies? With cosmetic procedures now normalized and on the rise almost to the point of pathology, it’s hard to pinpoint all the sources of pressure women experience when it comes to their looks.

Ann's reconstruction failed, and the implants had to be removed. After two additional operations within a year of the mastectomy itself, bringing the total number of surgical procedures on that part of her body to five, others tried to encourage her to undergo yet more operations.

"Unfortunately,” Ann says now, “although it does give you something to cling to as a silver lining through the initial shock of it all, the reality should be better presented to women that the surgeons really cannot or choose not to have a favorable outcome with one or two surgeries.” Instead, it turns into a cycle of "just one more," with patients seduced into continually thinking that they are approaching, but have not yet gained, personal perfection. “I am adjusting to a life with no breasts and additional scarring and damage that could have been avoided entirely,” Ann says.

What's shocking is that women endure these things after they have already battled cancer. Some undergo an unreasonable number of surgeries in order to try to restore their breasts. Ann told me about one lady she encountered in a Facebook support group who had experienced 36 such operations. Ann had endured enough with four and decided to "stop the assault" on her body and her health so she could attempt to return to a better, healthier life. While grateful today to be cancer-free, she was left with cut pectoral muscles that scarred and took time to heal. Her recovery has been ongoing.

Another sexually predatory business

Like the multitude of other money-driven businesses that prey on women's self-image to stay in operation -- the beauty industry in general, for example -- cosmetic surgery and, specifically, breast cancer reconstruction facilities take advantage of women in vulnerable positions who are facing a life-threatening illness. At $10K plus per surgery, as of a few years ago, it really shouldn't take more than a few tries to get it right, and if it does, each one shouldn't cost as much as feeding a small family for a year. Understandably, most women want to feel more normal after going through such a harrowing ordeal and are pressured by society to look a certain way, so they are willing to endure multiple surgeries in an attempt to improve their self-image and feel more like they did before their mastectomies. And this is the carrot dangled in front of them, the "silver lining" as Ann put it, that they will feel better about themselves, more beautiful and womanly after they subject themselves to these expensive surgeries. Who wouldn't want to feel better after facing cancer?

"I am disgusted by the entire 'breast cancer industry,' which I am certain prays upon most women's self-image issues,” Ann says. “This in turn propels them to continue with reconstruction attempts to achieve what should be possible with fewer surgeries."

But the push for women to have breast augmentation surgery started before the procedure was used for reconstruction. Fans of the Swindled podcast or those who remember Dow Corning’s big legal battle in the 1990s, will recall how as early as the 1960s and 1970s, millions of women had already undergone breast augmentation surgery. There has been a long history of deception by companies promoting the use of breast implants, often with no adequate testing. Using implants for reconstruction gave breast implant companies a larger market.

One of the worst frauds related to breast implants was committed by the company PIP, Poly Implants Prosthetics, founded in 1991 by a French man, Jean-Claude Mas, who was really more of a salesman than anything. He aggressively pressured companies to purchase his inadequate breast implant products, which ruptured at double the rate of others on the market and contained his own recipe of silicone, not the medical-grade version he insisted it was. Even PIP’s saline implants were faulty. Cutting corners to make a profit was more important than women’s health, apparently. Imagine going through cancer, having reconstructive surgery, and later facing additional illness caused by ruptured implants and cheap, industrial-grade silicone leaking into your body. This happened to more than one woman. Other women developed autoimmune disorders, fatigue, painful lumps, and even cancer.

Mas is no longer producing implants, and PIP was shut down in 2010. But this doesn’t mean all breast implants are now safe. In 2017, the FDA gave a warning about certain types of implants being linked to a very low but increased risk of developing BIA-ALCL, a rare type of cancer. It should be noted that a French woman died after developing this type of cancer after her PIP implants leaked.The FDA’s warning is not to say implants cause this type of cancer, but there is an increased risk of developing it when certain types of implants are used.

