Posted by: Diana Cassar-Uhl, MPH, IBCLC | August 8, 2012

The surgeon who changed my life


Well, no, it’s not really like that.  I wasn’t sick, and the “changing” part was that the guy refused to operate on me.  At the time, I was kind of mad about it.

I was 26, and in the best shape of my life having just run my first marathon. I loved running and spent a lot of time in the gym, too.  At my well-woman check-up, the Nurse Practitioner took one look at my chest – the entire perimeter of my body where my sports bras touched me was chafed and oozing.  Shoulders, underarms, all around my ribcage were just wrecked.  Even at 125 pounds (ah, youth!), my breasts were still an ample 34DD, and I struggled with back/neck/shoulder pain, deep grooves in my shoulders, and chafing was part of my existence.

On the beach, weeks after meeting with that surgeon

“Why on earth have you not had those things reduced?” she asked me during my breast exam, obviously disgusted by the scabs and glossy, exposed skin. (I feel compelled to mention that this woman is still practicing around here, and I’m told she still says such horrific things, but at that time, I was just happy to have a civilian female as my primary care provider.)  Honestly, it hadn’t really occurred to me that I would be a candidate for a breast reduction, other than that I wished I could wear cute, sleeveless dresses or tank tops that showed off my fit arms.  Surgery hadn’t seemed feasible until then.

“Um, I don’t know?” I answered, feebly.  She put in a referral for me to see a surgeon, which immediately led to another referral to the plastic surgery clinic at Walter Reed Army Medical Center.  The year was 1999.  I was sent on medical TDY from New York to Washington, via the Delta Shuttle out of LaGuardia with a bunch of businessmen.  I don’t remember much about getting to Walter Reed from the airport, except that it was scary.  The hospital was old and tired.  I found the plastic surgery clinic and sheepishly presented myself for my appointment.

I don’t remember the doctor’s name.  I remember that he was from North Carolina, and his accent was pretty thick.  I remember that he drew with black marker on my breasts and chest, and took pictures and notes, and didn’t say a whole lot while he was doing that.   There were Xs and lines and circles and arrows all over my upper body.  I remember that I felt really weird sitting there in a medical setting, with my visions of sleeveless dresses but knowing this was more about finding a solution for my chronic shoulder pain and the awful chafing.  And I remember what he said when he finally spoke to me after his assessment.

“Have you had any babies?” he asked me.

“Um, no.  I don’t even have a boyfriend right now.”

“So you think you might have babies someday?” he went on.  Why does this matter?  Do I get my breast reduction or not?

“I don’t really know … probably.  Yeah, I hope I have babies someday.”

“Look,” he spoke quickly, but with his North Carolina twang.  “When you get pregnant, your breasts are going to go south.  They all do, from the pregnancy.  So do me a favor – have your babies, and breastfeed them if you want to.  Then, when you’re all done, and your breasts have gone south, come back and see me, and I’ll make you the envy of all your friends, because you’re actually a candidate for a breast reduction, but they won’t be.  Come back when you’re done using your breasts.”

I was shocked, and a little embarrassed.  I had only ever seen one baby breastfeeding up close, and breastfeeding was the last thing on my mind at that point in my life.  I think my disappointment showed on my face, and the surgeon spoke again.

“I’ve done 687 breast reductions in my career, and only two have been on women who weren’t done having babies yet.”  He went on to tell me about those girls – one, a teen with such severely large breasts, she needed to secure herself with duct tape just to get out to the door to school.  “She would have been an L-cup,” he told me.  I don’t remember what he said about the second case because I was lost in thought about how this guy probably changed that poor young girl’s life … for the better … but it had become clear he wasn’t planning to change mine, at least in the way I was seeking.

I left the clinic and rode the Delta Shuttle with the businessmen back to LaGuardia airport, sad to deliver the news to my friends that I wasn’t going to have a breast reduction after all, and I wouldn’t get to wear cute tops and dresses, and I’d still be sore and chafed.

Because the surgeon wanted to make sure I had the opportunity to breastfeed someday.

Now, there are women who have breast reductions and go on to breastfeed.  My friend and colleague Diana West, IBCLC wrote about them in her book Defining Your Own Success: Breastfeeding After Breast Reduction Surgery and has been educating women and healthcare providers about breastfeeding after surgery for over a decade.  I didn’t know about these women in 1999.  I didn’t really care in 1999.

She was about 4 months old here — so sweet.

In December of 2002, I gave birth to my first baby.  I had read books and prepared to breastfeed her, but it wasn’t until we had major problems doing so that my commitment to nursing Anna was solidified (yeah, I’m one of those people who likes to do things that someone tells me I can’t do, so on our 5th day in the hospital, when that nurse said “you can always just pump and bottle-feed,” it was game on and there was no flat or inverted nipple, no bilirubin of 22, no return to work, no nothing that was going to keep me from breastfeeding).  I stayed committed through 105 fever and severe mastitis on my 8th day (while my husband was gone the entire day and night playing a gig with Tommy Tune in NYC); I stayed committed through Anna’s bloody diapers and bad, bad guidance from our pediatrician; I stayed committed at 3 weeks when Anna refused to sleep for more than 45 minutes at a time, happy only when I nursed her, as I hissed to her half-sleeping daddy at 2 in the morning, “I know why people quit this.”

