A bad experience with a plastic surgeon highlights the lack of empathy for some breast reconstruction patients versus those who choose elective breast augmentation.
By Steven Martinez
Keri Stephens is a 38-year-old mother of two and editor of Plastic Surgery Practice sister publication 24×7 Magazine.
Late last year, a frightening diagnosis upended her life, but a negative experience with a plastic surgeon inspired her to speak out in hopes that other doctors might avoid the same mistakes.
In July of 2020, just as the pandemic was hitting its stride, Stephens was going over patient history forms with her gynecologist for an unrelated procedure. Her doctor asked her a question that would lead her on a life-altering journey.
The CHEK2 Gene Mutation
“My doctor was looking at my forms, and she asked, ‘do you have any first-degree relatives with breast cancer, and what age did they have it?'” Stephens recalls.
Stephens had an aunt diagnosed with breast cancer in her 40s, and her doctor recommended she get tested to see if she was genetically predisposed to breast cancer.
It wasn’t the first time that Stephens had considered her genetic risk of cancer.
Her grandmother once mentioned that the American Cancer Society was tracking her family because all the women on one side eventually developed breast cancer. Her father had also recently been diagnosed with an aggressive form of prostate cancer.
Stephens knew that her aunt had taken a genetic test that came back negative for BRCA gene mutations, the most common mutation linked to breast cancer.
But her doctor explained that the BRCA mutation was not the only thing the tests looked for.
At her doctor’s insistence, she took the test. The results indicated a CHEK2 gene mutation, a lesser-known mutation linked to a high incidence of breast cancer.
Combined with her family history, Stephens’ risk of developing breast cancer was unnervingly high. Her father eventually took a genetic test, which confirmed he had the CHEK2 mutation as well.
The news scared Stephens. Not only was her own life at risk, but she also worried that she could have passed it down to her children.
“It really sucked because I felt that I was always healthy and, not completely invincible, but not high risk or anything,” Stephens says. “It felt like a bomb being dropped on me, honestly.”
She could commit to biannual mammograms for the rest of her life, but her doctor recommended a double mastectomy as the best preventive measure.
“The second I found out, I wanted to take action because I’m very action-oriented. I didn’t want to sit around and worry,” Stephens shares. “It just felt like there was a ticking time bomb in my body.”
Double Mastectomy and Breast Reconstruction
Things moved quickly. Before long, she was scheduling her surgery for October and consulting with a plastic surgeon about her breast reconstruction.
Stephens wasn’t a candidate for immediate implants, so she would have expanders put in immediately after the mastectomy procedure, periodically filled with saline until her implant exchange surgery. The two doctors would work in tandem during the surgery, so her mastectomy surgeon recommended a plastic surgeon she regularly worked with.
But the first meeting with the plastic surgeon left a sour taste in her mouth and tainted her experience with him throughout the reconstruction process.
In his office, the plastic surgeon began by asking her, “What do you want them to look like?”
She answered that she didn’t care and that she just wanted them off.
“You do care,” he insisted.
In the moment, still raw from the news of her test and impending mastectomy, her only concern was getting everything over with.
“Honestly, I don’t really right now. I just want them off,” Stephens responded.
Then he said something that irritated her.
“Well then, why are you getting reconstruction?” he asked.
“That just really rubbed me the wrong way because I was dealing with the genetic mutation, knowing that I had to have a double mastectomy. It was so emotional,” says Stephens of the encounter. “It made me feel completely disregarded and just completely ignored of my feelings, and it frankly pissed me off a lot.”
It bothered her enough to tell her breast surgeon that she didn’t like him. But the breast surgeon assured Stephens that he did good work and explained that it would be a process to find someone else to work with.
Stephens decided to go ahead with the same plastic surgeon, but it wasn’t the last time the two would not see eye to eye.
When she met with the plastic surgeon to discuss how big she wanted to go with her implants, Stephens explained that she didn’t want to be bigger than she was pre-surgery. He told her that women always tell him they wished they went bigger.
“I’m very happy with my decision,” she told him. “I’m happy. I know me, I know I’m going to be happy with this.”
He asked her again if she was sure and told her that he could do anything she wanted. Again she reiterated that she was OK with her decision not to get bigger implants.
