Her husband’s roving eye made Emily want to reconstruct her breasts

Emily was delighted with the result and thrilled with her slim waist as a result of the tummy tuck she got from the transfer of her abdominal muscle. Once again, we met up at our favourite hotel in Mombasa where they and we went to celebrate our Christmas and New Year. This time, she was in the pool with her husband and children every day. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • Luckily all went well and, in view of her being left with a flat chest after surgery, I raised the question of breast reconstruction with her but she reminded me of what she had told me before. “I told you I don’t need them anymore.”
  • I gently introduced the subject. “I just wanted to tell you that you are too young to pass the rest of your life without your breasts. I must tell you that these days, we can reconstruct your new breasts from your own tissues without having to use silicone or saline filled prosthesis.”
  •  “Doctor, I have decided to take your advice and want breast reconstruction surgery. The children have gone back, so I am free.”

“Why don’t I give you the report from our pathologist to read?” I said to Emily as I handed her the laboratory report on her biopsy, which had arrived in my office one day prior to her second appointment to see me. I had glanced at it and it said: “Lobular carcinoma left breast. Anything on the right side?”

At Emily’s first consultation a week earlier, I had taken a full history from her and, in the process, discovered that she was a very intelligent lady. I was so impressed by her articulate replies to my barrage of questions that I looked at her profession again, entered by my secretary on the front of her file. She was a bank manager and just to distract her attention from her dismal diagnosis already swirling in my mind, I asked “What qualification do you need to get such a high powered job?”

“I did my first degree in Computer Science and Information Technology,” she replied. “I followed it up with a qualification as a certified accountant and, while I was attached to an accountancy firm, I obtained a second degree in banking, as a part-time student, attending evening classes.”

“Triple qualification!” I exclaimed. It was that particular conversation which convinced me that she was highly educated and well informed that I gave her the laboratory report to read. It was on the core biopsy I had done on her breast lump which I strongly suspected to be malignant.

SCARY RESULTS

“I am totally confused now,” Emily remarked after reading the laboratory report twice. “I have got a lump in my left breast, so why is your pathologist harping on the right?”

“As you probably know there are different types of breast cancer,” I explained. “Yours is the lobular type which often arises in both breasts. And, if not, it appears in the other breast sooner or later. Hence the question about your right breast, which I had checked thoroughly when I saw you last week.

“I did not find anything there but that does not mean that it will not appear there in the future and that has a bearing on the treatment.”

“So where do we go from here?” Emily asked.

“There are two views,” I replied. “The optimists amongst us remove the affected breast and watch the other side very carefully and remove it when it develops a lobular carcinoma. We do it on the basis of statistics because the second cancer appears in about 11 per cent of the cases.” As I noticed Emily listening carefully, I apprised her of the other view. “The fatalists remove both breasts straightaway. Their argument is that removing the soil in which the tumour can grow improves the outlook.”

“What do you advise?” Having given my information considerable thought and being unable to decide, Emily passed the buck. 

“I am in the category of optimists but, in matters like this, we leave the patient to decide after giving her all the information,” I replied. “You are a very intelligent lady; you can Google and consult your husband and even obtain a second opinion. I can arrange it for you if you wish,” I added.

“That won’t be necessary,” replied Emily. “Let me think and I will come back.”

She reported a couple of days later and conveyed to me her unequivocal decision. “My husband and I went on the internet and found that lobular carcinoma appears eventually in the other breast in 10 per cent of cases. We also discovered that lobular type is a vicious type of tumour and can metastasise very fast. Then I thought that I am 45 now with two grown up children and asked myself what I need the breast for?” Then, with an alluring smile, she added: “I asked Joe and he assured me that he won’t miss them either!”

“Is that your final decision because, once we remove both your breasts, there is no going back on it?” I asked to be doubly sure.

“Yes,” she replied. “I am psychologically ready for a double mastectomy.”

Luckily all went well and, in view of her being left with a flat chest after surgery, I raised the question of breast reconstruction with her but she reminded me of what she had told me before. “I told you I don’t need them anymore.”

