After my eighth and most recent surgery, I’ve been counting down the days. Three until I can have my first shower. Seven until I can remove the Ace bandage around my body. 14 until I can sleep in other positions besides elevated and on my back. 42 until I can lift heavy objects, stretch and exercise. All of it requires patience.
I’ve sewn clothes since I was 15 years old. I was drawn to the creativity, how each garment was unique and mine. Making my own clothes freed me from the department stores, the place where the majority of my classmates dressed themselves. Instead, I altered jackets and dresses from thrift stores and my mother’s closet. I bought Issey Miyake patterns and yards of fabric to make entire outfits. I’ve always felt most like myself when sewing for myself. And I carried this feeling through college, jobs, marriage, parenthood and now cancer.
I was diagnosed with breast cancer four years ago. Since then, I have had five different kinds of chests. My first type of chest was after my bi-lateral mastectomy when I had temporary expanders placed underneath my pectoralis muscles. Every week, I would enter the plastic surgeon’s office to be pierced with a long syringe through my muscle and into my expander where 50cc’s of saline was injected. My pecs inflated and ached with an eerie engorgement—I yearned to nurse a baby. I was a living balloon and fascinated by it. With my body so tender and unfolding, boxy wovens and forgiving knit tops became my staples. So that’s what I made: secret pajamas.
The secret pajama trend continued into my second type of chest when I had my expanders exchanged with teardrop-shaped silicone implants. I thought that reconstruction would replace my living breasts, that the only difference would be a smaller size from my amputated ones. But my fake breasts jutted out like a proud Barbie doll, plastic and immobile. I was hesitant to make fitted woven garments for this solid mass that never formed a cleavage. More knits and boxy tops were the answer—at least until I got used to it, I thought.
But just as I was beginning to feel comfortable with my new breasts, one of the implants dislodged itself and moved loosely in the pocket of my muscle. I had to shrug it into place multiple times a day. Furthermore, the teardrop-shaped implants had been recalled at the same time that I had discovered a belly button hernia caused by my second surgery, a laparoscopic hysterectomy/oophorectomy.
At the plastic surgeon’s office, I wondered out loud if I should go flat.
“No!” my plastic surgeon held her palm in the air. “There are still options.”
So during my hernia repair surgery, I replaced my teardrops with a smooth low-profile set. I cried in the shower afterward. This third type of chest was too sexy; I looked like a Penthouse centerfold. I realized my body wasn’t built for something round—sewing had given me this knowledge but it was used too late. Based on my measurements, my ribcage is wide and deep and my shoulders are narrow and sloped. I couldn’t move my arms across my body without my implants being in the way. I had to change my side sleeping position with arms raised above my fake boobs. The skin in my armpits chafed. With all the discomfort, I continued to make secret pajamas.
Then one morning I woke up to my dead-weight arm resting on my left implant while I slept. The site felt sore and I stood up. A sudden rush of fluid filled that side of my chest cavity with an audible suction. I moved my implant back and forth and heard squish-squish, squish-squish.
I strode over to my husband and threw my arms into the air, exasperated.
My fourth kind of chest should have been my final surgery. I was to be explanted with a flat closure. Instead, my plastic surgeon left redundant skin. This is a common practice among surgeons who believe that women don’t feel complete without breasts. They contour the torso with skin bags just in case the amputee changes her mind and decides to wear implants again.
As a sewist who likes precision in garment construction, I didn’t like the aesthetic of my excess skin. The folds showed through all my dresses and tops highlighting what had been done to me. In public, people stared. I would become self-conscious, sometimes holding whatever was in my arms across my upper half to hide the extra flaps of skin. Whenever possible, memade sweaters, cardigans, loose jackets, overalls and smocks were used to cover them up.
My plastic surgeon who performed the botched flat closure was crestfallen. She didn’t realize my skin would relax as much as it had.
“I’ll do whatever you want,” she said.
She helped me research and curate a list of seven plastic surgeons. Skin sewists. I had one in-person consult before the pandemic hit. This surgeon berated me. He said I was too judgemental. When I showed him images of what a flat closure looks like, he said the jobs were ugly, the skin was pulled too tight and was therefore shiny. (Nevermind that skin is also taught with implants).
“Have you gained weight?” he wrinkled his nose at my chest.
“If I did, I would gain it everywhere. You know that.”
“I know exactly what I want.”
