Saturday, December 28, 2013

How Will My Chest Change in the Weeks, Months, and Years After My Mastectomy?

I've been asked this question many times by women who visit BreastFree.org. Some wonder whether lumps and bumps left after surgery will smooth out. Others worry about concavity. For most, the answer seems to be that while some small changes may occur over time, it's unlikely your chest will undergo a dramatic transformation.

If you're slim, your ribcage may become visible after mastectomy surgery. Because you had little fat to begin with, once your breast tissue has been removed there may not be much padding between your skin and your rib cage. Usually, it's only after post-operative swelling resolves that you may notice the outline of your ribcage beneath your skin. Unfortunately, your chest is unlikely to plump up over time. As my surgeon explained it to me, fat cells don't migrate from other parts of the body to fill in the spaces. Fortunately, not all slim women have this issue, but some do.

If you're on the heavier side, you may find that you have too much tissue under your arm at the end of your incision. This phenomenon is known as a "dog ear." A dog ear can also occur at the other end of your incision, next to your sternum, though this is much less common. Slimmer women can have dog ears as well, but they're usually smaller and less bothersome. If you merely have little puckers at the ends of your incision line, these will likely flatten out over time, but larger dog ears generally won't resolve on their own.

I haven't been able to track down the origin of the term "dog ear," but basically a dog ear occurs because the elliptical incision used to remove a breast is closed in a linear fashion. This causes tissue to bunch up at the ends, especially under the arm. If your breast surgeon knows you don't want reconstruction, it should be possible to avoid or minimize dog ears, though your incision line would likely have to extend further under your arm.

Even if you wind up with dog ears, the good news is that they can be fixed. However, you will need minor surgery, preferably by a plastic surgeon. The procedure is normally done on an outpatient basis, during which the dog ear is excised. This usually results in a longer incision line, but a smooth result. Lumpiness caused by less-than-perfect surgical technique can also often be revised by a skilled plastic surgeon.

Another unwelcome surprise after your mastectomy swelling recedes can be some degree of chest concavity. This can vary with the type of mastectomy performed, the amount of body fat left on your chest after surgery, and even your underlying ribcage anatomy. Further, if you've had implant reconstruction and opted to have your implants removed, there's likely to be more pronounced concavity, as implants put pressure on the ribs and tend to compress them. This is especially true if you've had the your implants in for a long time.

The small amount of concavity that may occur after a simple mastectomy probably won't be noticeable in clothes even if you choose to go flat. If you wear breast forms, the concavity is easily corrected and should have no impact on your appearance in clothes.

Bottom line, while problems like lumpiness and dog ears probably won't disappear on their own, they may improve a bit over time and, if you're still unhappy, an outpatient revision by a plastic surgeon can leave you with a smooth, flat chest. Prominent ribs and concavity unfortunately won't diminish over time, but can be easily camouflaged. And for those of you who find yourselves with a smooth, flat chest after your post-op swelling goes down—you're fortunate, because it's likely to stay that way.

Note: I'm not a medical professional and the comments above should not be construed as medical advice.

To see some very moving images of women post-mastectomy, with and without reconstruction, visit The Scar Project.


Thursday, May 30, 2013

You Don't Have to Give Up Those Strappy Dresses and Cute Swimsuits

After Amy Gallatin had a bilateral mastectomy without reconstruction, she set out to find ways she could wear the clothing she'd always enjoyed. In the following essay, she shares what she has learned.

When I was diagnosed with DCIS in the fall of 2008, I elected to have a double mastectomy. After checking my reconstruction options, I knew pretty quickly that reconstruction was not for me. I wanted to be done with poking and prodding and medical stuff.

My recovery from surgery wasn't too bad. I'm an avid Pilates exerciser and went back to class after two weeks because I was concerned about lingering range-of-motion issues. Pilates is an excellent form of gentle stretching and I credit my lack of after-effects to that regimen, along with some pro-active deep tissue work (myofascial release and massage) to keep scar tissue from building up. The American Cancer Society has guidelines for gentle stretching immediately after surgery and I did those stretches, too. I was actually very surprised by how little pain I had post-surgery. Even though I’m a complete baby when it comes to pain, I never had to use the painkillers my breast surgeon prescribed for me.

Before surgery, I was a small 34B and went braless whenever I could. I wore lots of little strappy dresses during the summer, cami tops, things like that. After surgery, I felt a pang when I looked at my strappy summer dresses and cami tops and bikinis and thought that I would never be able to wear them again. Sometimes it seems that the folks who are in the mastectomy products business would have you believe that you need to say goodbye to fun bathing suits, cooler dresses, and tops that don't go neck-high (take a look at some of the mastectomy bathing suits and you'll see what I mean). That was a little depressing. I’m a musician/performer and I tour quite a bit. I wanted to look the same as I always had, on-stage and off.

