I make an appointment with Vivian’s plastic surgeon.
It’s not as if my sister’s warning didn’t land with me: it did. There is considerable truth to the fact my diagnosis is directing my life right now. I should’ve been more informed about the consequences before I got the test: it was stupid not to be. But this is where I am. And by the end of the drive back to Brooklyn, I’ve settled on the two key reasons why I disagree with Mara. First, I am old enough to make important decisions for myself, about my future. And second, I don’t believe in fate in the way she imagines it, as something that happens to you, regardless of your involvement. I have free will, and I use it.
Knowing my sister is wrong and acting in direct opposition to her advice feels both freeing and frightening. It’s the feeling of looking around for an adult and realizing I am the adult. I am my best option.
* * * *
Dr. Dan Murphman’s offices are as sleek and impersonal as a Midtown cocktail bar. Black leather sofas, bright track lighting, shiny new issues of Cosmopolitan and Vanity Fair. On the walls, framed articles of Murphman in various Top Doctor and I’m So Great lists. A bit arrogant, but I suppose that’s to be expected. He was one of the first names that came up when I googled New York plastic surgeon.
The bottle-blond receptionist has jugs the size of basketballs. I’ve always been a bit judgy about women with implants. Now I might be the one getting fake tits.
I see you, karma. I see you.
It’s 12:58 p.m. I text Steph.
Here. This place is terrifying. Where you at?
It was her idea to come. I told her she didn’t have to but she was surprisingly insistent.
Even though this is just a consultation, tension tightens my muscles. I tell myself to relax but I rarely take my own advice.
Trying to busy myself with Clean Clothes outfits proves fruitless. I’m distracted with thoughts of boobs. I found an article online about women who “go flat” after mastectomies: no reconstruction at all. I thought about this, because I want to consider all my options, but it’s not for me. I can’t imagine not having breasts, to the point that it’s worrying. I mean, they won’t function as breasts from a biological standpoint. I’ll have minimal, if any, sensation. So who am I getting reconstruction for? Me? Or the way I appear to others? As a woman, the question of appearance is complicated enough. If I wear a short skirt, am I celebrating my sexuality or succumbing to a sexist stereotype? Let’s say celebrating: but what if I wear that skirt to a meeting with a male client because I know it’ll give me some kind of advantage? And is it actually an advantage? I could ponder this endlessly: one thing I know for sure is that my client is not questioning what he wears when he meets with me and neither is anyone else.
The receptionist calls my name: Dr. Murphman is ready for me. I gather my purse, annoyed and yet oddly satisfied that Steph didn’t make it.
I knew it. I can’t rely on her.
* * * *
Dr. Murphman has a framed portrait of himself above his desk. It looks like an actor’s headshot, the kind a casting agent might consider for LA Gym Owner or Sleazy Investment Banker. Slicked hair, every tooth capped, and I strongly suspect chin implants. Flanking his picture are very boobalicious photographs of Kourtney Kardashian and Salma Hayek. Did Murphman do their boobs or are the pictures supposed to make you assume that?
“Hi. Dr. Dan Murphman—you can call me Dan.” He extends his hand. Manicured fingernails. Firm shake.
I take a seat. “Lacey Whitman, you can call me Lacey Whitman.”
“Great,” he says, glancing at my file. “BRCA, right. Honestly, you’re making the right choice.”
“Honestly, I haven’t totally decided yet,” I say, crossing my arms over my chest. “I might end up sticking with surveillance. Mastectomy’s just so . . . final.”
His face flickers, and I wonder if he meant I was making the right choice coming to see him. “Well, as you can see, I’m best in class. Even though the circumstances might not be ideal, I promise you’ll walk away with a beautiful set of breasts, covered by insurance. That’s a home run.”
Home run? Seriously? I’m so miffed by this I can’t think of what to say.
“Now, some breast surgeons take too much tissue to be able to deliver a good result,” Dr. Dan continues. “Who’s on your team?”
I thought the point of mastectomy was to remove all the breast tissue. “I haven’t decided yet.”
“I can make some recommendations of some surgeons who are excellent, best in class.” He reaches for a clicker. “Let’s take a look at—”
The door flies opens. It’s Steph, flustered, in her leopard-print puffy jacket and bright orange beanie. “Sorry I’m late. Subway drama. Hi.” She waves at Murphman. “Steph. Friend of Lacey’s.”
He indicates Steph should sit. “As I was saying, let’s take a look at some of my work.”
Steph sinks into an empty chair. I give her a smile. I’m a little relieved that I was wrong about her. She came.
Murphman hits the lights. A projected image of two sets of boobs lights up the opposite wall. Steph jumps. “Cripes! Wasn’t expecting that.” Then, “Ooh. The ones on the right are rather nice.” The pictures are cropped from the bottom of someone’s chin to the top of her stomach. The breasts on the left, the “before,” are small, the size of apples. The second pair are at least a cup size larger: full and lovely. Pale pink scars circle under both breasts like silvery snail trails.
Murphman speaks without looking at them. “Example of smooth, round silicone-gel breast implants—270 cc, subpectoral. A 32A/B to a 32 C/D.”
I have to admit: they look good. “Is that a BRCA reconstruction?” I ask.
