I never knew I had small breasts!

Boob denial

Over the last three+ years, I have heard more boob discussions than one should in an entire lifetime. I have also had the opportunity to see some incredible breast reconstructions (and some just okay ones) and have had so many conversations regarding my own “breast situation.” I love how people love to add those little comments in like, “Oh hunny, go bigger. You can afford too!” Again, it wasn’t until I really started paying attention that I thought to myself, “wow…maybe I am on the smaller side…” and until some women, and my husband for that matter, helped to point it out.

One might ask how you could not know that you are of the more “average” or even below average size but until all of this BRCA stuff came up, I just never really noticed! You would be amazed what a group of BRCA women talk about (or show you) when you put them in a room together! It also probably didn’t help that I wore the wrong cup size for the majority of my teenage/adult years so maybe I was just in denial about my boobs or just didn’t care.

The best part was last summer I went wine tasting, had maybe one two many glasses of wine, and nonchalantly asked my husband (in front of another couple might I add), “Out of all the boobs you’ve EVER touched, how do mine compare in size?! Small, medium, or large?” I was dead serious and demanded that he answer me. I thought he might fall over or pass out. Now, let me remind you, I had had A LOT of wine and wouldn’t let it go until my poor husband admitted to me, “I guess they are on the smaller side.” I was actually surprised! I knew he wouldn’t say large but I thought to myself, maybe medium? I guess he was thinking there was an extra small category and at least I am not in that. My poor husband just couldn’t win and the couple with us found it to be totally amusing.

“Foobs”: Breast shopping

If I had a crayon or eraser, my breasts are NOT the first thing I would add or erase from myself. Obviously if I didn’t know my boobs were that small, it’s pretty much the last thing I would go under the knife for but this is the hand I was dealt so if I am going to get new breasts you better believe they are going to look amazing! To get these amazing boobs, or “foobs” as us BRCA people call them, I must go boob shopping.

The better term is probably surgery and surgeon shopping but I like to refer to it as boob shopping or “Foob” shopping. Now, BRCA has A LOT of terminology and foobs is one of them. (ie. Fake + Boobs = Foobes) So, Foob shopping is the process of looking at all the different types of prophylactic mastectomies that are out there, comparing and contrasting them, and then finding the right surgeon. Once I have chosen my surgeon I am sure Chad and I will feel the type of breast we want and pick the size (totally weird, I know) but I am still in the earlier stages. I don’t even know if I want to go bigger. I think I just want them perkier and pushed together more so I can actually have some cleavage. Hell, if a girl has to get all her tissue removed and go through such a crazy surgery then I should at least get perky breasts.

I am pretty confident that I know what type of surgery I want which definitely narrows down my choices of surgeons because it is a highly new type of breast reconstruction and only a handful of physicians in the country are trained in this type of surgery. This does, however, cause some problems when it comes to insurance coverage and it also requires traveling. No one within 30 miles of DC is able to perform such a surgery which means I will have to travel to New York or Chicago and stay overnight in a hotel for nearly two weeks if I decide to go with this specific type of mastectomy. Again, another predicament. My choice would be New York because it isn’t as far and I have family near there but unfortunately it is looking like my insurance wants me to go to Chicago.

The surgery I want: the one-step/ direct-to-implant

During a typical mastectomy, the chest muscle and breast skin must be expanded over a period of several weeks to create a pocket of sufficient size to hold the implant therefore there are several procedures performed. Alternatively, stitching patches of acellular dermal matrix to the sides of the muscle or along the inframammary fold creates an instant pocket and more complete coverage of the exposed implant edges. This is called a direct-to-implant reconstruction or more commonly known as the “one-step.”

Direct-to-implant reconstruction offers three distinct benefits over traditional implant reconstruction including the following:

  • Single-step implant procedure doesn’t require expansion
  • Women who combine this procedure with prophylactic subcutaneous (skin-sparing) mastectomy and nipple-sparing mastectomy can complete their entire reconstruction in a single step.
  • Acellular dermal matrix integrates into a woman’s healthy tissue so the breasts tend to look more natural

Who is calling the shots?

