Big Surgery decisions after a breast cancer diagnosis

There is no “one-size-fits-all” approach to breast cancer surgery and in fact there are a number of surgical options depending upon your diagnosis. This article explores the choices made by a range of women together with some advice for making your own decision.

By Kim

My breasts

I’ve always had small breasts and the size never bothered me. But by the time I was diagnosed with cancer at 40, I didn’t like the look of them. After breastfeeding, they lost the little bit of volume they previously had, and they were ugly.

Facing the decision no woman wants to have to make

But even so, when faced with the decision no woman wants to have to make, I couldn’t envision myself without breasts. After diagnosis, a part of me looked forward to having boobs that wouldn’t sag and leave gaping spaces in bra cups. It was that reason, and for the sake of my husband that I didn’t really even consider going flat. I can confidently say that Corey would have supported me fully if I had gone flat, but I’ve been married to him for 23 years and I know that unlike me, he actually liked my small saggy old lady boobs. So I wanted to love him by having my breasts reconstructed.

But not every woman feels the same as me. And not every husband is wired like mine. And that’s okay. Below, I will introduce you to some women who have been faced with this choice, and give you a few thoughts to consider while working through the decision making process yourself.

Jodi – flat

Jodi was 46 when she was diagnosed with breast cancer. She knew from the start that she would have surgery and go flat.

“I knew without a doubt I didn’t want it (reconstruction.) I didn’t want anything else put in my body. I guess I just felt that my breasts didn’t define who I was, so I was okay with not having them,” she said.

Though I chose a different road than Jodi, she speaks truth. Our current culture tries to convince us that our value lies in our physical bodies, but culture speaks lies. Our value is in our spirit, not our cup-size.

Cathy – single mastectomy with reconstruction

Cathy had a single mastectomy after being diagnosed with breast cancer at 40. She immediately knew she would undergo reconstructive surgery to match her remaining breast.

 “I remember having the thought, ‘I’m not going to stuff my bra for the rest of my life,’” she said. Cathy’s reconstruction took place in 2000, and two decades later, though she has had to have some revision surgery on her natural breast, she has no regrets.

Rachel – preventative double mastectomy with reconstruction

Rachel was 20 when her mom died of breast cancer. At age 35, Rachel tested positive for the BRCA 2 mutation.

Because she didn’t actually have cancer, Rachel had a hard time deciding whether to go through with the double mastectomy and reconstruction surgeries. A biopsy scare in the midst of her uncertainty made the decision for her. After a spot was found on an MRI, Rachel was required to have a biopsy. Though the results came back negative, she never wanted to go through that again. “I’d just be waiting for it to be positive. Every time,” she said. “I couldn’t live with that stress every six months. It’d kill me.”

Kerry – Initially went flat, later chose reconstruction

Kerry had three young daughters when she was diagnosed with breast cancer at 39. She chose to go flat after her single mastectomy in order to get back to normal life as quickly as possible.

For almost 20 years, Kerry was flat on one side. It was after she lost weight and decided she wanted to look symmetrical in a swimming suit that she started thinking about reconstruction. “In the back of my mind, for a long time I thought, ‘if I ever get breast cancer again, I’m doing reconstruction,’” she said.

When an abnormal mammogram on her remaining breast led to a second cancer diagnosis nearly 20 years after her first, she didn’t hesitate to choose reconstruction. Kerry is happy with her reconstruction, but doesn’t regret the years she spent flat.

Prompts for reflection

Thoughts and questions to consider in your breast cancer surgery decision making process:

• Like me, do you have a significant other whose opinion you value in this arena? If so, ask them for their thoughts and let the response have some weight in your decision making.
  
• Like Jodi, if the thought of having a foreign object placed in your body, or the thought of prolonging treatment by going through the reconstruction process is unappealing, maybe going flat is the best choice.
  
• Like Cathy, if you choose reconstruction after a single mastectomy, consider that you will likely need surgery on the natural breast to make them match as closely as possible. And years down the road you may require more surgery to bring uniformity back to the breasts as the natural breast changes.
  
• Like Rachel, if you test positive for a gene mutation and are having a hard time deciding whether or not to undergo surgery, consider how the stress of bi-annual mammograms or MRIs will affect you with your heightened breast cancer risk.
  
• Like Kerry, remember the decision you make between reconstruction and going flat now doesn’t have to be your forever decision. It’s not uncommon for women to change their minds down the road.

There’s no right or wrong answer to the question of breast reconstruction versus going flat. It’s an intensely personal choice, and one that no one else can make for you.

This article contains excerpts from Life Reconstructed: Navigating the World of Mastectomies and Breast Reconstruction by Kim Harms originally published by Familius copyright 2020. Kim Harms is a freelance writer, speaker and author of Life Reconstructed: Navigating the World of Mastectomies and Breast Reconstruction (Familius 2021.) Harms has a degree in English from Iowa State University. She underwent a bilateral mastectomy and reconstruction surgeries in 2016 after being diagnosed with breast cancer at age 40 and provides resources to women going through similar circumstances on her website. She lives in Huxley, Iowa with her husband, the youngest of their three sons and one crazy dog. You can find Kim online and on social media:

Website –   kimharms.net

Instagram – @kimharmslifereconstructed

Facebook – kimharmslifereconstructed

Order Book – Life Reconstructed on Amazon

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Future Dreams hold a range of support groups, classes, workshops and events to help you and your carers during your breast cancer diagnosis, including ones about surgical options. These are held both online and in person at the London-based Future Dreams House. To see what’s on offer and to book your place, see here.

May 2022

This article was written by a guest author based on their own experience of breast cancer and its treatment. It is important to note that this is one person’s experience and that whilst there may be commonalities between the experiences of different people, everyone has a different diagnosis/treatment plan/general experience. The information and content provided in all guest articles is intended for information and educational purposes only and is not intended to substitute for professional medical advice. It is important that all personalised care decisions should be made by your medical team. Please contact your medical team for advice on anything covered in this article and/or in relation to your personal situation. Please note that unless otherwise stated, Future Dreams has no affiliation to the guest author of this article and he/she/they have not been paid to write this article. There may be alternative options/products/information available which we encourage you to research when making decisions about treatment and support.