Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Most women who undergo mastectomy are offered the opportunity to have breast reconstruction. Some women choose to have their reconstruction at the same time as their mastectomy. Others opt to wait. Some must wait, due to medical conditions that increase the risks of surgery. Nevertheless, more than 80 000 women undergo reconstruction after surgery every year."1
I decided not to undergo reconstruction with my mastectomy. When my breast surgeon asked me to schedule a visit with a plastic surgeon, I was reluctant to heed his suggestion. I had just endured a lumpectomy, followed within a week by a wide excision and axillary node dissection, plus a sentinel node biopsy as part of a clinical trial. I had been poked, prodded, and made to watch more vials of my blood collected than I thought humanly possible. I was also sporting drains, stitches, black and blue marks, and a numb left arm.
When I finally agreed to find out more about reconstruction, I found the plastic surgeon extremely thorough. He measured and examined my breasts from every angle. He determined the amount of skin available in my abdominal area, buttocks, and back. He took copious notes about my general health and previous medical history. Finally, he explained in great detail the options for reconstruction.
First, I could choose the least invasive reconstruction procedure, involving the use of saline-filled tissue expanders to stretch the skin over the chest wall, followed by insertion of a permanent breast implant and construction of a nipple on the surface. The second option was flap surgery, using tissue from either my stomach or shoulder to create a pocket for an implant or to create a new breast. Finally, I could select free flap surgery, the "gold standard" of breast reconstruction, in which a new breast would be created from my abdominal tissue, and the blood vessels feeding the tissue would be reconnected underneath my skin.
Along with his explanation of the procedures, the plastic surgeon showed me color photographs of post-mastectomy scars and reconstructed breasts. While it was clear that he considered these pictures to be mere tools of the trade, for me they were extremely graphic and unnerving. To this day, I think that seeing these photographs contributed to my reluctance to view my mastectomy scars.
I decided that I wanted to see some pictures of one of the alternatives to surgical reconstruction—breast prostheses. I found descriptions of both ready-made and custom-made options, and even one company that would make a mold of my breast and create a duplicate. The advantage of a prosthesis was that I would not have to have additional surgery—I could just pop it into a special mastectomy bra, which would have a pocket to keep it securely in place. The negative side, of course, would be that when I removed my bra, I would be reminded of my experience with cancer.
Weeks before my mastectomy would be performed, I stood in front of the bathroom mirror and looked at my naked breasts. They weren't much, and I never paid too much attention to them. But now that one of them was about to be removed, I was agonizing over the loss. Would I feel disfigured every time I looked at my chest? Would my husband be repelled at the sight of me? Would my kids treat me differently? Would anyone notice?
I weighed all the choices in my mind, talked to my husband about his feelings, and even asked my children for their opinion. The bottom line from everyone was that it was my decision. They would all support whatever I wanted to do. As my husband put it, "I didn't marry you for your breasts." My children just wanted me to be healthy and alive.
After a lot of soul-searching, I decided to avoid reconstruction. Probably the biggest factor in my choice was the fact that I had gone through 3 surgeries in 6 weeks. I had been a faithful patient, but at some point in time, I just felt I had to throw up my hands and say, "I have had enough."
If reconstruction could have enhanced the statistical chance of surviving longer or avoiding a recurrence, I would not have hesitated to go under the knife again. The fact that the surgery was cosmetic only made my decision easier for me personally. I decided that I was confident in my self, secure in my body image, and willing to tackle the world sans breast.
I really did not mourn the loss of my breast. When I awoke in the recovery room, I was so happy to be alive that it didn't occur to me to feel any less than myself. After about 3 days at home, I finally looked at my chest in the mirror. The scar was long, neat, and very red. I knew that it would fade over time.
Some women choose to undergo reconstruction because they worry that they will not be able to feel feminine without normal-appearing breasts. Others do it to please their husbands or partners. In the end, I decided that I was comfortable in my own skin, and I needed to do what felt right for me.
It has now been 2½ years since my surgery, and when I occasionally think about reconstruction, I immediately dismiss the idea. My prosthesis is comfortable, looks great, and is undetectable. I have adjusted to the new shape and contours of my body. I am relaxed about my appearance and often forgo my bra in the house and have even ventured out in public without it.
I realized that my breasts do not define me as a woman. Perhaps my curves have changed a bit—I'm a little lopsided, but I maintain my warped sense of humor, competitive nature, a sharp tongue, and the need to help others. I'm still me, and I'm alive, happy, and better than before.
Bily L. Breast Reconstruction: One Woman's Choice. JAMA. 2001;286(17):2163. doi:10.1001/jama.286.17.2163-JMS1107-7-1