The beginning seems like the place to start: puberty.  Puberty brought with it headaches and breasts that budded like sweet plums and only stopped when they’d achieved proportions that were both foreign and shameful, like a pair of those grotesque, award-winning pumpkins.  Foreign, because I think of myself as having a tidy, logical mind. I wanted a tidy body to follow, and my breasts were anything but tidy.

An underappreciated aspect of being busty is the – perhaps primal – reaction of the heterosexual male to their presence.  It seems to me that, no matter the age of the woman bearing the breasts, they are a signal of availability.  The larger they are, the more available.

I’ve loathed them my whole life.

This was not my first round of visiting surgeons and making jokes about how someone owed me dinner after the awkward examination.  This was the first time I had already decided I was going to go through with the surgery.  I had found an NIH study that retroactively looked at women who had gone through a reduction and also experienced migraines, and the study had found that there was a not insignificant number of women who found that the surgery improved their experience with migraines.

A note on the migraines.  At 13 they were headaches.  At pushing-40, they were two day affairs, complete with the occasional bout of vomiting, managed (poorly) with narcotics and dread.  I am not fond enough of pain to undertake surgery for vanity, but for the chance of managing the migraines?  I was all in.

Of course any medical discussion of the breasts was bound to be uncomfortable, and in the interest of focus, perhaps I should write my open letter to doctors everywhere in another post.

Given my age and family history, the doctors were insistent that the process start with a mammogram.

Recommendation number one: don’t get a mammogram if you are at all hormone-induced tender.

The mammogram revealed little bright flares of calcification, a cluster of three in lefty that was … concerning.  So biopsy removes all the questionable cells, the pathology reveals DCIS, now I have a plastic surgeon and an oncology surgeon.  Yay me?

The surgery had been scheduled for before Christmas.  It got pushed back to the end of January, as I now had two surgeons with schedules to balance.  The plan was to start with the oncology surgeon, who would excavate around the little marker they left buried in lefty to clear my “margins.”  Basically, scrape a swath of flesh around the place where the malign cells had been.  That tissue would get closer examination in pathology, but meanwhile, the plastic surgeon would take out the weight of breast tissue determined by my insurance company and I would wake up with (comparatively) feather-light breasts.  Two surgeries, one recovery time.

And that’s what we did.  A little over 3/4 of a pound came off each breast.  If you have read this far with interest because you too are contemplating this surgery, a list of things I had wished I’d known are next.  If you have read this far with interest because you are contemplating this surgery and somewhere in that process you’ve found DCIS, you get an extra list of things I’d wished I’d known.

Things I wish I’d known about getting a breast reduction:

1. Your fear of the pain of recovery is way worse than the actual recovery.  Not everyone is this lucky, but I was on pain killers for the first three days – Vicodin, not Percoset – and after that?  Really not painful at all.
2. If you have sensitive skin you might be allergic to the antiseptic that they swab you down with pre-surgery.  Those itches are MISERABLE.
3. Either healing was super itchy or I was especially itchy because of some otherwise undiscovered allergy, the itching was unbearable.  I ended up e-mailing my surgeon and she prescribed me steroids.  Don’t be afraid to speak up post-surgery if you have questions, if something seems abnormal, if you aren’t feeling right, if you itch…  Whatever it is, send an e-mail, call the office, whatever.
4. When you first wake up, your breasts are the shape and hardness of barbie boobs.  It is really quite incredible, and strange.
5. When the surgeon tells you that it is impossible to say for sure what size you will be when you’re done?  Believe them.  And then connect them to this article.  *Digression after the list.
6. You may loose sensation in one or both of your nipples.  You may be hypersensitized in one or both of your nipples.  You might have one go one way and the other take another route.  Both are likely to pass with time.  Not guaranteed, but likely.  I got one of each, and both are making progress, though getting sensation back is slower than getting the hypersensitivity to calm down, at least for me.
7. You know how it used to be that you were familiar with the bra companies and which ones made bras that fit you?  Throw that out the window for a while.  You will likely need to find a new go-to bra company and a new go-to size.

*Digression.  A doctor who has not lived with large breasts is going to understand your issues technically, abstractly.  They can look at you and see how the breast structure isn’t meant to support that much weight.  They can assess proportionality, or make an aesthetic call about what your ideal girls would look like.  But on a fundamental, necessary level, they don’t understand.

This matters, because they are likely operating under the cultural assumption that, within in reason, big boobs are better.  And so they are likely to balance a mix of the insurance requirements for how much weight must be removed, the understanding that bigger is better, and their notion of what a nice boob looks like.

But the amount of weight required by the insurance company may not get you all the way to where you want to be.  For example: I would like to be able to run across the yard without physically holding my breasts in place.  That is a significantly different measure, it is a dramatically different way of thinking about the surgery you are about to undertake.  And there is so much uncertainty.  How do you turn 350 grams into an understanding of the volume that is going away?  It means something to the surgeon, who will be standing over you with a scale to the left, carefully weighing each cut to keep the insurance company happy.

If you combine the second chart in the article with my experience, it adds up about right:  350 grams is approximately 3 cup sizes.  (The article suggests about 115 grams of tissue/cup.)  And that’s consistent with my results, 4 months later.  To end up where I wanted to, they would have needed to remove another 230 grams, at a minimum.