Stephens ended up going slightly smaller than she was pre-surgery, arriving at a small C cup. She says her only goal was to look as normal as possible and feel comfortable in her clothes, and in the end, she was happy with her decision.
“I didn’t want to look like Dolly Parton,” she says.
Stephens says that one of the common experiences shared by mastectomy patients with breast reconstruction is many people expect them to be happy because they’re “getting a free boob job.”
But the reality of the situation is much less desirable.
“First of all, it was not free, I had to pay my insurance, and second of all, this was not a ‘boob job,’” Stephens says. “Mastectomy patients are very, very adamant that we did not get a boob job, and I think that’s a trigger for a lot of us.”
A Lack of Support, A Lack of Empathy
Unlike the typical breast augmentation, the outcome of reconstruction surgery is far from natural-looking because a mastectomy removes most of their tissue and leaves visible scarring.
During the consultation process, Stephens says she was never shown any photos from a procedure like hers. In general, there was little acknowledgment from her plastic surgeon that this procedure was any different from elective plastic surgery without any medical need.
She says that, unlike typical plastic surgery, no matter what the outcome was, she wouldn’t look better than she did before the surgery.
“Personally, I felt like he was a little bit insulted that I wasn’t excited about any of his creations. To him, it was like, ‘I’m an artist,'” Stephens says. “He was just looking at his creation or what he could do for me. There was no acknowledgment of the fact that I was not excited about this process. This is something I don’t want to have to do.”
One part of the process that Stephens felt was lacking was emotional support for her situation from those giving her medical care.
When her father was diagnosed with prostate cancer, he was set up with another patient with the same diagnosis as a mentor to talk and help deal with the situation.
Stephens ended up connecting with other women in similar situations through informal Facebook groups. They served as a source of information for what to expect and functioned as a support group from people who understood.
“It is definitely an emotional process for women going through this, and I think that there needs to be more acknowledgment of that and maybe pointing them toward resources,” Stephens says. “I’m not expecting plastic surgeons to be emotional about it, but just understand that it’s a very different situation than a typical breast implant patient.”
Her Facebook groups would prove invaluable when Stephens was still in intense pain a few weeks after her first surgery. She remembers that she could not walk with her kids through the neighborhood on Halloween and was doubled over on the sidewalk in pain.
On Facebook, peers told her they were prescribed the nerve blocker gabapentin. Stephens’ plastic surgeon was responsible for her postsurgery care, so she told him about the pain, hoping he could prescribe her something.
But she says he dismissed it, telling her, “Well, yeah, you just had a mastectomy; it’s painful.”
Unable to deal with the pain, Stephens decided to take her husband along on her next visit, hoping the plastic surgeon might take her more seriously if he came along. Her husband works in the wine industry, and she’d heard that the surgeon was into wine, so she offered him some of her husband’s wine.
Once again, she told him how much pain she had. This time he immediately responded, “Well, you need gabapentin.”
“So he did not give me the medicine I needed until I brought my husband with me and offered him wine. So that’s how I feel about that dude. He’s the worst,” Stephens says. “To be honest, I couldn’t stand him. He was good at his job, but from a patient perspective, he just missed the mark a lot.”
One Bad Experience
On December 31, 2020, Stephens went in for her breast implant exchange surgery, and her ordeal with the plastic surgeon was over.
She still needs one more surgery for a fat grafting procedure, but she has been hesitant so far because of her bad experience. She says she will be looking for a different plastic surgeon when she finally decides to do it.
“There was no sensitivity, and I think that’s something that breast surgeons or plastic surgeons really need to know when they’re working with reconstruction patients,” Stephens says. “You’re not dealing with the same kind of person and nothing against someone who wants implants, but it’s a different situation. I didn’t go there because I wanted to be there.”
Stephens says she wants plastic surgeons to try to empathize with their reconstruction patients in the hopes that they better understand what they are going through.
“This is, for a lot of people, a life-or-death situation,” Stephens concludes. “They’re getting reconstruction to, I guess, claim some power over what’s happened to them. But it’s not the same, and they shouldn’t be treated the same. Just have a little empathy for what they’re going through because it’s not a fun situation.”
Steven Martinez is associate editor of Plastic Surgery Practice.