On the road to wholeness

Oct. 08--The cancer is gone, but Dawn Burge is still searching for her breasts. Four surgeries later and two to go, the Moweaqua resident can't think of the scarred skin and tissue on her chest as breasts.

"We're still trying to reconstruct me," Burge said.

Between 1998 and 2007, the number of double mastectomies for breast cancer patients increased from 3 percent to 18 percent. In that same span, reconstructive breast surgeries jumped almost 20 percent according to a study in the Journal of Clinical Oncology.

"I'm not your by-the-book case at all," Burge said.

A series of setbacks means Burge, in the meantime, is still waiting while other women have been diagnosed, treated and finished the reconstruction process. Previously unemployed and lacking health insurance, Burge was nine months late in getting her annual mammogram last year when she noticed the marblesized lump in her right breast.

"Your first thing to decide is a lumpectomy, mastectomy or bilateral mastectomy," Burge said of her stage-two cancer. She opted for the surgery that would remove both breasts to prevent it from spreading to the noncancerous one. She also chose to do a full breast reconstruction, with implants, nipples and tattoos to recreate areola skin coloring.

"That's every woman's choice, if it defines you being a woman," Burge said.

Her first surgery on Jan. 9 removed the breast tissue and put in expanders under the muscles to stretch out the skin for future implants.

"They closed me up too soon," Burge said.

After the surgery, doctors told her microscopic cancer cells were left behind in the margins, or the tissue surrounding the tumor. A month later surgeons removed the expander and the remaining cancer cells.

"They went clear down to my ribs," Burge said.

She woke up to an unexpected pain on her left side. The surgeons needed to take skin from her abdomen to cover her chest.

Burge started radiation treatment, and after time to heal, scheduled surgery to put the expander back in.

"When you have radiation, it can turn muscle into concrete," Burge said.

For six hours, the surgeon chipped away at hardened tissue creating enough of a pocket for their smallest implant. Back muscles and an 8 1/2 -by-11 inch piece of skin were moved to her chest.

Burge almost gave up on the reconstruction.

"But you know in your heart, you're not done," she said.

Surgery No. 4 in August replaced the expanders. She has two more to go for the final expanders and implants.

Dr. Jordan Youngerman, a surgeon with Decatur Memorial Hospital, said breast reconstruction is different than 20 years ago.

Cancers are being detected earlier. Surgical techniques, standards and implants are better. And more women are choosing to remove both breasts.

"A lot of women are deciding they don't want to sit around and wait for the other shoe to drop," Youngerman said, who did not treat any of the patients mentioned in this article.

There are many surgical options and the process and outcome is different for everyone. With reconstruction, the overall goal is to return breasts to where there are only two large scars, as opposed to the results that prosthetics offer.

"I'm just trying to return them to a sense of normalcy," Youngerman said.

Youngerman said he enjoys all parts of his job, but working with recovering cancer patients is gratifying.

"I'm a reconstruction surgeon at heart," Youngerman said. "This has a special place in my heart."

He encourages patients to take notes and ask questions, knowing how overwhelming all the information is on top of the recent trauma. "It's about giving them choices guided by what's possible," Youngerman said.

And once they have all the information, some decide it's not for them.

In 1995, Melba Stockdale was diagnosed with breast cancer at age 65. Biopsies revealed she needed a double mastectomy.

"If that's what it's going to take to get this gone, that's fine," the Oakley woman said of her thoughts at the time.

Her doctors encouraged her to do a reconstruction, but looking back now Stockdale said she would have gone a different route.

"I would not have the expanders put in, I would go with the prosthesis," she said. "The prosthetics today are so near to being a real breast, I probably would have done that."

Her left saline implant started leaking after the surgery, and was removed. Then, she got a staph infection. It was about six months before Stockdale was finished.

For years after, she provided her first-hand experience as a resource for other mastectomy patients. Her implants are uneven and uncomfortable to lie on. After surgery, it was difficult to lift her arms.

Still, Stockdale said the implants give her some anonymity.

"Most people who didn't know me back then and know me today didn't even know I had it done," Stockdale said. Burge said besides the aesthetic impact of not wearing a low-cut shirt or swimsuit, she's struggled with feeling like a woman.

"The doctors have told me, your anatomical parts don't make you the person you are," said Burge, who also had a hysterectomy. "It's what's inside." Only after the last surgery, Burge said, she'll feel whole again. But right now she can't imagine the end result.

"To me these don't look like breasts," Burge said. "They're just there."

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