The Big “C.”
“Cosmetic” Reconstruction after a Cancer Diagnosis:
A Patient’s Story

Foreshadowing is defined as “…an image of something suggestive of what is to come…the organization and presentation of events and scenes… so that the reader or observer is prepared…for what occurs later…”

In this particular presentation of events, I was the writer. The subject was skin and nipple sparing mastectomies. But no amount of foreshadowing could have prepared me for what was to come.

My writing career is focused on professionals and publications dealing with health, beauty and wellness. Many of my clients are cosmetic surgeons. Last summer I wrote an article featuring the latest surgical technique available to some women with breast cancer called “skin and nipple sparing mastectomies.” Earlier in the year I worked with Dr. Andrew Kornstein featuring unique procedures on his website including the same surgery with one exception—it is done in-house in his office surgical suite. “How far we‘ve come,” I thought—light years from the maiming, virtual amputations and long hospital stays—an exponential leap from replacing breasts with flaps, mounds and tattoos. My second thought was, “How lucky I was to have been spared.” I spoke too soon.

In 2006 I discovered a small lump, undetected by a mammogram. It was cancer, Stage I. After absorbing the initial shock, I opted for a lumpectomy followed by 7 weeks of radiation. Except for a small divot on the side of my breast, I was physically unscathed. Breast cancer for me was more a mental illness—a hole in my armor. How can someone who doesn’t even catch colds get cancer? The answer according to the great medical minds is they simply “don’t know.” Only 3% of those diagnosed with breast cancer have the infamous BRAC gene. The rest of us? A veritable lightning strike. In July of 2011 I celebrated my 5 year anniversary. No more looking over my shoulder.

In September 2011, just as my article hit the stands for breast cancer awareness month, and Dr. Kornstein’s site was complete, I felt a lump. Once again, it did not show up on a mammogram. I learned that when breasts are dense like mine, it can be as difficult to visually detect as a snowball in a snowstorm, even using digital imaging. Lightning struck twice—another Stage I cancer but this time in a radiated breast. The suggested treatment was a double mastectomy or take the chance I might not be lucky enough to find the next lump until it was too late. While the diagnosis was beyond upsetting, the serendipity of being privy to the latest, least invasive surgery and my working relationship with Dr. Kornstein dialed down my panic.

Dr. Kornstein arranged a meeting between me and his cancer surgeon partner from a prestigious New York institution where I was pronounced a good candidate. According to the cancer surgeon who has done hundreds of these procedures, there is no data to suggest a recurrence when opting to keep the shell of the breast. Removing tissue only and replacing it with a silicone implant is safe. A radiated breast, however poses a bit of a hurdle due to the potential for poor circulation. It could require a two step operation to retain the skin and nipples. Dr. Kornstein arranged several meetings and calls—some international—with other physicians who’ve worked with radiated breasts to be prepared either way. This clearly demonstrated his dedication and commitment to doing the right thing and anticipating any surprises. Fortunately my circulation was acceptable when examined during surgery. For extra reassurance Alloderm (donor skin full of stem cells) was placed between my skin and implant to expedite healing.

It was very important to me to emerge from this experience looking and feeling whole. I had seen Dr. Kornstein’s photo gallery. I interviewed him on his philosophy and approach to in-house mastectomies well before the subject became personal. Dr. Kornstein will tell you that reconstruction deserves no less emphasis on an aesthetic outcome than cosmetic breast enhancement. That attitude sets him apart from others who might share his technical genius, but not his judgment, vision or compassion.

I stayed the night in his recovery room with his nurse and left the next morning, very comfortable. Tylenol was all I took for mild soreness. One week post op I looked as though I’d had a breast augmentation, not reconstruction. I will never have to look into the mirror and be reminded of what was taken away. My only memory will be the body given back to me by Dr. Andrew Kornstein. It feels good to write a happy ending—especially my own.

Isabel Stoltzman
Dallas, TX