“You don’t know you’re confused. You need to wait a year.”
“Are you able to perform this?”
“Women don’t like to lose their breasts.”
“Are you able to perform this?”
He tilted his head, stared at my loose skin and frowned.
“I can do that,” he said, nose high in the air with small nods of his head.
At home, I crossed off the cocky asshole from my list.
The second surgeon was slammed and not accepting new patients. I met the third surgeon via Zoom. Through the digital haze, she discussed how she would cut and sew my skin. The consult was promising. I used my sewing experience to ask pointed questions and understood the answers. The fourth surgeon was referred to me by a nonbinary person who had had a keyhole surgery (an incision around the areola) to remove excess breast tissue. Their chest looked amazing. Since this surgeon worked in Seattle, I had to email photos and I could only consult by phone.
After I described my surgical history to this latest candidate, I was caught off-guard his reaction:
“It sounds like you’ve been dealing with a lot of biases.”
Silent tears began to fall. It was the first time during my reconstruction, that a surgeon acknowledged the difficulty cisgender women have requesting a flat chest after breast cancer. Again, my sewing history proved useful and I found this surgeon to have a lot of insight. I booked him that day.
My takeaway from my experience is this: I am only a victim of breast cancer. I take full responsibility for my surgical choices. All of the plastic surgeons who I talked to (with the exception of one) care very much about their patients, however, some still hold biases that women are unable to heal without breasts. I have found that the healing occurs not exclusively from reconstructed breasts but from a neat, clean finish, similar to a couture garment. I feel fabulous wearing my new chest in a way that I never felt with my sexy, beautiful fake breasts or my flat closure fail. Also, I have many friends who love and enjoy their reconstructed breasts, and they don’t have issues with them. If my teardrop implant hadn’t dislodged and this style hadn’t been recalled, I might still be wearing them—or maybe not. Comfort is important. Regardless it took four years, six months of chemotherapy and eight surgeries for my body to feel like home again.
For the first time since my diagnosis I am looking forward to sewing everything: corsets, fitted dresses and artsy garments. Maybe some will have padding added to the chest. I don’t mind playing with my silhouette. For now, I practice the adjustments needed for a flat chest. And what’s better to practice on than secret pajamas? They’re still wearable even if I fail.
The years of doctor’s visits are finally over. Last week I made the six-hour roundtrip drive to Seattle for my post-op appointment. I shook the skilled hand of another type of sewist and thanked this person who set me free.
Since we are Sewcialists and understand what it takes to construct garments, quilts, stuffies, home decor, and the like, I’m sharing my reconstruction photos in case your body ever needs to be pieced together after breast cancer.
Here is my second set of implants. The sexy ones. Keep in mind that these breasts are completely fake. There are no mammary glands. My pectoralis muscles were stretched to form pockets. Silicone implants were inserted into each one. My nipples were saved and resewn onto my chest (for educational purposes, I did not retouch my nipples; Sewcialists might have covered them for publication (editor: we did not)). The incisions are two anchor scars. Those who choose not to save their nipples have a different incision: a short straight line across the middle of each breast. For people who require breasts to heal from cancer, I highly recommend this surgeon. She performs beautiful reconstruction.
Here is my failed flat closure (these photos were taken on the morning of my revision surgery for my second flat closure). The pectoralis muscles snap back close to the ribcage after implant removal, however, there are excess bags of skin and tissue (known as redundant skin). Also, there are hollows on my chest from where the mammary glands were scraped out. My chest is left with anchor scars. This is one of many ways to sew a flat closure and is successful if the skin is pulled tight. This was performed by the surgeon who created my reconstructed breasts. I do not recommend her for flat closure.
Here is my second flat closure. The excess skin has been removed and replaced by two long incisions. The hollows are absent. So how was this performed? Take a guess and comment in my Instagram stories (@h.o.m.u.n.c.u.l.u.s). I’ll share the answer there and save it in my highlights. You’re a sewist. Tell me: how would you get rid of the redundant skin on my chest?
Flat Closure Now
Dr. Shannon O’Brien (breast reconstruction)
Dr. Jeff Kyllo (flat closure and transgender procedures)
Denise Archer has been sewing since she was 15 years old when she created magic from Issey Miyake patterns and her mother’s Singer treadle. Denise’s personal garments and projects can be found @h.o.m.u.n.c.u.l.u.s