At some point, the dust settled.  Maybe it wasn’t even until after my second baby was born – I honestly don’t remember when it happened for me, that feeling of empowerment, of knowing that I was doing something for my baby that countless women before me had done for theirs, something only I could do for mine.  I discovered somewhere along the way that breastfeeding wasn’t only about what I fed my baby, but about how I mothered her and how she learned to relate to me.  The God-given potential of my big, unwieldy breasts – even bigger and more unwieldy now after three pregnancies and nearly a decade of lactation had been fulfilled.

She was always happy there … I was home base.

I don’t know the name of that North Carolina plastic surgeon who worked at Walter Reed Army Medical Center in the summer of 1999, but there isn’t a single day that I don’t think about him with a thankful heart.  The experience of breastfeeding has been a life-defining one for me, leading, of course, to my becoming a La Leche League Leader, an IBCLC, and now working toward a Master’s Degree in Public Health.  I aspire to study epidemiology next, and to spend the rest of my working life conducting and publishing research about breastfeeding, with the hope that my life’s work can enable more mothers to be empowered by their experience of breastfeeding.  If you had told me in 1999 that breastfeeding, mothering, epidemiology – any of this – would be my sweet spot, my calling, I would have laughed at you.

Would I have breastfed my own children after reduction surgery?  Possibly, but given the woefully substandard breastfeeding support where I received my medical care and the fact that no women in my family had positive breastfeeding stories to share, I don’t know what lengths I might have gone to in order to make it work if the obstacles had been any bigger than the ones I faced.

Today, I am 39, with a strong enough history of breast cancer to spur some healthcare providers to talk to me about a prophylactic double-mastectomy and breast reconstruction.  If determined beneficial by genetic tests for BRCA1 and BRCA2, I could, perhaps, be a candidate for a surgery that could prevent cancer and give me the chance to go sleeveless at long last.  Now, though, I’m ambivalent.  I struggle with whether I could really part with this assemblage of glandular and fatty tissue that has played such a significant role in the lives of my children and me.  What if I ever needed to lactate for a grandbaby — or if one of my children grew up and got sick, and I could help by re-lactating and providing human milk again?  Such considerations don’t occur to most people, for whom breastfeeding is a small part of their history, but for me, they are huge.

My answers will come, or perhaps the big decisions will be made outside of my control — like the 1999 decision of an Army plastic surgeon that changed my life.

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Responses

  1. What an amazing perspective! The surgeon’s thoughtfulness astounds and moves me. So glad you encountered him after the incident with your primary care provider. And what an amazing journey you’ve had since. Thanks for sharing.

  2. Diana, after all the awful stuff we’ve been subjected to over the last few weeks in “honor” of WBW, this was absolutely beautiful!! What an amazing surgeon — and good on you for realizing how right he was….

    Jan

  3. Thanks for sharing your story. I’m 5 months in on my adventures with breastfeeding and mothering and I never knew what a gift nursing could be. What an awesome surgeon. :)

  4. What a beautiful story. Thank you for sharing!

  5. Not that you would ever tell the name, but I feel like I ran into the same physician/midwife in NY. When she saw I had an in grown hair, she made her disgust and displeasure no secret. I was so embarrassed and it was just the two of us in the room. I had/have never been treated like that before.

    Your story is a great one. What an awesome and thought doctor the Surgeon from NC was. Wow!

  6. I too am 5 months into feeding my baby, it’s the most wonderful experience! Well done for that surgeon not letting you have the surgery, what an amazing man! Well done you for listening to him and not seeking out a second opinion, and for realising he was right all along…

  7. This is a great story, thank you for sharing! I’ve been BFing most of the last 4.5 years and it is life changing in ways you can’t predict! How wonderful that that surgeon recognized it as a normal and wonderful part of womanhood.

  8. What an absolutely GORGEOUS story (and those pics are soooo precious!). I’m sitting here reading it as I nurse my 3rd baby and am into my 8th year of lactation. LOVE to you, Dear Sister!!! ♥

  9. What a wonderful outcome! I’ve always known that eventually I would ask my doc about a breast reduction/lift, but knew that I wanted to breastfeed & wasn’t willing to risk jeopardizing my success with that. I’m so glad that doc planted the seed for you before it was even on your radar.

  10. This is an amazing story-thank you for sharing it. I’m saddened by the nurse practitioner’s response to you-it seems so shaming and dismissive, but the surgeon’s response certainly made up for it.

