No, WSJ, I didn't have a "boob job."

Implants with a side of chemo, please. Don't mind my missing lymph nodes.

What I had was cancer.

In my late 30s, with no family history of any cancer, my doctor found a lump during a routine check-up at which I was mostly concerned my white coat syndrome was high blood pressure. My doctor wasn't overly concerned about the lump, but she is thorough, and she sent me for imaging.

I tend to catastrophize, but made a concerted effort not to in this case. (The irony.) I’d just returned from a tropical beach vacation with a friend, I was feeling good and nursing a very stupid sunburn. I’d just been swimming in the ocean, riding horses, and sipping frozen margaritas in a hot tub. I was young, healthy, fit, strong. I responsibly kept up with all my annual check-ups. How could I have cancer?

Photo by Paulo Netto. All rights reserved. (Photographed 9 days prior to lump detection.)

However, the vibes were off the day of my mammogram and ultrasound two weeks later, a grim and grey Friday in late March. A kind radiologist let me know the lump would need to be biopsied. "You'll chat with Yvette at the far end of the check-in desk, she schedules all of the biopsies."

Okay, thank you, doctor.

The mammography technician, a very sweet and small and stern Eastern European woman, was waiting outside of the room. "You're going to speak with Yvette?" It wasn’t really a question. "I'll take you to her."

I'm assuming some people get so freaked out they run right past Yvette and out the door in a blur? I'm also now aware that the lump was so clearly malignant on imaging that I was prioritized as urgent. I was personally escorted to Yvette, and the technician stood over her shoulder while we scheduled my Tuesday morning biopsy.

Deep down, I knew this was my final weekend as a normal, "healthy," non-medically traumatized woman. I wanted to put pajamas on and crawl into bed and turn the world off. I walked home, stopping by my doctor's office to pick up the prescription for the biopsy on my way. Only two more blocks until you can cry in peace and privacy at home, I told myself. Just hold it in until then.

Ultimately, I decided to take advantage of this extraordinarily weird weekend. It was my last taste of freedom, in a way. The end of my old life. I told no one what was going on. I didn't want to be seen as a cancer patient until I officially was one. I went on a hike upstate with a friend, then out for a cozy two nights in the country with the person I was dating at the time. As we returned to the city the night before my biopsy, I quietly stared out the car window. I knew our complicated romance wouldn't survive the cancer even if I did. How do you pre-grieve so many things at once?

On a hike in upstate New York three days before the biopsy.

On the day of my biopsy, as I lay in an imaging room with one arm up, the radiologist and ultrasound technician were communicating with silent nods, points, and the occasional "hmm, uhm-hmm."

I knew. They knew.

I completely disassociated from my body, and the remainder of the appointment is a bit of a blur. My memory of it is from the perspective of floating above the scene, off to the left, looking down. They asked me if they could also biopsy a lymph node.

Yes, of course, doctor.

I slammed back to earth when the radiologist calmly explained he was writing down the names and numbers of some breast surgeons. "I think you'll need one."

After I changed back into my street clothes, the radiologist brought me into a dark room with screens and showed me my imaging. He empathetically told me why he believed it was a malignancy, and again urged me to make an appointment with a breast surgeon.

"If you don't end up needing it, you can cancel. But good to have one on the books."

"Is that ... who does reconstruction?" I asked, my voice shaky as I desperately tried to remain calm. If breast tissue was going to be a problem, I wanted a mastectomy, I wanted it gone. I wasn't even sure I wanted reconstruction or if it was possible to stay small-chested, as I was naturally.

My goal was to exit this experience with as close to the same body as I possibly could.

I went home and I waited. I changed into pajamas and didn't change out of them for two days. I ordered many vanilla milkshakes for delivery from the local bodega. I kept an appointment later that week with my new gynecologist, and wondered how to start the conversation about what was going on. Just wait until she sees the Steri-Strips and deep biopsy bruise? There's no box on an intake form for, "Nobody in my family has ever had cancer and I don't even have a diagnosis yet but anyway, I probably have breast cancer."

I spent my time in limbo, waiting for pathology results, trying to be proactive. I called breast surgeons and filled out paperwork, but couldn't schedule appointments without the pathology results. I did wig consults. It was the wigmakers who let me know not every cancer patient needs chemotherapy, and if I did, how to get it covered by insurance. They were so kind and helpful, and wouldn't sell me anything until we knew I'd need one. They prepared me that with breast cancer, I might not even know right away.

Six days after my biopsy, a spring morning in early April, I received a MyChart notification at 6am. It wasn't really a debate on whether or not I’d wait for the radiologist to call me and tell me what we both already knew - I had cancer.

I opened the pathology report.

CLINICAL INFORMATION:

Highly suspicious irregular breast mass, left breast 4:00;

Suspicious axillary lymph nodes with thickened cortex, left axilla

GROSS DESCRIPTION:

The specimen is received in 2 parts.

A. Breast, left 4:00, needle core biopsy:

1. Invasive ductal carcinoma

B. Breast, left axilla, needle core biopsy:

Lymph node, portions of, negative for carcinoma.

