Jo's story is part of a series looking at the many and varied experiences of breast reconstruction and the decisions behind a woman's choice to have reconstruction or not.

Jo (Rangitàne o Wairau) was diagnosed with breast cancer in her late 30s during the Covid-19 Level 4 lockdown. Having treatment during Covid-19 meant her initial options for breast reconstruction were limited, so she opted to wait and have the reconstruction she wanted.

I was diagnosed at ’30 young’, aka late 30s, with ER+, PR+, HER2+ breast cancer. I’ve since found in the world of breast cancer I’m considered ‘young’, so I’ll take it. I feel fortunate to have had a diagnosis and treatment like mine. While it was given at the peak of a pandemic, there were no delay in any of my treatments end to end. My journey has been a balance of decision-making during a pandemic, to having a plethora of options now.

My treatment and she (yes she) was a doozie. I learned it’s situational to you: your age, where you are in life (fertility, did I want to extend my family?), body type, type of cancer, where the tumour/s sit.

First off the rank, or chest if you will, was surgery. I had a skin-sparing mastectomy with an expander and sentinel lymph node biopsy on my right breast, as well as breast reduction on my left breast. The first place I looked after my mastectomy was at the new girls, which looked good. Recovery was my biggest mental challenge, because I truly underappreciated how long it would take my body to recover. The recovery period is like having two C-sections at once – I compared it to my recovery of my C-Sections where I bounced back fast. It took me five weeks until I felt like me again – going from active (use that term loosely) to restricted body movements was tough going. I was vigilant with all my physio exercises to avoid lymphoedema and did an extra week just in case. I listened to my body and set achievable day-to-day goals with exercise: ‘I’ll walk to this bit today, the other bit tomorrow’. My partner of 17 years was an important part of my recovery and I was fortunate to have a lot of support as I wanted to retain as much independence as possible.

The result of my biopsy decided my course of treatment as the mother trucker had spread to my nodes. Since then, I’ve smashed 12 cycles of chemo, 15 cycles of radiation, 17 cycles of Herceptin and I’m nine months in on five years of Tamoxifen (endocrine therapy if you want to be flash about it). I’ve also had five MUGA scans and blood tests and CTs in between treatments.

Because I was diagnosed at the peak of the pandemic, the options laid on the table for breast reconstruction were limited. There were restrictions on hospitals when it came to surgeries (type of surgery and length of stay), coupled with no referrals being taken at that time for the Hutt Plastics Unit.

I knew that I could never go ‘flat and across’. I’ve always been top-heavy so going from a lot to nothing did not feel right. My decision and choices had nothing to do with a sense of femininity (which we can akin to breasts), instead it had more do to with where I was in my life. My girls had done their dash, they were feeding vessels for my children and I have no plans on expanding my family. I did see an opportunity to get a boob job, as well as being relieved of the backaches and the cons of being top-heavy, so I jumped at it (not literally – I have an aversion to exercise).

We are fortunate to have two hospitals in the public sector for reconstruction where I live: Wellington Hospital does ‘flat and across’, implants, or latissimus dorsi reconstruction (using fat and skin from the back), and Hutt Plastics, which does all the above as well as any surgery options that use your own tissue (from your tummy) to form your breast.

What I recall was a discussion around what having a mastectomy would mean, the impact that any treatment, like radiation, may have on my surgery options, and that any reconstruction choice would always mean multiple surgeries. The options I was given were having ‘flat and across’, reconstruction with an implant or having delayed reconstruction with an expander, so I could take the time to consider my options. I was also given the option to have surgery on my other breast for symmetry (this would be ‘sisters not twins’ aesthetics).

Delayed reconstruction with an expander was a decision from the onset. Each department I was involved with gave feedback to the other, so when I met with my breast surgeon he could say there and then what the options would be. I can’t fault any of my consults with my surgeons at both Wellington and Hutt Hospital. I appreciated the emphasis my breast surgeon at Wellington Hospital had on ensuring that I was given the opportunity to consider all my options. When the Hutt Plastics Unit reopened in August, I was referred and I’ve had two consults since then. We had to wait until my all my treatment finished and my oncologist gave the all clear for my reconstruction surgery to be booked. Having an expander wasn’t terrible; it had a purpose and it’s done that. I can’t wait to divorce it – the feeling’s mutual, I’m sure. My one deciding factor to reconstruction was having something that felt like a breast, so I’ve chosen the DIEP flap surgery, which will occur this side of the new year. I can’t say what the definitive moment was when I decided, I just knew this was for me.

I’m no advocate for breast cancer, I just happen to have it. How we get through our journey (wherever you are on it) is as much about mental resilience as it is the treatment working. My advice to other women looking at breast reconstruction is don’t write off any options – if it’s an option, that’s great, that’s a start. It’s easy to be get caught up on the ‘I heard, they said’ but do what’s right for you. If you’re waiting on reconstruction like me, be kind to yourself, find a silver lining in each day, and please stop overthinking. Take the time to smell the roses and reacquaint yourself with you.

Jo works in the public health sector (corporate), and lives in Porirua with her partner and their three tamariki.