Matters of the Flesh

Shirtless and with the top of my jeans pushed down below my hipbones, I stood before the plastic surgeon’s studied gaze. Photos were taken from all angles. As he prodded gently at the flesh around my hips and buttocks to assess whether the fat there could be used to construct a new breast, I tried concentrating on the posters on the wall and feigned composure. But the most awkward moment was yet to come.

“Lie on the exam table and raise your feet and legs slightly,” he requested. He stood over me, both hands on my stomach, thumbs alarmingly close to my belly button, and pulled my fat up toward the ceiling. This is as scientific as it gets for plastic surgeons when it comes to judging the ability to use a patient’s own tissue for breast reconstruction, apparently. Never a fan of having my stomach touched even at the best of times, I focused all my energy on not squirming as he assessed his potential materials.

“The issue is that there is quite a bit of, er….volume in your breasts...” he began awkwardly.

“Oh! Right – no, no, I definitely don’t want to be as big as I am now,” I said, relieved that he had at last released his grip on my stomach fat. “Smaller is fine. In fact, I see the ability to stop needing to safety pin the gaps in my button-down shirts to be one of the big benefits to come out of this whole experience.” Once again, humor serving as my metaphorical hospital gown as I lie flat on my back, exposed on an exam table.

After each plastic surgery consultation, I have walked away reassured that I should be able to achieve a satisfactory cosmetic result from my reconstruction. But they have also featured moments of almost comical humiliation. One surgeon drew all over me with a Sharpie, à la Dr. 90210, pointing out that my nipples should actually be about an inch higher than they are. It took the better part of a bottle of rubbing alcohol and a pack of cotton balls to scrub away the marks from that one. Another described my breasts as “long,” not exactly the adjective one hopes would characterize these particular body parts at the age of 33.

And although my first surgeon described me as “too skinny” for the stomach fat transfer alternative (I thought about asking him to put that in writing so I could frame it for posterity), that did not stop him from being able to pinch what was clearly well over an inch as he stretched my belly fat skyward.

Now that I am nearing the end of chemo, with only 2 sessions left to go, I must make my decisions about surgery, which my doctors have advised me to schedule about 4-6 weeks after my final chemo treatment. Due to my genetic status, I will be having a bilateral mastectomy. Thanks to advances in medical techniques, I can have what is known as a “skin-sparing” mastectomy with immediate reconstruction, which means I will wake up from surgery with some sort of breasts in place. In theory, these can be made from either my own tissue or from implants. In practice, since I am having both breasts removed, implants are probably my best option.

But I still have an array of choices to make over the next few weeks, which means more appointments with more plastic surgeons. Michael and I are planning to celebrate the end of chemo with a trip to Miami in late March for the wedding of friends – despite these upcoming consultations, I will probably be able to muster the confidence to avoid spending all my time there in a giant flowered muumuu, but I will definitely be packing the rubbing alcohol and my most supportive underwire bikini.

Scarfabulous

There are some benefits to wearing a wig - my shampoo and highlight costs are way down, I haven't spent time blowdrying since before Christmas, and I've had lots of compliments on my new "straight with bangs" style.

But maintenance is trickier than I had expected. Since Wanda the wig is made from real human hair, it needs to be washed every 20 wears or so. In theory, I can do this myself - wash it in the sink, squeeze out the excess water in a towel, let it dry on its stand, then use a flatiron or curling iron to style.

I tried this once. Having liberated my seldom-used flatiron from the depths of the closet and with my newly purchased large-barrel curling iron at the ready, I set the wig on its stand on a dresser and quickly realized that I needed to take another approach. Any time I came near the wigstand with one of my styling instruments, it promptly fell over. So I switched to working on it while on my head. This was fine for flatironing the sections around my face, but I was hopeless when it came to the bangs. Every time I tried using the curling iron, the hair ended up caught in the barrel's catch, resulting in attractive, random 90-degree bends for portions of each section. And as with when I had real hair, I was a bit ham-fisted when it came to doing the back. I tried holding the wig on my left hand and styling the back with my right, which worked to an extent, but did not quite result in the straight, shiny locks Edward gave me when he first styled the wig in the shop and fitted it to my head.

So after wearing self-styled Wanda about 10 times, I gave up and took it in for servicing. Two days and $50 later, it came back softer and shinier (and also curlier - apparently next time I need to tell them that I want it not just straight, but "STRAIGHT straight.") Although I realize this will rapidly eat into my shampoo and highlight savings, and although I am frustrated that I can't do a better job myself, it seems like the best option to preserve both my sanity and my vanity.

