Friday, November 13, 2009

Essentialism and breast reconstruction

Next month, when I go in for my prophylactic bilateral mastectomy, my breasts will be reconstructed with the help of silicone implants and something called Alloderm. Because the implant will be placed behind it, my pectoral muscle must be cut and extended to accommodate the implant; the Alloderm creates a pocket to hold the implant in place and eventually bonds with my own tissue.

So far, so good. (Maybe a little gory, but simple enough.) But what exactly is this magical Alloderm? Well, it's tissue. Human tissue. From cadavers. (Pause for everyone reading this to shudder.) Now, before proceeding, a word about marketing: I'm in the business of bullshitting, and Alloderm is in desperate need of better PR. Sure, the brand name is nice and sanitized, but why would anyone, ever, willingly associate their product with the word "cadaver"? Cadavers conjure decay and, of course, imply death. Why not just say it's donor tissue? Which it is. From a dead donor. But nonetheless, you see my point. Like most of you reading this, I'm not totally cool with this; it gives me the heejeebees. But why? Obviously, I'm not thrilled with the idea of a cadaver, or any part of one, coming into contact with my body, let alone being purposefully implanted in it. But if I were to need a heart transplant, would I feel anything but tremendously grateful to receive one from a recently deceased person who is, by definition, now a cadaver? What's the difference?

These are questions I've been thinking a lot about recently. I'm reading a fascinating book called SuperSense about neuroscience and cognitive development and how our brain processes supernatural belief. And what makes us uncomfortable about transplants (whether they be organ or tissue) is that we all hold some supernatural belief about essentialism. We tend to believe that the essence of the person is imbued in the physical properties of the body. And there is something deeply unsettling about incorporating any part of a stranger (because what if they were someone really awful, like a child molester or a Republican, when they were alive?) into your own body. Never mind that Alloderm goes through an extensive stripping process that rids the tissue of most of its sources' DNA and other "essence." Never mind that the tissue was donated by someone who wanted their body to be of use to others when it was no longer of use to them. Never mind that without this Alloderm, this breast reconstruction would not be possible. Never mind all the positive aspects. The heebeejeebees linger. (There is even a discussion about this on the FORCE message board; apparently lots of ladies are struggling with this.)

I'm a rational person. I'm highly educated. I believe in science and reject supernaturalism in all its forms. But yet, I'm weirded out by donor tissue. I know I shouldn't be. But I am. And ultimately, the reason, according to the book's author Dr. Bruce M Hood, is that the human brain is wired to believe the unbelievable and the irrational. I know I shouldn't think of this tissue as unclean (it goes through sterilization) or possessing the essence of its donor (because at the end of the day, we're all just meat, you know?), but I do. And that's the struggle I'm having, not only with this aspect of surgery or being BRCA postive, but of the entire experience of pitting rationality against emotions. Our thoughts and feeling about things can be incredibly dissuasive even when our rational mind wants us to proceed.

My BRCA friend Brandi posted a link to this Australian news article on my Facebook page this morning. Essentially, it reports that in female pigs, scientists have been able to induce breast growth using the pigs' own fat cells; the long term implication is that women who have had mastectomies may be able to regrow their own breasts. Amazing stuff. But when I first read the article, I couldn't help but imagine that pig boob in the picture sewn onto my body. I know that's not what they are proposing (and dear jebus the implications of that on my husband, an avowed bacon lover, I can't even begin to imagine), but my misreading/misunderstanding actually raises fascinating questions again about essentialism: would a pig's breast continue to be the pig's or the human's onto which it was grafted? Would the human assume pigish qualities? Obviously, that's all science fiction. And the actual process the article discusses is incredibly promising (and ironically one day might obviate the need to even consider Alloderm in future mastectomy patients). But I'm so ensconced in the heady considerations of Hood's book, I can't help but see its implications and applications everywhere.

And the end of the the day, one of the most difficult aspects of processing the news you carry the breast cancer gene is that you've been told there is something wrong with yourself so microscopic and so pervasive that it exists in every cell of your body. And that news affects the way you view yourself. If this mutation is in every cell in our bodies, we must be, by definition, mutants. (And though more cartoonish and more super-hero-esque than our zombie friend the cadaver I talked about earlier, "mutant," no matter how tongue-in-cheek the implication might be, is not a desirable or coveted state of being.) So how do you square this scientific fact (my DNA has a typo and because of that I'm likely going to get cancer) with your self-perception (despite that, I'm still a good person with excellent taste in shoes)? Does being a mutant trump everything else? Or does being yourself trump being a mutant? What defines us? DNA (something real)? Or our "essence" (something supernatural)? Fascinating questions for which I don't have ready answers. But I do know I can't stop admiring the new turquoise ballet flats I picked up in Montreal last week.


  1. What an amazing blog! Thank you so much for making contact. I find your experience fascinating - I may have to write about it one day.

  2. Great post. Love the shoes.

    As you know, I readily embrace my inner mutant - I always suspected that there was something fundamentally different about me although this was not what I thought it would turn out to be.

  3. Hello and thanks for employing your obvious writing talent in such a purposeful way. The perspective you offer, the entertaining quality of your work, and your willingness to sacrifice your privacy for the benefit of helping other - these are certainly admirable qualities.

    To your point about the use of "cadaver" to descibe the donor tissue matrix known as "AlloDerm", early communications regarding the product were not intended for patient education. AlloDerm has been utilized in soft tissue repair and wound care procedures for over a dozen years (oral surgery, hernia repair, urogynecologicel procedures, TRAM repair procedures). The product makers, LifeCell Corp., exist in the bio-medical world, where most of the dialogue and medical education efforts are directed towards qualified surgeons. Surgeons, of course, are quite comfortable with the term "cadaver".

    I, too, was psychologically taken aback with the term "cadaver" on my first visit to my plastic surgeon when I learned that, after 4 1/2 years of having NO breast reconstruction options, I could finally have my breasts restored with AlloDerm and implants. My restoration has so dramatically impacted my quality of life that I take every opportunity to enlighten others about the AlloDerm/implant procedure. I am quite happy with the appearance of my reconstructed breasts, the fact that I did not have to impact any other part of my precious body to acheve natural looking breasts, and that my procedure was accomplished in a single surgery. Someone, somewhere in heavan, continues to have a purpose in this living world through the donation of tissue they made to me.

    LifeCell is now developing patient-friendly communications, including a great new website:

    To view my story visit:

    Thank you again.

  4. blushieee80@aol.comDecember 9, 2009 at 3:47 AM

    Ty for this blog. I myself have been told that I have the BRCA 1 and struggling with it. I will be having surgery mid-January 2010 and having trouble with the decision to having it. Ty again for the blog. Trying to do research on this gene and be at peace with it.

  5. Trust me, no one is more squeamish than I am about anything and I turned to Alloderm for my breast reconstruction. My nipple sparing breast reconstruction with silicone implants and AlloDerm was a much easier process that I ever imagined, and gave me beautiful, natural-looking, natural-feeling breasts. I had very little pain, made a quick recovery, and maintained a good deal of sensation. And I was once at high risk for breast cancer. Since then I have gained a better quality of life and enhanced my appearance as well. My doctor, Dr. Andrew Salzberg, of the New York Group for Plastic Surgery (, was amazing. I recommend anyone to visit his site ( and get more details on this procedure. Squeamish or not, it might be the answer for you.

  6. Breast reconstruction helps a woman regain her lost confidence and therefore, should only be done by experts in this field. Only seek for the best services and safe procedure. Thanks for sharing your valuable insights and feel free to visit me on my site for more related posts.