    I have often considered breast reduction (I feel your pain with the chafing, pain, grooves, etc.), but somewhere in the back of my mind, I always thought I’d wait until after I had kids (even though for many years I was unsure that I was going to have kids). I think it was this thought that gave me the determination to continue in spite of searing pain due to cracks and plugged ducts for the first 5 weeks of breastfeeding. I thought to myself-I’ve been carrying these breasts around with me for so many years, dealing with the challenges they present, they had better serve their purpose now!! Now my son has just turned a year, and our nursing relationship continues to be a valuable part of our life.

  11. I got teary-eyed reading this because you’re passion is inspiring and because I, too, feel nursing shaped the way I mother my child. I never thought I’d be such an advocate for breastfeeding but, like you, I overcame obstacles and challenges along the way along with a lack of support from some around me. I run a nursing support group and, although my own son self-weaned just shy of four years old, I enjoy talking with other nursing moms, learning of their experiences, helping those who may need help, and overall spreading information about nursing and the benefits to both child and mother since I see so much misinformation; misinformation that it kills me to know leads many to make bad choices and miss out on the nursing journey. Thank you for sharing this, and for all you do for women who will come after you.

  12. Diana,

    I just came from seeing a breast reduction mom this afternoon. I am so happy for you and that Tarheel MD.
    Another reason to keep breasts is that they feel so good to your kids when they hug you!

  13. I was always a big chested girl and was proud of it! Here in America you are lucky you can get well fitting bras for any size. In Hungary not so much. I was lucky enough to work as a medical corset maker thus I was able to make my own bras that fit and were sexy at the same time. You do not have to have smaller breasts to wear tank tops or sleeveless dresses. I’m sorry but your younger self was quite delusional. You were young, you were fit. I’m sending this as a message to those who are young and have issues with their body image. Yes, chafing sucks bad. With good bras that can be corrected too. Oozing, I’m all to well familiar. Unless it is a medical threat I would never have my girls made smaller. I love my boobs. Now that I have a son and I’m 40+ I still do not want them smaller, alas Mother nature makes it happen want it or not.

  14. “The experience of breastfeeding has been a life-defining one for me…” I can totally relate! Loved your story!

  15. I’ve skipped over the comments, sure that my story is unique, but even more sure that other women are also crying over this story. While I have NEVER been athletic in my life, My boobs have always been the first thing you see of me. At least that’s how I’ve always felt. Started out in my marriage as a 36DD, and after six kids, I’m at a 36 K. Deep grooves, back pain, gross underneath my boobs; but i, too, am ambivalent about a reduction. Maybe I will get pregnant again – three of my kids are post “I’m done” and what if my daughter need help with breastmilk…it does give me pause. It is one thing I can give my kids that no one else can. That, and going sleeveless is not a goal of mine; just to be able to wear clothes right from the rack – that would be nice! If you told me that I could donate this wonderful glandular tissue to friends who don’t have, then I would absolutely consider it, probably.

  16. [...] such as this post from Best for Babes, 100 words (by Lactation Matters editor Amber McCann) and this one from Diana Cassar-Uhl. Mainstream parenting site The Bump even got on board, proclaiming Aug 15 [...]

  17. Thanks for writing this. I had a similar experience when I was around 20. I was lucky enough to have found a surgeon who told me that if I had the surgery there was a chance I couldn’t breastfeed my children. I already knew that was important to me at that time, so I never had the surgery. I went on to breastfeed two babies for about 5.5 years total, and later became an IBCLC. Breastfeeding two gave me a new appreciation for my huge breasts, and I just love all they have done for me and my children. (I’ve also met more than a few men who have let me know that they think it would be a crime to change them in any way). All this has really helped me to appreciate what I have–though sometimes I do think it would be fun to wear skimpy tops…

  18. As I sit here, nursing my 5th child, I’m reading your article and just inspired by your journey. I’m 5’4″ (almost lol) & right now 2 cup sizes past a DDD… pretty sure this is my last child, but I’ll wait a couple years to be sure before I consult about reduction. I have horrible neck pain and had some back problems this pregnancy especially, but I refuse to sacrifice nursing for my own problems. And now I need to go research re-lactation, lol. Thank you so much for sharing your experience!!!

  19. Such a beautiful, well-told story – it brought tears to my eyes. Thank you!

  20. I wasn’t going to comment but I feel like someone needs to be on the pro-surgery side. I had a breast reduction 12 years ago. I am currently exclusively pumping for my second child (she just couldn’t latch and after 12 weeks of PT, OT and LC help, I turned exclusively to the pump). My first child was a champion nurser though I did have to supplement with her. I have barely supplemented my second daughter. My doctor did warn me about potential breastfeeding issues and did the surgery in such a way that I would have better success with breastfeeding. Would I go back and change things? No, because that surgery took away my pain and it allowed me to run half marathons. I would never have been able to do that with my old boobs that required three bras to do step aerobics. While I feel breastfeeding is important, I am glad that I did not spend the last 12 years waiting to feel better. I’m glad that I decided to take care of myself instead of sacrificing my needs for potential future children. I wouldn’t be the Mom I am today if I hadn’t learned to do what was important for me to be healthy.


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