The Cocoon Phase

Reflecting on a workshop I recently attended, I realised how lucky I am. Whereas the other eight women wanted to change the course of their lives and careers, I am very happy doing what I do. I am a plastic surgeon with a special interest in breast reconstruction. 

Most of my patients are women, many of whom have been diagnosed with breast cancer. I get to share some of their brave experiences on their journeys to recovery. I refer to this as The Cocoon Phase.

This phase starts once the diagnosis of breast cancer is confirmed. There is usually a reaction of shock and a sense of bewilderment, a search for reasons. Often the patient feels overwhelmed – not only have they been diagnosed with a potentially life threatening disease, but they may also be faced with losing one or both their breasts. The possibility of losing their hair due to chemotherapy looms ominously. There is also the fear of the unknown: how will their bodies react to the treatment? How will they and their loved ones cope emotionally? Many of them feel that life as they knew it came to an end with their cancer diagnosis.

What they do not yet see, but I see all the time, is that their diagnosis can be the start of a journey to a more fulfilling and vital life!

The part I play in this journey is a positive one: I reconstruct the breast or breasts that these women are about to lose, or have already lost.

Fragile Cocoons

The woman I meet at the beginning is often scared, vulnerable and feels that she has lost her femininity – reduced to “a cancer patient”. As the reconstructive process evolves, I often get to know my patients better and experience them as so much more than the fragile patient who first walked into my rooms. I am introduced to a whole woman and watch enthralled as she emerges from her cocoon.

This is especially true when we use a tissue expander to stretch the overlying skin before reconstructing the breast. The expander is inflated every three weeks in my rooms, generally while the patient is still on chemotherapy. During these visits my patient talks to me about the ups and downs of these tough times, and I learn a little of her inner experiences.

Once chemotherapy is over the expander is removed and a permanent implant is inserted. By this time her hair is usually growing back and she starts to feel emotionally stronger. Once the nipple is reconstructed, and the areola tattooed, the patient feels whole again. The butterfly emerges andis free to fly again.


The time spent in the chrysalis may feel intense and never ending but, when reflecting back on this phase in later years, women often report that it seems just a short chapter in their lives. Some even see their diagnosis, and the trauma that they went through, as a turning point that helped them to grow, to focus, to start living life differently and more positively.

They learnt to let go of negative energy and start focusing on positive aspects of life and making the most of their lives.

I am privileged to play a role in helping women to heal, in coming to know the real woman and to see her transform into a beautiful butterfly.

Written by Dr Carla Norval