Before the surgery, and with a complete inability to wrap my mind around 350 grams, it seemed to me that anything was possible – I could come out a B cup, for all I knew, and I didn’t think I was ready for that dramatic of a change.  But I was really hoping to land somewhere between a C and a D.  After the surgery… If I had *started* at this size and walked into a surgeon’s office, I could be approved all over again for breast reduction surgery.  DEEPLY disappointing.

My unhappiness with the degree of reduction dawned on me slowly.  At first, the Barbie boobs were entertaining.  I kept trying to buy medium sized stretchy bralettes, my husband kept telling me I needed a large.  No, I insisted.  My boobs are supposed to be in the C/D range now, medium is the right size.

Says the lady who hasn’t seen C since 14.  I don’t know what the hell a C is supposed to be. I don’t look at anyone’s boobs but my own.

It took me a long time to accept that I am still busty.  At first, it was funny.  Ha ha.  I went through surgery and I have so much to share that they could take out 1.5 pounds and I still have big boobs.  Ha ha.

And then I went to try on bras and realized that it wasn’t funny anymore.  My dream of being able to buy a bra at Target that didn’t require an advanced degree in engineering to design was dead.  I still need the bras that cost $80.  On sale.

The point is: that article is going to make a difference in the conversation you have with your doctor.  I’m *sure* that you can’t get precision out of their chart, but in my experience, it is a pretty good starting place.  The prediction in cup size using their chart would have been spot-on.  Print out a copy of the article and take it with you.  If your surgeon doesn’t take you seriously or is affronted by your insistence or reacts with anything aside from curiosity/interest/being willing to talk to you about getting to the right size, FIND A NEW SURGEON.

If you are looking at breast reduction + DCIS.  Also, things to know with DCIS…

1. DCIS is not cancer.  It is pre-cancer.  A risk factor for cancer.  It is not cancer.  Whoever tells you that you have DCIS may or may not make this clear to you.

   I have had doctors tell me in the same conversation that I am not a breast cancer survivor and that I now have a three generation history of breast cancer.  My grandmother found DCIS in a breast when she was 85.  My mother died of breast cancer (and never had DCIS).  They found DCIS in me.  So if I’m not a cancer survivor with DCIS and my grandmother doesn’t have cancer, she has a cancer risk, then there is only my mom with breast cancer and your three generation theory is bullshit.

2. Removing breast tissue reduces your risk for cancer.  It doesn’t make it go away, but less breast tissue, less breast tissue that can go wrong.  When they are talking to you about the things you can do to reduce your risk for cancer in the future, keep in mind that you have already done something to reduce your risk of breast cancer.
3. They are likely to suggest you go on tamoxifin. Tamoxifin is pretty standard post breast-cancer treatment.  It supresses estrogen and if your DCIS reacts to estrogen, taking away estrogen seems reasonable.

   Except it isn’t.  Because tamoxifin is associated with an increased risk of endometrial cancer.

   Let me understand this.  You want to treat the one risk of cancer by giving me another risk for cancer?  Oh, you can f&ck right off with a spoon.

   Incidentally, no one said “oh, by the way, this drug we want to seriously consider taking to prevent cancer might give you cancer.”  Informed decision my ass.

4. Any time someone brings up the scary C-word, the first instinct is to react like you’ve got a spider crawling on you.  It isn’t reasonable, it isn’t rational, you just flail and scream and slap at yourself until the spider is gone.  Never mind if you’re in the middle of driving a car at the time.  Similarly, the doctor says cancer, and suggests surgery tomorrow and chemo the day after, and all you can think about is getting this vague and terrifying thing out of your body as soon as humanly possible.  It all seems reasonable.  Except the cancer didn’t show up yesterday, and in most cases, the cancer isn’t going to kill you tomorrow, so taking a couple of weeks to get a second opinion, do your own research, look into the efficacy of the proposed treatment and its risks, cut all sugar out of your diet… Take that time.  Not that much is likely to change in a week or two, and you can’t possibly make a good, rational decision about what you’re going to do sitting in a kleenex of a hospital gown with a doctor looming over you.
5. Everyone in this situation has incentives.  This doesn’t make anyone a bad person, but all of those incentives are not aligned.  Your doctor has three entities to make happy, and of the three, you’re the only one that doesn’t involve money.  The other two entities are the health insurance and the malpractice insurance.  You’re trying to be healthy and everyone else is trying not to get sued.  Insist on your perspective being heard.  Do not do anything you don’t feel 100% informed about.  Carrot juice is not likely to save you from cancer, but chemo doesn’t come with promises or guarantees either.  The right answer will be unique to you, and it will probably lie somewhere between doing nothing, carrot juice, and doing everything.  Decisions made out of fear are usually bad decisions, and scared decisions under time pressure from figures of authority are especially likely to bring with them some regrets.  This is your body we’re talking about.  No one else lives in it. Insist on a process that YOU feel comfortable with.
6. If they do a lumpectomy at the same time as the reduction, expect the side with the lumpectomy to take longer to heal.

This is probably enough for one Sunday night, though I have more to say – particularly about the doctor/patient relationship.  That can wait for another post.

Breast reduction blog posts tend to get a lot of new traffic – if there are brand new readers with questions that I haven’t touched on, use the comments.  I’ll try to answer, though I am not promising I’ll respond quickly.

Also: I still have the migraines.

Also the second: all the tissue they removed cleared pathology and I don’t have to see the oncology surgeon until July, at which point she may receive a piece of my mind.