If you've had a mastectomy, your medical profile may make you a candidate for reconstructive surgery. There are several kinds, but the main choice is whether you want to live with the way your body looks and feels with just one breast or none at all or have doctors construct something artificial.
Some women are quite sure they want reconstruction
The decision to go ahead and have the surgery is a no-brainer for some women: It may be importanteven essentialto your self-esteem to have two breasts and that they look as close as possible to what you were used to (or better).
"I knew that I wanted to do reconstruction; I just didn't know what kind," says Sharon O'Donnell, 51, of Hamilton Township, N.J., who finished her surgery in November 2007 and eventually decided to get tissue expanders and implants. "I've always been athletic, and I didn't like the idea of a TRAM flap [surgery]; I didn't want to lose musculature in my body."
Johanna, 41, of Chesterfield, Mo., was equally sure that she wanted to wake up from her mastectomy surgery already on the way to having her breast reconstructed. "I made sure my reconstruction was done before the third week in July ," the one-year anniversary of Johanna's diagnosis with stage IIB invasive ductal carcinoma. "It helped to have the reconstruction start immediately. Psychologically, that helped me along the way."
Reconstruction is not for everyone
But some women opt out. In fact, only about 17% of women who've had a mastectomy end up having reconstruction.
"I have no plans for reconstruction," says Debbie Arkin, 49, of Tampa, Fla., who had a double mastectomy to remove stage IIA invasive ductal carcinoma in 2006. "I love not wearing a bra. I had 34DD breasts and am enjoying the break from having all that weight on my upper body. I lost nine pounds of breast in the surgery."
Counter to some misguided notions out there, women who don't have surgery "aren't 'letting themselves go' and it doesn't mean they don't care about their sexuality," says Leslie R. Schover, PhD, professor of behavioral science at the University of Texas MD Anderson Cancer Center in Houston. "Some women are just comfortable with that [choice] and don't feel the need to have something artificial."
It's worth remembering, too, that reconstruction won't leave you with Playboy-perfect breasts; there will be scars no matter what type of operation you choose. And if you had issues with your breasts (or your body in general) before having cancer, reconstruction is unlikely to make those disappear. "There's also the issue of balance between the two breasts. The reconstructed breast may be perkier and stand up more," adds Schover.
Or decide later
If you're just not ready for the extra surgery that reconstruction entails, it's fine to decide later, says R. Bruce Shack, MD, professor and chairman of the department of plastic surgery at Vanderbilt University Medical Center in Nashville. "For some women, they have enough to deal with with the cancer. Some women are sent to me right after they've gotten a diagnosis. All they can think is, 'I've got cancer.' I tell them, 'Don't think you have to make up your mind about breast reconstruction today; you're never going to come in and I'm going to say it's too late.' The same options are available for delayed reconstruction as for immediate reconstruction." And those women who delay or avoid reconstruction can choose a breast prosthesis.