In 1970 Jean Zalon discovered a small lump in her left breast. A week later she became one of the more than half a million women in the U.S. who have undergone mastectomies. The 59-year-old Zalon subsequently contributed to another, less well-known statistic. She joined the nearly 5,000 American women who have chosen breast reconstruction as their way of coping with the drastic surgery. Before her illness Zalon worked with cancer victims for a medical insurance plan in New York City. Since her restorative operation, she has literally bared her chest to hundreds of women who want to see the results with their own eyes. Zalon, who believes the number of breast reconstruction operations will triple in the next few years, has written of her experience in I Am Whole Again (Random House, $7.95). In the Central Park West apartment she shares with her photographer husband, Jules, Jean Zalon talked with Harriet Shapiro of PEOPLE.
Why did you write your book?
I felt compelled to tell women about my experience. All of us are terrified of having a breast removed. But I feel strongly that reconstruction removes some of the terror of permanent mutilation. What I’m saying is, “Hey, woman, here is another avenue open to you. You can be rebuilt.”
How does the medical profession view breast reconstruction?
When I sent out questionnaires to nearly a hundred breast and plastic surgeons across the country, I got an almost unanimous response that reconstruction will not mask a recurrence of dormant cancer cells. Many doctors have been very approving, because they see reconstruction as an inducement for early detection.
How did you discover your cancer?
Early one morning while I was taking a shower, I felt a small lump in the lower central part of my left breast. The next morning I went to see my doctor and six days later I entered Beth Israel Hospital in New York for a biopsy. But I didn’t have the operation right then because I refused to sign a release. I could not tolerate going into the operating room just for a biopsy and finding out only hours later that I no longer had a breast.
Then what happened?
Two days after that I had a modified radical mastectomy, meaning that the doctor removed the breast and a number of lymph nodes from the underarm area.
How long was it before the shock wore off and you began to understand what had happened to you?
For a while I did very well. All my friends showered me with attention and told me how brave I was. But I remember once saying to Jules, “I think I am going to die.” Then two months later, when we were in Ireland driving south into the beautiful countryside, I suddenly got socked with what had really happened. I had always felt nothing could touch me, and now I realized I had cancer and was going to be mutilated for the rest of my life.
Was it difficult facing how you looked?
In the hospital, a resident came in to change the bandage. I had no desire to look, but I saw myself reflected in the TV screen hooked to the ceiling and tears just streamed down my face. I didn’t look for a long time after that. A friend of mine said the first time she saw herself after surgery, she got into a shower and screamed for 20 minutes.
How did you learn about reconstruction?
I knew that women had breasts augmented or reduced. I asked my surgeon, “Isn’t it possible to rebuild a breast?” Because the technique was in its infancy, he was hesitant. Later he changed his mind when he felt confident the procedure was safe enough to approve for at least some of his patients. About two years after my mastectomy, I went to see a woman dermatologist who was very young and fresh and she said, “Why are you walking around like this? Why don’t you have reconstruction?” She was very matter-of-fact and gave me the name of Dr. Saul Hoffman, who became my plastic surgeon.
What were your friends’ reactions?
Some of them said, “I didn’t know you were so vain.” But I wasn’t trying to be a sex object. I just wanted to be back where I was before the mastectomy.
How does a woman find a doctor qualified to do reconstruction?
She should ask her original surgeon, and if he opposes the procedure she should go to another who might not.
How soon after a mastectomy can a woman start reconstruction?
As early as three months, as long as a year. If a woman is having chemotherapy, reconstruction should be postponed until the treatment is over.
Did your husband and children support your decision?
Because they knew nothing then about reconstruction, they worried that by tampering with the area that had had cancer I might stir something up. When I looked for encouragement, I didn’t get it. I had to go ahead for myself.
Who can have reconstruction?
Women who have had a modified radical, where their chest muscles are still intact, can have it just as I did. If they’ve undergone a radical, they would have to be more motivated because the procedure is more complicated. That’s because the missing pectoral muscle must be replaced with a prosthesis.
How much does it cost?
There are generally two or more operations, and together they run from $2,500 to $5,000. Health insurance coverage varies widely from state to state, with some insurance companies providing reimbursement for reconstructive surgery.
Could you explain the procedure?
In my case, Dr. Hoffman did a vertical incision along the side of my rib cage. Then he created a pocket under the skin and inserted an oval-shaped silicone prosthesis. Some doctors prefer using a silicone gel inside the prosthesis, but mine was filled with a saline solution. The silicone used in reconstruction should not be confused with the extremely dangerous liquid silicone injections used in breast-enlarging operations.
After the implant, why did you have a second operation?
Sometimes it’s necessary to match the natural breast to the newly implanted one. Some women prefer not to have the surgery, but I felt like Picasso’s unbalanced lady. I had to slip foam into my bra to fill out the contours of my new left breast. For a better match my surgeon reduced and raised my right breast. He also created a new nipple on the left with a bit of labial tissue from the outer lip of the vagina. If the original nipple tissue is not malignant, some women are able to save it from their diseased breast—a process called nipple banking. During mastectomy the nipple is stitched into the groin area until the surgeon is ready to begin reconstruction.
How does the new breast feel?
After about a year the implant started to soften. At this point it’s very similar to my own breast. It is quite soft and has the same density, although when I bend down it doesn’t quite flow the same. I have skin sensation, but the nipple has no feeling. I used to be inhibited about sleeping on my stomach because I thought the insert would break. I’ve gotten over that anxiety.
How did reconstruction affect your love life?
I could walk around unclothed. I liked myself much better. With my husband I was again much freer and a far more wholehearted partner.
Were the operations painful?
There was some discomfort. But it wasn’t too difficult, because I felt I was going through such a constructive thing.
Are there ever complications?
Rarely. Sometimes the body extrudes the implant or scar tissue forms inside the breast and makes the implant very rigid. But if something like that happens it is correctable.
What about scarring?
I have a scar, but with time it has become very faint. I did a little test about two years ago. I walked into a sauna with a lot of bare women. I watched to see if any of them looked at my breasts, but nobody gave me a second glance.
How did you feel after the operation?
Oh, God, I was delirious. It was a high in my life. My body had been imperfect and suddenly I had two breasts again. I felt reborn. In the hospital I carried on and said, “Please find mastectomy patients so I can show them my breast.” I wanted them to see how perfect the reconstruction could be. And because I no longer had that visual reminder of my illness, the cancer experience was finally erased for me.