But it does not solve every problem. I can't wear Wanda to the gym, or to swim in, and I need to wear something while she is "in the shop." While I don't mind going bald or wearing scarves and hats at home, I am still a bit too self-conscious for the "bald and proud" look while out and about. For our trip to Turks and Caicos, I found a great alternative - my "Scarfabulous" is a bandana made of swimsuit material, with hair attached. Since the hair is real, it can get wet. It comes in several lengths and colors, and the "warm light brown with blonde highlights" is very close to the hair I shaved off in December.

I had originally intended to cut it to shoulder length to more closely resemble Wanda, but shortly before we left, Laura and Sarah came over for the fashion show and advised me to keep it long. So "J.Lo." (as Sorrel christened her on New Year's Eve, when her shaved-headed husband Alex rang in 2007 by wearing her around our party) was my beach look, and also kept me covered at breakfast, lunch and yoga classes. In the evenings, I switched back to Wanda. If anyone noticed, including an acquaintance from business school and his wife who were also staying at Parrot Cay, they were too polite to say.

I will be dropping Wanda off again for refurbishing this morning, on my way to Chemo Number 6. Things are going well with the new drug, which I started two weeks ago - no nausea, less bone pain, and just a few eyelashes missing so far. Of course, the steroids they have me take the night before to help stave off allergic reactions are likely the reason that I am up at 5 a.m. writing instead of sleeping, but I will take that over the numb fingers and toes and overall body pain that some women feel as a result of Taxol.

So now that the side effects are not a concern, I can devote my energy to worrying about my hair. Wanda doesn't come back until Saturday. And although I am not in the office today and tomorrow, I do still have to go to and from the hospital both days, as well as to the grocery store. With snow on the ground, J. Lo feels a bit unseasonal. It's too cold for just a Grace Kelly-style headscarf, although I am planning to wear the gorgeous scarf Jeannie and Sivan gave me when we have friends over for dinner on Friday night.

This may call for breaking out the short wig I wore to play Sharon Osborne once - I have tried it on, and apart from being a purpley-red henna color that is not found in nature, it's not a bad style. It's not quite the same as Samantha matching her wigs to her outfits in the final episodes of Sex and the City, but it is a good excuse to try on a few new identities over the next few weeks and months as my hair and I embark on the long journey back.

Resemblance

"Are you two sisters?"
"I knew that was your mother the minute she walked in the room."
"Do people tell you all the time that you look like your mother?"

Yes. Since childhood. Despite different eye color and haircolor, that I can get a tan while she freckles, and that the clothes she wore in her 20s were so tiny that I couldn't hope to fit into them past the age of 11, I have always been able to see how similar we are.

For some women, "you sound just like your mother" are fighting words, an accusation to be hurled and defended against. When Mom relayed the story of the London cab driver asking the sisters question when I was 16, she laughed and told her friends that she was worried I would be insulted. But I have always been pleased by and proud of the comparison.

Now, as if appearances were not strong enough, we have all the proof we need that we are indeed related - Mom has tested positive for the BRCA 1 gene mutation, as we suspected she would based on my results.

This means that she has a 56-87% chance of developing breast cancer by age 70 (vs. the 7% chance the general population has). It also means her risk of ovarian cancer is as high as 40% (vs. 2% for non-mutation carriers).

Although she has big decisions to make in the near future about measures that can dramatically reduce her chances of developing these diseases, for now we are relieved that there is no immediate concern - her mammogram and other scans came back clear. The maternal instinct may be even stronger than the genetic bond - Mom said that her first thought on getting that good news was not "Thank goodness I don't have cancer," but instead, "Thank goodness I can focus on helping Courtney get well over the next few months."

For which I am very grateful. So far, I am cautiously optimistic that the second half of my chemotherapy will go as smoothly as the first part - I had my fifth of eight sessions on Thursday, and apart from some increased sleepiness, I have been feeling remarkably well the past few days. Five down, three to go, followed by surgery in April and hopefully getting the reconstruction and recovery completed by the summer.

And now that I have finished the first chemotherapy drug combination and am on to a new drug, I am even starting to see some new peach fuzz sprouting on my head. Although it will take some time, I look forward to the day when a cab driver catches sight of us in the rearview mirror and can't help but tell me how much I look like my mother.