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My cancer diary: I’m reconstructing me… a bit at a time

Karen Skinazi gets ready for fat grafting

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A woman receiving a radiation therapy treatment for breast cancer

So, you’ll take it from my thighs, right?” I ask, squeezing the juicy bits between my fingers for emphasis, “and insert it here?” I gesture at my bosom.

The doctor nods and suggests I also meet with the plastic surgeon; for best results, she says, they’ll do the procedure together.

The procedure comes with various names: lipomodelling, lipofilling, fat grafting, fat transfer, fat augmentation. It involves violently pumping fat cells from areas where they’re deemed undesirable (I have watched a video, which is not for the faint of heart, and there is a lot of muscle involved!); running the fat through a centrifuge machine to remove impurities; then injecting the clean fat into the breasts to round and fill them out. Because I get monthly injections in my abdomen, I need to avoid taking fat from there, but luckily there are other options.

I’m at this hospital appointment the week of my 50th birthday. I reckon that after half a century, I currently have none of the cells with which I started this life. So, what’s the big deal if I move a few of the existing ones around? Not exactly dramatic. Nonetheless, this me at 50 is a me I never imagined. First implants and now liposuction. It all feels rather strange for a woman who doesn’t even own a hairdryer and whose idea of makeup is, more often than not, a schmear of lip balm.

As I chat with the doctor, I glance out the window; the hospital is on the campus of a university where, years ago, I applied for a lectureship. At the time, a friend who worked there went to a party. Afterward, she confided that a colleague of hers, a senior figure at the university, had heard about my application; drunk, the woman announced, in front of a large crowd, “That’s just what we need! Another Jewish princess!!” (Did anyone say a word in response? Nope. Not even my friend. But after some of the things I’ve heard since October 7, that nugget of everyday antisemitism feels oddly low-grade now). The joke of it was this: a princess I’m not!

Naturally, I have my share of vanity. When a group of my friends burst out of a wine bar shouting “Surprise!” last week on the heels of my big birthday, I was a) so happy I had gotten my roots done at the salon that morning, and b) immediately pushed my sunglasses high up on my face to hide both my emotional reaction as well as the fact that it’s been weeks since I last got my eyebrows threaded.

Still, I’m pretty lazy in the appearance department. “You’re the lowest maintenance person I know,” my sister (pictured, left, with me) likes to tell me. She also tells me her friends all have mini fridges beside their beds to keep their magic cosmetic potions just the right temperature. I have a pile of books towering over my head beside my bed. Different strokes for different folks.

It’s not, however, a mid-life crisis that’s brought me to this appointment. When I was diagnosed with breast cancer a year ago, I was given a scan. There was no sign of cancer in the lymph nodes, so I opted to have a mastectomy with immediate reconstruction. One and done. I hoped to waltz out of that hospital room (in fact, I could hardly walk…) and never return. Only after my sentinel lymph nodes were removed did we learn that a very small amount of cancer was present in the lymph nodes, meaning I needed radiotherapy.

Of course, I took the recommended treatment. Radiotherapy is highly effective at killing cancer cells; unfortunately, it is also highly effective at ruining implants. The tissue around an implant often forms a capsule, which hardens over time, distorting the implant and making the area inhospitable for a replacement. The skin, too, becomes tighter. There’s not much you can do on your own to avoid it. Believe me, I try! I do my stretches. I have massages. I go, religiously, every Friday to a group physiotherapy session called “breast class” (à la Are You there, God? It’s Me, Margaret, I was picturing a lot of “We must, we must, we must increase our bust! The bigger the better. The tighter the sweater. The boys depend on us!” with chests stuck out and elbows flying…so was a bit disappointed to discover it was more like old-school weight- resistance training).

Fat grafting, according to all the scientific studies I’ve read, can be very successful in mitigating the damage caused by radiation. And it’s a relatively minor procedure. They put you under, move the fat, and that day, you walk out in the equivalent of Spanx to minimise bruising and swelling. It’s true you might have to repeat the procedure several times; the fat sometimes dies, gets reabsorbed, etc etc. But if I can avoid future major surgeries – the implant being removed, the breast being rebuilt with autologous tissue reconstruction (skin and fat removed from another part of my body to create a new breast) – I think I would be crazy not to do so.

And who knows, maybe I’ll lean into the high-maintenance thing, start putting more care into my appearance. Maybe at 60 I’ll invest in a hairdryer. At 70, an eyelash curler? The possibilities are endless.

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