Wednesday, September 22, 2010

book review: Meet Virginia: Biography of a Breast

If you are like me, you prefer to be knocked out for your surgeries yet you wonder what the heck went on while you were sleeping. If you are like my wondertwin, you wish you were awake and able to keep an eye on everything going on and maybe even give directions to the surgeons. You can find some surgery video online but sometimes that is a little too much detail. I remember looking at video of a hysterectomy while I was still recovering from mine and deciding that it was just too painful to watch as they inserted instruments and had blood squirting everywhere. Perhaps that isn't the best thing to see immediately before or after surgery! Most of us are scared enough as it is.

What if you could look at some still photographs, a little less gory than video, that show you what goes on in the operating room? I was very curious indeed when I heard of a new book that follows a woman, photographer and all, into surgery as she undertakes a mastectomy with immediate reconstruction.  Meet Virginia: Biography of a Breast by Jay Agarwal, MD (reconstructive surgeon), Ravinder Ahluwalia (medical student), Leigh Neumayer, MD MS (mastectomy surgeon) and Anne Vinsel (photographer) sheds some light on the mastectomy and reconstructive process.

The book facts: I was going to try and impress my librarian dw by listing the isbn number and all the publishing details but this book appears to be self-published. So here's what I found, 176 page, hard cover (coffee table book size) published in 2010 and selling for $39.95 USD. It can be purchased on the website I wish I had thought to count how many pictures there are, but I didn't and I don't have a copy of the book to do so now. I can tell you that the majority of the book is photographs with brief descriptions provided by either Dr Agarwal, Dr Neumayer or the patient.

The patient facts: While the name of the patient is given in the book, I'm not sure she wants her name all over the web, so I'm leaving it out for her privacy. I'll refer to her as dp (dear patient). I'd like to thank her for being brave enough and generous enough to share her journey with us. DP was diagnosed with cancer in her left breast and undergoes two surgeries. No radiation or chemotherapy were needed. The first surgery is a total skin sparing mastectomy (kept the nipple) on her left breast with expander reconstruction. In this surgery she also has a previous implant removed from the mastectomy side and undergoes sentinel node biopsy. The second surgery consists of the removal of previous implant on the non-mastectomy side and replacement with a new implant, and exchange of expander with a silicone implant on the mastectomy side.

Author notes: This book is meant for breast cancer patients, families and friends in the hope that it will make it easier to understand what happens during breast surgery. It is meant to be used by the patient in conjunction with her doctor. Photos were taken during the actual surgery as well as before and after.

The rest: I first heard about this book from my local FORCE monthly newsletter. Just so happens that it was written by some doctors at the big cancer house I frequent (although none of my doctors reside there). I admit that I do like the big cancer house and like all the free counseling they give me and they have helped me out a lot but this is an unbiased and unsolicited review.

I don't have $40 to shell out for a book and it wasn't in the cancer library holdings yet so I contacted Karen, my local FORCE coordinator and she was kind enough to loan me her copy. Did I mention that this book is a nice coffee table size? Sure would make a conversation piece if you do decide to display it as such! As we are standing in the middle of the library, Karen pulls out her book and bam, there is the naked bust of dp for all to see. I am pretty used to naked boobs by now but not used to seeing them on a book cover and out in public like that! There is an alternate book jacket if you flip it over. This one is of dp in surgery with 3 people in scrubs working on her. This photo just exposes her left breast a little bit.

The book does have an intro about different types of breast cancer and goes into a little detail about how to make a decision on which type of mastectomy is best for your cancer but the info provided is really just a starting point. There are some good books out there that go into greater detail about your surgery options; see the left side of my page for a few resources. Now for the heart of the book and what we've all been waiting for - surgery photos. We see pics of dp at all stages from pre-surgery to the final outcome after the exchange is made and healing is underway. Some of the instruments used during surgery are shown and explained including the geiger counter, skin hooks, electrocautery wand and retractor. Detailed photos show the many steps in dissecting the breast tissue from the muscle and skin until it can be pulled out from the skin envelope. (Not as gross as it sounds, kind of cool in fact). We see the process of the human cadaver skin being used to create a pocket for the expander and eventual implant. Photos capture how the expander gets stuffed through the small incision into the pocket. The magical part is how small the incision is in comparison to our whole breast and how they are able to get everything done in this small gap in our breast. Sometimes you will see at least 6 hands dancing above the breast all doing something different yet working together. Some of the photos stand out in my mind such as when the old implants are squeezed out of the incisions but one I won't soon forget is when Dr N is checking the skin to make sure she got out all the tissue. You'll know which one I'm talking about when you see it!

I know I talk about the "slice and gut" and "cutting the bitches off" in my blog because that is how it feels in my heart. But when you see these photos you will be amazed that it isn't like that at all. Even as dp is on the operating table with no implant or breast tissue left, she does not look deformed. Smaller, temporarily, but still whole and still beautiful.

This book is about one woman, one type of mastectomy and one type of reconstruction. It does not delve into the possible complications of surgery or the loss of sensation or recovery times. There are so many options out there, just for incisions alone so do your research. Read some reconstruction books, read the message boards and talk to as many surgeons as it takes to find the one right for you.

Wrap up: My faithful readers all know by now that I don't like surgery and am kind of afraid of it. That said, I did not find this book scary. If you are especially squeamish, you might not like the first part where they are removing the breast tissue. I thought this was a great book and wish they had one for each type of reconstruction. I didn't understand everything they were explaining but it would be a great book to read and then take to your doctor for further explanation. It might help people who don't know what questions to ask. I would love to see this book in every surgeon's office.


  1. I would love to see this book, too. I'm going to check for local resources. Thanks for the review!

  2. Wow, you with your brand new boob scar already ready to look at surgery photos! The book just came out recently so you might have to ask your library if they will purchase one. Good luck!

  3. This book is amazing, beautiful, clarifying. It is nice to be able to see the step by step pictures of what goes on "behind the scenes" and the explanations by the doctors were really helpful. I wish every doctor would be more aggressive with skin sparing mastectomies. The before and after pictures of the patient in Meet Virginia are beautiful and her breasts seemed perfect with very little scaring. Anyway, I found a website where you can buy this book if you want to check it out: I personally think it's worth buying because it helps to understand "the process" and be able to explain it to others by showing them these incredible pics. Good luck y'all!