There were a lot of other words and descriptions I didn't understand at the time, but would come to know well. I had what I needed to schedule appointments with breast surgeons, however, so that's what I did.

A few hours later, the radiologist called me. He talked me through the results, checked in on whether or not I had appointments with breast surgeons, walked me through what I could expect from those appointments.

In the weeks that followed I had more mammograms, more ultrasounds, more biopsies, a breast MRI, a genetic panel (turns out I have a gene mutation with a moderate increased risk of breast cancer), and so much bloodwork. I chose a breast surgeon, who recommended reconstructive surgeons.

"I want to stay small, is that possible?" My reconstructive surgeon told me it was, validated my choice, and explained the surgical path to achieve what I wanted.

Celebration of my natural breasts the weekend before the mastectomy.

My mastectomy was scheduled for mid-May. Both my breast surgeon and my reconstructive surgeon would be in the operating room, working in tandem. My breast surgeon would remove my left breast first, the one with cancer, and the closest layer of lymph nodes. Due to the location of my tumor, it was recommended that my nipples be removed, as well. The lymph nodes would be sent to the on-site lab to be tested during surgery. Once my breast surgeon completed her work on the left, she'd move over to the right. At that point, my reconstructive surgeon would place a tissue expander, which he would fill with saline in follow-up appointments in the months to come, to allow the skin to slowly stretch to accommodate the implant. He'd do the same on the right side. (Eventually, the tissue expanders are exchanged for implants in a second surgery.)

If my lymph nodes came back positive, my breast surgeon would return to the left and remove more for testing. If they were negative, she'd begin closing me up.

Fun fact: Once you have lymph nodes removed, there's always a risk of lymphedema. I can no longer have my blood pressure taken, blood draws, or anesthesia administered on the left side. Any time I'm in a hospital setting or will be given anesthesia, I need to request and wear a "limb alert" bracelet, which lets medical providers know my left arm is off-limits. Physical therapy is often recommended after a mastectomy to reduce your risk of lymphedema and to help restore range of motion, which can be mildly to severely impacted. Oh, and hot tubs are to be avoided, or only enjoyed for a short period of time.

I woke up numb in my chest and upper underams due to the nerve damage that occurs with a mastectomy, and with JP drains attached to my body, which I'd need to empty multiple times per day, and track the amount of fluid each time. They could only be removed when this number was low enough. I had one drain on each side for three weeks.

My reconstructive surgeon gave me two timelines for completing the process: one if I needed chemotherapy, one if I did not.

Photographed by Paulo Netto. All rights reserved.

One week after surgery, I had a follow up with my breast surgeon, where I found out how surgical pathology had staged my cancer. It was smaller and earlier than my surgeon predicted based on imaging, so we celebrated this win. It was also much more hormone receptor positive than the biopsy indicated, which was a good thing. It meant a clearer treatment path. However, the chemo question still loomed large.

My tumor was sent to a lab for Onctoyping, which examines certain characteristics to determine recurrence risk in early stage hormone receptor positive, HER2 negative breast cancers. If your score is under 25, there's no real benefit to chemotherapy. If it's over, chemotherapy is recommended to reduce your risk of recurrence.

My breast surgeon told me my oncologist would speak with me more, but there was around a 50/50 chance I'd need chemotherapy. If I did, I was a great candidate for cold capping, which is cryotherapy to help reduce hair loss. She let me know I should talk to my oncologist's team about that if I was interested. (I was very interested.)

My oncologist expanded on these odds, explaining he felt there was a 40% chance I would not need chemotherapy, a 40% chance I would and it would be a very clear and short course, and a 20% chance the Oncoscore would be high enough a more aggressive plan would be needed. "We're not going to worry about that 20% right now."

I wouldn't need radiation, which my reconstructive surgeon was happy to hear, as it tends to complicate the result of that surgery due to the way the skin tightens. It also prolongs the amount of time the tissue expanders would be in, and extends the timeline of surgery.

Five weeks after my mastectomy, my Oncoscore returned: 37. I would need chemotherapy, but it fell into his 40% chance of a clear and short course. Four rounds, spaced three weeks apart.

I ordered those wigs.

I also had to decide quickly if I wanted to preserve my fertility. Just wanting to begin chemo so I could be done with it, I opted against IVF and dove right into the sweet, sweet poison.

I underwent chemotherapy from July through September. My reconstructive surgeon finished my saline fills before I began, so we could use those two months for the skin to adjust, rather than needing to tack on additional time after active treatment.

I cold capped, but I lost about 70% of my hair anyhow. It’s uncomfortable and adds two hours onto every session, but one of the chemo drugs I was on, Taxotere, comes with a risk of permanent alopecia. I'd made peace with the idea of losing my hair as long as it grew back, and anecdotally cold capping can help preserve the integrity of the follicle, if not the strand.