So, I embarked on a research project. I wanted to see just what was out there besides specialized mastectomy products and just how far I could push the envelope. This is what I found: strapless bras that are undetectable under strappy cami tops and dresses; "stick-on" breast forms (prostheses) that will stay in place in a regular bra; camisole tops and dresses with built-in bras; regular swimsuits that can be worn with breast forms.

After I’d found all these things, I went on a dive trip to Mexico—warm sun and fun bathing suits, what's not to love? Diving in Cozumel involves being in tight quarters on dive boats and wriggling in and out of wetsuits between dives. I wore my two-piece swimsuits with triangle tops, swim breast forms inserted, and no one was the wiser.

Tops

Soft Surroundings
Underwire Tee
I own shelf-bra camisoles in every color, and use my lightweight post-surgery foam pads in them. They're perfect for layering under a jacket, a crop top, or a scarf. The current layered look and the plethora of scarves now in fashion are great for this. Soft Surroundings makes a number of tops with built-in underwire bras, including halter tops, bandeau bras, and camisoles. I especially love their Underwire Tees because they present an off-the-shoulder look that is very flattering. They come in short and three-quarter sleeve lengths. Soft Surroundings has brick-and-mortar stores as well as an online site.

Solutions and Norm Thompson also sell camisoles with built-in bras, called “Perfect-Fit,” that are perfect for breast forms. They come in lower-cut and higher-cut versions and it’s nice to have that choice. They also recently have started offering lined lace camis that are very cute.

For working out at the gym, I look for higher-cut racerback tops with shelf bras and wear my post-surgical “puffs” in them. They stay put really well because there’s no weight to them.

Bras

Herroom has a great selection of different bras, including the reasonably priced Elita bras; one is a little pullover bra with pockets for inserting breast forms. Super comfortable.

The Rhonda Shear Ahh Bra is comfortable and good for holding breast forms. It keeps the forms separate and avoids the “uni-boob” look, plus it smooths bra bulge. The Ahh bra also comes in a racerback style for wearing under racerback-type tops. The Genie Bra is similar but has removable pads and hence openings that will accommodate breast forms. My most recent find is the Coobie Bra, a delightful little cotton lace-trimmed number with removable pads (and hence pockets). The pads can be left in with the breast form or removed. They come in a variety of colors and patterns with camisole-type straps. Cute and comfortable!

You can find strapless molded-cup underwire bras with a little silicone strip around the inside bottom of the underwire that keeps the bra from slipping down your chest with the weight of the breast form. I can wear strapless tops or halter dresses with them. Bear in mind that I’m smaller-breasted; I’m not sure how well this would work with larger, heavier forms. The little silicone strip is the key to keeping the bra in place. Warner’s makes a bra of this type.

Swimsuits

Lands’ End has a selection of specialized mastectomy suits. Also, I found that many regular bathing suits are sold with removable pads. They work well for inserting your own forms since the openings are already there. I usually use a triangle-top two-piece. (For more swimsuit ideas on the BreastFree Blog, see Swimsuit Edition, Breast-Free Style.)

Dresses

Athleta dress
Athleta sells lots of dresses with shelf bras in them. Also, I’ve found some halter dresses with removable pads, just like those in the bathing suits, which will accommodate forms.

Both Anita and Amoena, as well as other breast form manufacturers, sell “stick on” forms, with a sticky surface that enables the form to stick to your skin. These will not work without substantial support, such as a bra, much to my disappointment. I’ve tried both brands and I prefer Amoena. The sticky surface on the Anita form came off fairly quickly, within months of infrequent use. Amoena’s sticky surface holds up much better. A good feature about both these forms is that they come with a back pad—when you put the pad on, they function just like a regular form.

I use my clear swim forms if I’m wearing something skimpier, as they are much more unobtrusive when glimpsed through an armhole or down the front (many swim forms are clear and chlorine resistant).

* * *

I think the main thing is not to be afraid to experiment and see what works for you. I had some of my existing dresses altered, taken in a little around the chest, so they fit better and don’t gape. For dealing with low-cut or gaping tops, I’ve found clever panels that can be attached to a bra and cover the "cleavage" area. They also can hide scarring and prevent non-pocketed breast forms from popping out. One such panel is called Cami Secret; another, by Fashion Forms, is called Cami Too; and a third one is Cleava.

Around the house, I don’t bother wearing breast forms and many times when running out to the store I just throw on a hoodie or a scarf. I’ve gotten more comfortable with how things are over time, but I do like the way certain bra/top combinations allow me to look like the “old” me when I go out. My husband says, “No one would ever know.” I keep up with my Pilates and have added yoga to my regimen, as the stretching is very important to maintaining range of motion. Life is good.

Good luck and have fun experimenting!