The fundamental problem is that most doctors don’t go into detail about all the risks involved with reconstructive surgeries.

 Complications and contradictions

While Ann has been able to look at her entire situation as a learning experience and has adapted phenomenally well as a member of the "flat and fabulous" club, some women aren't prepared to face outside pressure to have surgery so soon after battling cancer. Obviously, these kinds of decisions are difficult, personal, and depend on more than a simple desire to look a certain way. There is much to consider before undergoing any operation, but women battling breast cancer are pressured to make a decision right away.

"They want to do the surgeries quickly when you are diagnosed,” Ann says. “You are just in such a state of shock trying to process it all that you accept what one or two doctors tell you without probing more." In Ann's case, given her small, athletic stature, she was never a good candidate for reconstructive surgery, but she wasn't told this by her first surgeon.

The surgeries resulted in other complications, ones that eventually led Ann to do her own research and eventually demand the implants be removed. According to Ann, the first error was that, even though her first plastic surgeon knew she was an athlete and runner, he should not have cut her pectoral muscles to put the implants underneath. Plastic surgeons need to consider each patient individually. A good surgeon will look at the implant size, the implant type and shape, the patient's body type, and how much breast tissue is available to cover the implant. In Ann's case, being a petite, post-menopausal runner with a low BMI made her a poor candidate for breast reconstruction surgery, period.

Initially, she asked her surgeon to remove the implants, stitch her muscles back down, and put the implants on top due to severe animation deformity. Animation deformity is a complication of breast reconstruction associated with subpectoral implants. Contraction of the pectoral muscle can lead to disfigurement caused by implant displacement. What reconstruction surgeons don't often tell their patients is that women who have battled breast cancer are far more susceptible to this condition. Around 78% of them struggle with this issue.

Ann’s exit from “the system” and reflections

After everything she had already endured, Ann didn't expect her surgeon to do a "totally lopsided, shitty job" that would force her to have to come back for more corrective surgeries. At this point, she switched to a different surgeon whom she liked and respected more, however, he was the first one to tell her honestly that she was a poor candidate for reconstruction all along. Regarding her first surgeon, she said he made her cry every time she left an appointment, but she looked at the experience as a way to learn how to stand up for herself.

She allowed the second surgeon to try to fix what the first had done, but, unfortunately, she developed complications from the surgery due to the lack of fat and circulation in the area. This meant she had to have another operation. Her surgeon was going to try to go ahead with the repair, but shortly before the operation, she changed her mind and decided to just have the implants removed without the added steps of trying to fix anything.

Ann had to be very firm about it. "I was realistic that, and he agreed, one more surgery probably would not do it, and I said I was done and wanted to get on with my life,” she says. “Unfortunately, the damage had already been done."

After all of this, Ann has gradually been able to feel more comfortable in her skin and confident with her body image, and, over the years, the emotions around her experience have changed. "You can google what other ‘flat’ women look like,” Ann says, “and you will see that the biggest problem for me is that those visible folds are not fat or extra skin that can be removed -- they are my pectoral muscles that were cut from the sternal attachments and then stitched back down in a straight line.”

This was the only way the procedure could be once the lower attachments were removed. Also, she says, all of the extra surgeries dissolved any remaining fat she had. But she had made a positive decision for her health. Although she wishes she had done it sooner, she has adjusted. She states, "I do not wear prosthetics--do not even own a pocket bra and refuse. To me it seems to further support the entire industry. I want to be proud of my body the way it truly is!"

None of this touches on Ann’s financial consequences, which have been staggering.

Ann's message to others is to avoid rushing into any surgery. She suggests, "Do the research first or at least look for surgeons with a track record of less versus more surgeries. There is definitely a miscarriage going on here. In my opinion, too many women are being subjected to too many surgeries."


 Thank you to the individuals who helped me with this post including friends who read it and those who helped with editing. 

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