I would like to think that Chad and I are calling most of the shots when it comes to my healthcare but I do feel a little a little captive to my health insurance. It is important that I get the surgery and physician that I want but if I go out-of-network it would just be too costly. Of course, the plastic surgeon that I want in New York City is out-of-network. The facility/hospital is in network and the breast/general surgeon is in-network but he is not. This is so frustrating!  I did speak to my insurance and they said that I have something called GAP coverage where, if there is no one within a 30 miles radius that does the procedure that I need/want, then I can appeal for in-network coverage. Whohoo! There is definitely not someone in this area that does the surgery so I think my chances are pretty good but we will just have to wait and see.

I will be attending the FORCE conference in June and have set up a consultation with the plastic surgeon for Chad and I to meet with. We will have to see what the doctor says, what my insurance approves and if Chad is as calm about this as he appears to be.

Other options:

The more I talk about it with my husband, the more he wants me to stay local. There are great physicians in the DC area but with a more lengthy process. I have started to contact some of those surgeons to get consultations just to see what my options are. It would be nice to be home in my own bed versus in a hotel and I have such a great network of friends and family here. Also, if something was to go wrong, to be near my doctor would be a huge asset. We will have to see how all these consultations go.

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5 Comments

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5 responses to “I never knew I had small breasts!

  1. Sarah Hartley

    Interesting. Thanks for sharing. This should be helpful for other women.

    • Good Luck, I would recommend Megan’s blog she has been very good at recording all the details. Welcome to the world of blogs they are such an inspiration to so many!

      http://goodbyebrcafate.blogspot.com/2010/06/8-weeks-post-op-things-are-looking-up.html

    • Hi Allison,

      Found your blog through the FORCE message boards. Glad to see another young BRCA previvor is sharing her story with the rest of the world. I’ve been blogging at goodbyetoboobs.blogspot.com about my own experience with BRCA (from “diagnosis” to surgery to recovery and beyond) for about a year and a half. Would you mind adding me to your blogroll? I’ll add you to mine (I desperately need to update that thing!).

      Couple thoughts:

      1) I can infer from this post that the doctor you are considering in Chicago is the doctor who did my reconstruction. I’ll be at the FORCE conference, too, so I’d be happy to meet up with you and give you a private show and tell. I have nothing but good things to say about this doctor and my experience with him. I’m leaning towards considering a revision (just on one side, and I’ll show you why in Orlando), but I still think the one-step surgery is the way to go. I couldn’t imagine going through the expansion process. In the meantime, if you have questions or want to chat, please drop me an email.

      2) About the “going bigger” thing. I actually just wrote about this on my blog last week. I think it’s common that, when faced with this terrible choice, we look for the silver lining and think, oh, well, since I’ve been dealt this shitty hand, I might as well get huge stripper tits. And other people can sort of joke about it — make a bad situation better — by saying, well, at least you get to go bigger. And if indeed that’s what you want, then go for it. But don’t think that just because you are going through with mastectomy and reconstruction you have to come out with different sized breasts. I chose to stay the same size (well, I’m maybe a half cup size bigger) because, eventually, I decided that looking like myself and feeling like myself (after all the disorientation of all this BRCA stuff) was the most important thing. And, you’ll probably discover, size isn’t exactly the most important aspect of reconstruction. There is so much else to consider — from what doctors to pick to what reconstruction method to chose to what kind of implant to use — that size is secondary. By all means, however, if you feel passionately about going bigger, then go for it. But if you end up the same size, the important thing is that you’ve taken control over your health and have reduced your risk for breast cancer significantly. And that’s what this is all about, isn’t it?

      Looking forward to meeting you and following your blog.

      All best,
      Steph H

  2. Hello!
    I loved reading your blog thus far!! In so many ways I can relate. I am almost 25, and am brca1 positive. I recently had my nipple sparing pbm with immediate recon…a little over 2 months ago now.
    Like you I have a very supportive fiance, and has been with me from the time I found out I carried the brca1 mutation..which was when I was 18.
    I am so thankful for having this knowledge, and the power to hopefully stop bc before it happened. You will feel so much relief once this is all behind you!! I wish you all the best in your journey!! And will defiantly keep reading your blog. This is mine http://goodbyebrcafate.blogspot.com/ …Mine was started after I had my surgery, so it is not as in depth…its more what I was going through, and feeling on a daily/weekly basis. There are photos too! 🙂
    Megan

  3. Soo funny…. I just noticed Betseys post above. That is my blog she is talking about haha. 🙂

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