When it was clear the cold cap wasn't working well for me, I struggled with deciding whether or not to continue in a modified way. When I say I struggled, I mean this was a game day decision. I was in my infusion room, delaying the start of pre-meds while I figured out what to do as I sobbed hysterically. Freeze the hair follicles too much, they could be destroyed. Don't protect them at all, and there was a chance Taxotere would destroy them. Ultimately, I decided to have the bald spots covered with gauze, and to proceed capping at a reduced level to hopefully still preserve the follicles.

While my chemo experience was relatively smooth all things considered, there were a few trips to the ER to rule out blood clots, a few fevers that had to be investigated to rule out neutropenia, and at one point my left tissue expander was pinching a nerve that caused chest pain we had to be sure was nothing serious.

Photographed by Paulo Netto. All rights reserved.

Once chemotherapy was complete, I met with my reconstructive surgeon to set a surgery date. While we could move forward as soon as one month after my final chemo, he preferred to wait two months as the body is that much stronger and able to heal. We scheduled for November, and for the first time since March, I had a break from seeing doctors. I felt like I could breathe again, maybe even relax a little bit. My implant exchange surgery was set, I didn't need to see my oncologist until late November, and I didn't need to see my breast surgeon again until February.

COVID, Monkeypox, and Polio were terrifying New York City at that time as a neat little trifecta, so I left for a month to allow my weakened immune system to recover more peacefully. As my surgery date approached, I took every precaution to the extreme to avoid contracting COVID but, lo and behold, one week before my reconstruction surgery, I tested positive.

I cried to my breast cancer support group, composed myself, called my surgeon's office, and was told it was hospital policy to wait three weeks after COVID to go into surgery, and the earliest date he had available was late December, just before the holidays. Desperate to have this experience wrapped up before the start of a new year, I grabbed that surgery date.

That weekend, while recovering from COVID, I felt a weird bump on my abdomen, near my ribs on my left side. Suddenly I longed for my biggest problem being that I was stuck with tissue expanders for a few weeks longer. Obviously, I immediately began spiraling. The second I had a negative test, I raced to my oncologist's office. He wasn't concerned, but since I was, he suggested for my peace of mind that my reconstructive surgeon remove it during my upcoming surgery.

Just before Christmas that year, I had my tissue expanders removed and my implants put in. My surgeon removed the little lump, which ended up being nothing more than necrotic fat, which can happen after body trauma.

I spent the holidays in a compression bra and during my recovery, began getting monthly Lupron injections, in order to suppress my ovaries so they stop producing estrogen, which was feeding my cancer. Effectively, I entered immediate menopause in my 30s. I also take an aromatase inhibitor every day, which blocks an enzyme in fat tissue from turning other hormones into estrogen. I'll be on endocrine therapy for ten years.

Six weeks after my reconstruction surgery, in early February, I was released into the wild without any movement restrictions. But to do what? Who was I now? What was my style? What did I enjoy? What did I want to do - tonight, this weekend, for the rest of my life? How much time do I have?

Photo by JMA Photography. All rights reserved.

I lost all connection with my body the day I found myself floating above her during my biopsy. I lost my hair, which had been a major part of my identity. It was growing back evenly, thankfully, with a hint of chemo curl texture starting to form. I didn’t look the same on the outside, and I wasn’t the same on the inside. Who was I now?

I did end up increasing my size ever so slightly with my reconstruction, something I went back and forth on. Reconstruction with implants isn't the same as having breasts - they soften and drop over time, but they don't really move much. It feels like you're wearing an underwire bra at all times.

I don't really consider them my breasts or part of my body, just foreign objects to make me look, from the outside, more like my peers. More like someone who didn't have cancer. It's an illusion.

My reconstructive surgeon is incredible. I recommend him to so many others going through this same nightmare. However, eventually, I do believe I'll have explant surgery with an aesthetic flat closure. Since I'm considering that, I have yet to do any nipple reconstruction, because it would complicate the result. And even if I don’t explant, I’m not really in a rush to reconstruct my nipples. I don’t have any tattoos and an areola tattoo simply cannot be my first one. I need one of my choosing first.

My hair is holding onto the chemo curl, but when blown out it's down to my shoulders now. I've got bangs, because I didn't before, and I can't look too much like her. I'm not her. She had a good run but we can't go back.

I still see my oncologist every three months, my breast surgeon every six months, and annual check-ins with my reconstructive surgeon. Once per month I head into the same infusion ward where I had chemo to get my Lupron shot and labs drawn. Sometimes I walk out with multiple bandaids, because they can only draw from my right arm, my veins are still damaged from chemo, and I require multiple sticks.

I don’t menstruate anymore. I don’t have nipples anymore. I get hot flashes. I’m much older than my age. I’m much older than my peers.

I'm still very much tethered to my breast center, and I will be for a very long time. I have to plan vacations around the timing of my Lupron shot. If I don't want to do this, the alternative is to have an oophorectomy, which I will probably do. The question is, when? Surgery comes with recovery, and it feels like I've already lost so much time.

If you've read this far, my only question to you is: Does this sound like a “boob job” to you?