“I thought that you were done with surgery, Stef. What are you going in for this time?” several friends inquire.

“This is the second stage of reconstruction,” I reply, noticing my friends’ confusion. “They take the temporary expanders out and put the permanent implants in.”

Knowing looks follow, as my friends begin to register what the process entails. I quickly interject:

This isn’t like getting a boob job, though.

“It’s not?!?” they comment with surprise. I then exhale as they launch into a well-intentioned story or ask a question about elective breast surgery.

How is Breast Reconstruction Phase Two not like Breast Augmentation?

1. The Incision: During a boob job, the surgeon makes a tiny incision near the armpit, the areola or below the breast. In breast reconstruction, the surgeon needs to open up the old mastectomy incisions. If my breasts were globes, my scars resemble the equator. My incisions are thin, but they are the entire width of my breasts. (For those of you who would like to see a photo, the first image from David Jay’s Scar Project is a realistic depiction of what my breasts will look like once the stitches dissolve.)

Yes, scars will fade. Yes, I can use Vitamin E oil to expedite the process. But, my surgeon anticipates that I will need laser treatments next year to help reduce the appearance of the scars.

2. Nipples: Women with elective breast surgeries still have their nipples. I have none since they were removed during my mastectomy surgery. (Breast cancer can originate in the milk ducts.) My boobs are like those on a Barbie doll. I plan to get new nipples made from a skin graft as soon as I am able to in 2013.

3. Muscle, Tissue and Swelling: In a boob job, implants are placed over existing muscle and tissue. That’s why after a breast augmentation, a woman’s breasts are so high and pronounced. During a mastectomy, all breast tissue and muscle are removed. Since I don’t have any breast tissue or muscle, I’m not swollen. What I see when I take off my surgical bra is an accurate representation of the size of my breasts.

4. Excitement: Women who get breast augmentation are elated to show you their fabulous new tatas. They chose this elective surgery. They wanted their new breasts.

I had breast cancer. I decided to get mastectomies and reconstruction, after reviewing my options with my team of oncologists and surgeons. Prior to my diagnosis, I never thought about getting any cosmetic surgery on my breasts.

Am I cautiously optimistic that this is my last surgery for a year? Yes. Am I thankful that these surgeries have dramatically reduced my risk of getting breast cancer again? Of course. Are they large, symmetrical and perky? Yep! Do I view my breasts as "mine" anymore? No, not at all.

I viewed last week's surgery as a necessity. I needed to have the expanders replaced with permanent implants, and they were. I've jumped over the next hurdle. 

I felt angry and sad regarding my mastectomies and ambivalent about reconstruction. Nothing about this process has involved excitement, aside from the news that I'm cancer-free.

I’ve tried to be as open as I can throughout this process, and I’ll happily answer any questions that you might have. Just please don’t ask me about my boob job.