I have read so many cruel, uninformed and downright crude comments about Angelina Jolie's supposed breastless/mutilated/ruined status. Most are juvenile blather that don't merit a response. But for every one of those, there's a woman who is delaying or avoiding potentially life-saving surgery out of fear she'll look like a freak -- or be subjected to the same kind of negative judgment. So, I've decided to go public with my own post-mastectomy reconstruction to let you see how far the art has come. At the bottom of this post is a link to an un-retouched, NSFW photo of my new "girls," one year post-op. I don't wish to debate whether preventive mastectomy is right or not -- that's a very personal decision. But it's time to shed some actual light on a subject usually kept under wraps, so to speak.
Options for reconstruction are... ample, though it's not one cup-size fits all. You may or may not be a candidate for the nipple-sparing mastectomy that Angelina had. You may be dealing with damaged or missing skin. Unrelated health problems or family circumstances may affect your choices. But if you want breasts, the odds are you can have them, they'll look pretty good and they won't bankrupt you.
Reconstruction is not considered cosmetic surgery. In the US, it's Federal law that insurance must cover reconstruction after mastectomy. And yet, most women still seem to assume that if you're not as rich as Angie, you're doomed to a lifetime of stuffing socks in your bra.
After doing my own research, I opted for "tissue flap" reconstruction. That's where they use fat from another part of your body to construct a new breast -- a whole piece, not liposuctioned and squirted in like filling a Twinkie. Every last friend I had selflessly volunteered to be a donor. But it was a natural resource I had enough of, thank you very much. They used tissue from my hips, though belly fat is most common. Blood vessels are reconnected using microsurgery, so it's warm, living tissue. It was done in the same operation as my mastectomy. Like Angelina, I kept my original skin, including the nipples, but everything except for the thinnest outer layer was replaced. It may be hard to see in the photo (linked below), but there is a scar circling each areola, one down from the areola to the base of the breast and another like a smile under each breast. The scars will continue to fade for at least another six months. Maybe some day they will be able to reconnect the nerves!
Angelina Jolie chose expanders and implants, as they probably couldn't scrape up enough fat from her entire body to fill an A cup. She was a knockout in her recent post-op public appearance. I've seen implant reconstruction first-hand, and it's amazing how natural they can look. There are other options too. I can't outline them all here, but I recommend The Breast Reconstruction Guidebook by Kathy Steligo. It's comprehensive and comprehensible.
Take the time to learn about your options. There are pluses and minuses to each path and not even the best doctor can tell you definitively which you should choose (though many will try). I can't stress enough: Talk to more than one plastic surgeon. Every surgeon, no matter how conscientious, has a particular type of reconstruction he or she is most comfortable with and that is likely what they will encourage you to go for. If you were shopping for shoes, would you but the first pair you saw without looking further? Shop around. It's not so easy return them later.
As promised, here's a picture of my actual reconstruction, one year after surgery, entirely unretouched. It was taken by my husband.