“No, just regular augmentation.” He clicks the remote. Another four more boobs appear. Again, the after looks fuller than the before. “Saline breast implants—”
“Can we go back to that last one, please?” Steph is sifting through a loose pile of notes. “I’m curious if you think, um, wait a second . . .” Half her notes slide to the floor.
“Let’s do questions at the end of the presentation,” Murphman says without looking at her.
Steph stiffens.
He gestures to the wall. “—placed under the muscle through an areolar incision.”
The next set of boobs appears, and the next and the next, a never-ending series of nipples from more breasts than world cultures in the It’s a Small World ride. It has the effect of completely desexualizing boobs, making them seem almost alien. I’m unsure how many of these women are previvors, like me. Next to me, Steph’s foot is jiggling the carpet.
The presentation ends. The lights flick on. Dr. Dan Murphman smiles with all his teeth. “Thoughts?”
Steph looks like she’s just eaten something bad. She hates him.
I ask, “What kind of reconstruction would you recommend for me?”
The doc says, “Let’s take a look,” and hands me a paper gown to change into.
Steph hovers, unsure. We’re not the kind of friends who swim naked together. “Should I wait outside?”
“If you want to be involved, you’re probably going to see them eventually.” I steel myself, and start unbuttoning my shirt. In less than a minute, I’m sitting half-naked on an examination table, tits out. Steph gives me a brave smile. There’s an almost imperceptible blush coloring her cheeks.
The doctor glances at my tatas with quick dispassion. “Implants,” he replies. “You don’t have enough fat for flap.”
This is what I’d already assumed: “Flap” surgery rebuilds your breasts using fat from your thighs, your tummy, your butt, wherever you can spare it. It’s the most natural-looking reconstruction, and it leaves you with breasts that are soft and warm, aging as you age. But it also takes the longest to recover from because you need two surgeries, and it’s complicated keeping the flap of skin and fat alive. Regardless, it sounds like having a couple of butt-boobs is off the table for me.
Murphman recommends expander-implant reconstruction. “Temporary implants called expanders are placed in pockets formed under the chest muscles. Over several months, the expanders are gradually inflated with saline to stretch the skin and muscles, each time requiring an in-person appointment.” He sounds like he’s reciting information from a textbook. “During a second, shorter surgery, the expanders are replaced with implants.”
“And how many of those have you done?” I ask.
“Plenty,” he says. “Like I said, the key to a good outcome is leaving me tissue to work with.”
“Isn’t the key making sure she doesn’t get breast cancer?” Steph asks.
Murphman grins at her as if she’s just made a joke, and indicates my left breast. “I’ll be able to fix this asymmetry.” I didn’t even realize the girls were asymmetrical. “Give you more of a lift here, and here . . . You’re a, what, 32B?” He guesses correctly. “We could easily take you up to a C cup.” He points to the picture of Kourtney. “Or a D cup.” Salma.
“I don’t think I want to go bigger,” I say.
“I can make you any size you want,” he says.
“Yes I know,” I say, “but I think I’m happy being part of the Itty-Bitty Titty Committee.”
Steph snorts.
“To be perfectly honest, most women want to go bigger,” he says. “Big breasts are beautiful.”
Steph rolls her eyes.
“Right,” I say, “I’m just not sure if they’re for me.”
“If you’re on the fence, go bigger. Trust me. Breasts are what makes a woman a woman,” Murphman says. “They’re the most fundamental part of a woman’s anatomy.”
I know this isn’t right. But I remember the way Elan’s face started to change in his apartment, before I told him about the bucket list. The burgeoning sense of what had to be disgust, as the truth of my plan played out in his mind. Maybe going bigger is an option. The upside for having two massive scars for the rest of my life—
“That’s total bullshit.” Steph’s voice surprises us both. “I’m sorry, but that’s just not true. Being a woman has nothing to do with how big your tits are. And let me tell you, as a woman who has been blessed with a couple of boulders, it’s not all fun and games.” She ticks off her fingers. “I always have to wear a bra, even though I hate them, I get chronic back pain if I’m on my feet all day, and I get catcalled a million more times than girls with small tits.”
Dr. Murphman holds up a hand. “Young lady—”
“Fuck you,” she says, and turns to me. “Lace, you don’t know how lucky you are, having small tits. You choose when you want the world to see them, respond to them. I don’t get that choice. Guys think big boobs is a constant invitation, like, if I’m born a double D, I’m obviously a fuck machine. Why do you think I wear T-shirts all the time?”
Murphman opens his mouth.
Steph holds her hand up. “Take your big-boob wankfest and shove it up your tight bleached arsehole.” She gets up, opens a door to the walk-in bathroom, closes it, opens the actual door, and hurries out.
* * * *
“Steph! Wait!” I catch up with her in the elevator bank.
She spins round. Her face is the color of a tomato. She looks dazed. “I’m so sorry. I don’t know what came over me.”
I’m dumbfounded. “What just happened?”
“I just couldn’t stand him talking to you like that.” She peeks back in the direction of the office, wild-eyed. “Did I just tell a surgeon to shove something up his arsehole?”
“Yes.” The elevator dings open. I pull her in, grinning. “And it was brilliant. Thank you. You’re right: fuck Barbie boobs. Fuck that guy.”
The elevator doors close. I flush, angry and confident and grateful for my friend.