After her diagnosis with breast cancer, artist Jo Beth Ravitz, 58, had lumpectomies, a double mastectomy, and breast reconstruction in short order. During the various surgeries to prepare her body for implants, she couldn't move her arms enough to work on her art. She documented her journey with a diary, excerpted here, and her husband took pictures.
Warning: Graphic surgical photos ahead.
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I'm having a double mastectomy
It has happened: The margins of my lumpectomies are not clear. So I will have a double mastectomy. It was my choice and, strangely, I made it without hesitation. Both breasts had cancer and the likelihood of recurrence is too great for me to just remove the left breast.
Besides, I want to get on with my life. Enough about breasts. I am so much more than breasts, but oh how I will miss my nipples...
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The day before surgery...
Almost every night for a while now, I enter a world of self-pity upon undressing. Tired and vulnerable, my mind loses control. I am one of the lucky women, so why am I mourning my breasts? Is my self-image so tied to my physical appearance?
This picture was taken the day before my mastectomy, which will also mark the beginning of my reconstruction. I've decided to have tissue expanders. They'll inject saline into each casing and then leave the wounds for two weeks. More saline is introduced weekly into the expanders after that, until they are fully inflated. Two months later I'll have implants put in.
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It's not pretty, but it's real. This is what my breasts looked like two weeks after my double mastectomy—immediately after their first saline fill-up.
I am my own inflatable doll—110 cc’s of saline went into each breast. The pressure is intense and painful. When the doctor removed the stitches, it was amazing that I didn’t burst at the seams. But he said that perhaps I will only need a few more fillings.
5 of 11
I feel graceless
I was not surprised this time by the amount of pain that the inflation brought, but I will be so glad when it is over. The doctor says two more visits and then I will be able to just do nothing but stretch until the switch to implants. Boy, do I wish I could sleep on my stomach or sides.
Meanwhile, I bump and stumble as clumsily as an infant, unable to find the grace of my previous body or reach to familiar heights. My posture is pulled down and over my new form. I am a wakeful witness inside my own chrysalis, waiting to break free again and fly.
6 of 11
Pushed and pulled
It's amazing what becomes familiar. I look in the mirror now and am not jarred by my missing nipples. Tomorrow, bigger breasts and more discomfort, but the countdown will then be for just one more inflation. I can’t imagine what will be pushed and pulled this week, or how much more pressure my ribs can stand.
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I am now officially a Barbie doll, so out of proportion. One more filling and hopefully just 60 cc's more.
I asked the doctor some more questions about what's to come and got a big surprise: I knew the nipples will be formed by reshaping some scar tissue or flesh on my breast and that the areolae will be skin-grafted from my groin. What I didn’t know was that sometimes the hair follicles from the groin continue to grow hair. How odd.
8 of 11
The last expansion was yesterday and it's difficult to breathe. I keep reminding myself that this is the last time I will feel this pain in the connecting tissue in my armpits, the pushing in and back, the trouble sitting upright.
I know that I have been lucky to find the cancer at such an early stage, especially if this is the worst part. But I forget that sometimes. There's a man in my neighborhood who is missing an arm. He laughs with his family and goes about his business, seeming to cherish every moment.
9 of 11
Here I am six months after implant surgery. It was a two-hour procedure: The doctor opened the first incisions, on the armpit sides, about three inches. He deflated the expanders and inserted the implants. Then I had to heal.
Tomorrow my body changes again when they give me nipples. My breasts will be complete with the cherries on top.
As I feared, the memory of my original body has diminished and now I will have a lifetime to become accustomed to a new set of breasts and nipples. This is so strange and remarkable.
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Cherries on top
One month after nipple surgery, I’m still a little tender around the scarring.
When I woke up from surgery, the doctor told me that scar tissue around one of my implants had pushed it into a new position, so he had to replace it. I'm definitely more comfortable now, but I do have a pucker in my skin due to the new positioning.
I’ve come to realize that this may not be the last surgery I’ll need for these implants. They, just like the rest of me, will need maintenance. My evolution continues.
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About the author
Artist Jo Beth Ravitz, who lives in Brooklyn, N.Y., was diagnosed with stage I invasive ductal carcinoma breast cancer on Halloween in 2003. During the breast reconstruction that followed her 2004 double mastectomy, she was unable to use her arms to work on art, so she turned to words; her husband took the photographs.