Prophylactic mastectomies are not for the faint-hearted. I made my initial decision to get one based on the negatives of getting cancer. I knew little about the surgery and recovery process. Once I started meeting with the surgeons, however, the negatives of the surgery brought me to the decision-making table all over again. Two realities most disturbed me:MORE: How to Assess Your Breast Cancer Risk Factors1. I may never be able to do push-ups again.Your pectoralis major is the main chest muscle that allows you to push your arms forward or bring them across your chest. During the first surgery, after they have removed the breast tissue, they lift the pectoralis major muscles up from the chest wall and use them in the breast reconstruction process. These muscles are no longer used as chest muscles for strength and movement. Instead, they serve as protective layers between the breasts’ skin and what will be the implants. If you place implants directly under the skin, you’ll likely get hard, lumpy scar tissue, and there is a high risk of complications and infection. Most surgeons will not even perform the surgery inserting implants directly under the skin.As part of the first surgery, surgeons insert expanders in the chest to gradually stretch out the pec muscles, so that they can cover the future implants. In order to keep the pec muscles from compressing the implants and making them “jump around” (as my surgeon put it) with arm movement, they may need to “quiet down” the pectoralis major by cutting nerves to make it less active.What got me most was when my plastic surgeon said, “You won’t be focusing on push-ups after the surgery.” What?! Push-ups are practically a part of my identity. I do at least 30 a day. I love them. Our family even has push-up contests—including ones in public, such as at Disney World (the photo above shows me with my son during one of our famous push-up contests). This alone was almost enough to change my mind about having the surgery, but my surgeon reminded me that the pectoralis minor muscle, over time, will strengthen and can take over much of the lost pectoralis major function. He noted that he has many athletic patients who ultimately find no problem doing what they enjoy. Still, I may not be able to win the family push-up contests anymore. I went through all of the other options with the surgeons. They can use other muscles, but they have even more serious downsides. For me, no other option is any better.After weeks of struggling with this issue, this is how I think about it now: “Hey, I’m a trainer. I’ll still have my pec minors, and I’ll develop them to the full extent I can and then go with it.” My guess is that although I will initially notice a big difference in my workouts, and I may need to change some of the focus of my exercise routines, I will not notice a big difference in my daily life otherwise. That’s what I’m hoping for anyway.MORE: Stay a Step Ahead of Breast Cancer With Exercise2. You lose the sensation in your breasts and nipples.Okay. So I could have guessed this one, knowing that they’re cutting out everything under the skin, but I hadn’t actually thought about it. The surgeon said, “You’ll lose the sensation in your nipples, and they won’t be erectile anymore.” Hmmm. Did I care about this one?  Actually, yes…quite a bit. Every woman has her own take on how important or not this is. The doctor did throw me a little bone when he said that some women get back some or even much of the sensation. “But,” he said, “don’t expect it. It’s not the norm.”Those were the two hardest hurdles for me climb over in terms of keeping my determination to move forward with the prophylactic mastectomy. But there were some other surprises: This is not just one surgery. It involves at least two surgeries and is a three-12 month process before it’s over.In the first surgery, they remove the breast tissue, create a pocket for the future implants, and put in the chest expanders. You wake up with drains coming out of your chest that stay in place for several days. Some women I’ve talked with who have had this procedure say that, because of the expanders, they actually had more back pain than chest pain after the surgery. My surgeon said this is usually caused by overaggressive expansion, and I should not have the same complaint.For the next several months, you have to go in every two to three weeks to have fluid injected into the expanders to stretch out the skin and pectoral muscles. I’m likening this in my mind to braces and getting them tightened every month to gradually move the teeth. Once you’re expanded enough, they do another surgery to put the implants in and make you look nice. One kind of cool thing is that you get to experiment with size in this process. You can keep getting expanded until it looks right to you. You can also back down in size. Nothing is final until the implants go in.I was worried about needing to have the implants replaced every 10 years or so after reading that was the case. My plastic surgeon says it’s a common problem with saline implants but not with the cohesive gel (“gummy bear”) type. He says that, while they are only guaranteed by the manufacturer for 10 years, he anticipates they will do well for the rest of my life.Finally, most women do not need to wear a bra after this surgery. Everything is stretched so tight that you don’t sag. On the down side, several women I’ve spoken with feel as though they have a tight bra (some describe it as a corset) on all of the time. One woman, three years after the surgery, said she still goes to take off her bra at night and quickly remembers she’s not wearing one. It just feels like she is. My surgeon, I’m guessing because of his skill and surgical technique, doesn’t think I’ll have this tight sensation issue.One of my takeaways after the investigating phase—trying to figure out what to expect and what type of surgery to choose—is that women have very different outcomes from breast cancer surgeries and from preventive surgeries. I’m sure that while some of it may have to do with the patient, my sense is that the surgeon makes the biggest difference. I am using someone who performed a surgery on another family member, and they were extremely impressed with him and pleased with the results. Given that endorsement and my sense from conversations with this surgeon, I feel confident that he’ll do a good job both in terms of aesthetics and function. I hope I’m right.MORE: Would You Remove Your Healthy Breasts to Prevent Cancer?

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