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Body image, personal choices factor into breast reconstruction surgery

By Marissa Harshman, Columbian Health Reporter
Published: October 4, 2014, 5:00pm
3 Photos
Susan Pagel of Battle Ground, left, high-fives fellow breast cancer survivor Becky Ewer at a social event sponsored by the nonprofit Pink Lemonade Project this summer in Jamison Square in Portland.
Susan Pagel of Battle Ground, left, high-fives fellow breast cancer survivor Becky Ewer at a social event sponsored by the nonprofit Pink Lemonade Project this summer in Jamison Square in Portland. Pagel underwent breast reconstruction, which she said helped her to emotionally recover from the trauma of a breast cancer diagnosis. Photo Gallery

October is National Breast Cancer Awareness Month. Find more stories of courage, treatment and survival in the face of breast cancer at www.columbian.com/news/health/breast-cancer

Susan Pagel was diagnosed with breast cancer Sept. 16, 2013.

Her biggest fear — beyond the cancer diagnosis itself — was what the cancer surgery would do to her body.

“I was absolutely convinced that this was going to be a deformity that would haunt me for years,” Pagel said. “I had a huge fear that I was going to have to get used to looking at myself deformed.”

The 52-year-old had reason for concern. Both her mother and sister are breast cancer survivors, and both underwent mastectomies with less-than-desirable results.

October is National Breast Cancer Awareness Month. Find more stories of courage, treatment and survival in the face of breast cancer at www.columbian.com/news/health/breast-cancer

“Their results were not results I wanted for myself,” Pagel said.

So unlike her mother and sister, Pagel opted for breast reconstruction, a process that would replace her breast tissue with breast implants. In February, the temporary expanders placed in her chest during her October 2013 mastectomy were replaced with breast implants.

Pagel opted for implants that are larger than her previous “A-minus” breasts but are still proportionate to her body. She wanted her breasts to look natural, not enhanced. But, more than anything, the Battle Ground woman wanted to feel comfortable in her own skin.

“For me, the implants did that,” she said. “You have to look at yourself in the mirror, and you don’t want that hideous reminder of the day you were diagnosed with cancer. I didn’t want that daily, in my face, ‘you had cancer’ reminder.”

Surgical options

Along with facing the emotional trauma of a cancer diagnosis, many women must also cope with short- and long-term changes to their bodies as a result of cancer treatment. Those changes can have a profound affect on how a woman feels about herself.

A cancer diagnosis may require a lumpectomy (removing the cancerous tissue and some surrounding noncancerous tissue) or a mastectomy (removing all of the tissue in one or both breasts). Those procedures can leave a woman’s breasts looking different than they did before cancer. Women may have the option to reconstruct their breasts, as Pagel did, or use a prosthesis to make their breasts appear as they did before surgery. They may also opt to do nothing.

Research hasn’t produced any conclusive evidence that one option improves a woman’s self-image more than another.

Pagel was confident the only way she would feel good about herself and her body was with implants.

“You come out feeling like you’re still whole, and that’s huge,” Pagel said. “You can’t put a price on that.”

But for Debbie Hoofnagle of Vancouver, the decision was different.

“From the beginning, I knew I wasn’t going to have a reconstruction,” she said. “I didn’t want anything foreign in my body.”

Choosing prosthesis

Like Pagel, Debbie Hoofnagle was affected by the outcome of a relative’s breast cancer surgery.

Years before her 2004 breast cancer diagnosis, Hoofnagle’s cousin had undergone breast reconstruction surgery. Her cousin suffered an allergic reaction when her implants leaked, putting her life in jeopardy, Hoofnagle said.

Hoofnagle knew reconstruction would require temporary expanders and follow-up surgeries that would add months to the process.

“I wanted to get on with my life,” she said.

Hoofnagle underwent a mastectomy on her left breast, leaving her without any breast tissue on that side. Her right breast remained a size DD.

To make her breasts appear balanced, Hoofnagle wears a rubbery prosthesis that slips into a pocket on a specially designed bra. Hoofnagle had long been self-conscious about the size of her large breasts, but wearing a prosthesis didn’t cause any additional concern, she said.

A couple of years ago, Hoofnagle mentioned to her oncologist the discomfort and pain caused by her remaining breast — an issue she had dealt with before her mastectomy.

The oncologist told Hoofnagle she could undergo breast reduction surgery on her right breast. Just as breast reconstruction is covered by insurance, so is breast reduction. Hoofnagle never knew it was an option.

Two years ago, Hoofnagle had her right breast reduced from a size DD to a size C. She got a new prosthesis to match her new breast size.

“I’m very comfortable,” Hoofnagle said. “I look even.”

This summer, Hoofnagle, 65, tried putting her prosthesis in her swimsuit, but it didn’t look right. She tried her larger prosthesis, but it too looked unsymmetrical.

So Hoofnagle decided to go without.

“I’ve gotten over the fact — if people look, oh well, they can deal with it,” she said.

Ten years ago, Hoofnagle said she wouldn’t have had the courage to go into public without a prosthesis.

“It probably would have traumatized me,” she said.

Rebuilding after cancer

When Karen Martin of Gresham, Ore., received her cancer diagnosis in July 2013, she made the decision to do everything she could to appear normal on the outside. That, she said, was critical to ensuring she felt normal on the inside.

For Martin, 54, breast reconstruction was an opportunity to rebuild herself after the devastation of a cancer diagnosis.

“Your house goes down, you rebuild and you move on,” Martin said. “Rebuilding myself after this was critical. I could stand tall after getting knocked down.”

Martin was diagnosed with a noninvasive breast cancer. While she could have undergone a procedure that would have spared more of her breast tissue, Martin opted for a double mastectomy and breast reconstruction. She didn’t want to face another cancer diagnosis down the road, and she wanted to ensure her breasts were symmetrical.

The decision, however, was a tough one. Martin researched the procedures and did some soul searching about what was going to be important to her down the road. She questioned whether she was being driven by vanity.

“It’s not about needing them,” Martin said. “It’s about how you see yourself and how you want to see yourself.”

“You always want to feel beautiful and whole and it’s OK to make a decision,” she added. “It’s OK if you want to look sexy again, no matter how old you are.”

For months, from the moment she received her cancer diagnosis, Martin wondered what her post-surgery body would look like. After a while, she could no longer remember what her body looked like before breast cancer.

“Right now it feels like I’m here and all that’s behind me,” Martin said. “I don’t feel reconstructed. I just feel like me.”

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Columbian Health Reporter