Because of the unusual nature of Emily’s breast tumour, my oncologist colleague decided to give her six courses of chemotherapy comprising newer drugs with severe side-effects. So when it was all over, I said to her: “After that terrible ordeal, I think you deserve a holiday.”

“I agree,” she replied. “Janet and Robert, both at universities in England, are coming home for their Easter holiday and we have booked a week at the coast. Normally they don’t come for the short Easter holiday but because of my recent surgery and chemotherapy, Joe has arranged for them to come.”

“Where do you stay?” I asked. She gave me the name of a hotel on the north coast in Mombasa. “We will meet up there,” I replied. “Our children are also coming and we always stay there.”

As expected, we met up at the beach hotel and Emily and Joe introduced us to their two children whom we often saw in the swimming pool. One day, I asked the daughter. “Don’t your parents swim?”

“They both are good swimmers,” Janet said. “In fact my mum is an excellent diver, too, but she does not like to wear her swimming costume because it reveals her flat chest and she can’t wear the prosthesis under her swim-suit, which I bought from Marks and Spencer in London. It is such a pity because she is a young mum. When she came to the university on our open day, many of my friends thought that she was my sister.”

 “What about your dad?”

“He does not swim out of sympathy for her,” Janet replied. “He says it is not fair for him to swim when mum can’t,” her brother Robert joined in.

So next time I met Emily alone, I tackled her: “I don’t like to talk surgery when we both are on holiday,” I gently introduced the subject. “I just wanted to tell you that you are too young to pass the rest of your life without your breasts. I must tell you that these days, we can reconstruct your new breasts from your own tissues without having to use silicone or saline filled prosthesis.” As I noticed that I had engaged her full attention, I continued. “Furthermore, my job as a specialised breast surgeon is not complete if my patients after mastectomy – in your case bilateral – don’t return to their job, their social and marital life. As a breast surgeon, I consider my job unfinished until I see my patient resume her original occupation, sports, hobbies, her social and sexual life.” I decided to be  quite explicit and not use euphemisms.

“What are you driving at?” Emily asked.

“If you are not swimming because of your flat chest, you better undergo reconstructive surgery,” I said.

“Let me think about it.”

RECONSTRUCTIVE SURGERY

However, though Emily had heard me out with rapt attention, in my own heart I knew that I had made scant impression on her with my arguments. So when she rang me a few days after we all returned to Nairobi, I was delightfully surprised when she said, “Doctor, I have decided to take your advice and want breast reconstruction surgery. The children have gone back, so I am free.”

“Let me talk to my plastic surgeon colleague and see when we can schedule it,” I replied. “He has been elevated to the position of a professor so, in addition to a busy practice, he has an additional responsibility to teach. However, being my former student, he gives priority to my patients.”

I rang the professor and he was very gracious and excited when I told him that I wanted to assist him. “I can’t wait,” he said. “What a privilege to be assisted by the same mwalimu who taught me how to hold a scalpel.”

Accordingly we carried out reconstructive surgery on Emily on both sides. We transferred one of her abdominal muscles with its blood supply to form the normal breast bulk and promised to pigment the areola and reform the nipples at a later date. Emily was delighted with the result and thrilled with her slim waist as a result of the tummy tuck she got from the transfer of her abdominal muscle. Once again, we met up at our favourite hotel in Mombasa where they and we went to celebrate our Christmas and New Year.

This time, she was in the pool with her husband and children every day. I remembered what her daughter had said to me when she went on the highest diving board and jumped into the pool looking like a dart thrown in an English pub or a spear thrown by a Maasai moran while he is being initiated.

One day, when I went for my early morning swim, almost a regular routine with me when I am at the coast, I saw her swimming alone. I grabbed the opportunity to appease my curiosity about human nature and asked her. “What really did drive you to have breast reconstruction? Though you were gracious enough to say that you took my advice, what was the real reason behind it?”

“My husband,” Emily replied coyly, “and his roving eye. He used to ogle the bikini-clad women, local and tourists alike. I noticed him doing it on our last holiday here and I decided to take it as a warning!”