Reconstruction decisions


With all the reconstruction options a woman has after breast cancer--immediate versus delayed, implants versus autologous, etc.--the first decision may be to have one at all. I'm currently working with one of our writers on an article on reconstruction after breast cancer and what to consider when deciding on when to have it, what type and whether to have one at all. We feature three survivors in the article, and we wanted one of them to be someone who decided to forego reconstruction.We reached out to our Facebook fans to ask why women may have decided not to have reconstruction, and we received answers that were across the board. After weighing all the options, did you choose not to have breast reconstruction after cancer?Thank you to all the women who commented and shared their story via Facebook and email!We ultimately chose Jackie's story. She was diagnosed with stage 2 breast cancer more than 10 years ago. "Reconstruction wasn't even on my mind at that time," she says. The thought of more surgeries turned her off of reconstruction. Once she finished treatment, she admits she thought about it briefly, but again decided she didn't want or need it. Other women brought up potential complications of reconstruction, and Jackie wasn't the only one who commented that additional surgeries just didn't seem worth it. Cambria says, "I had neo-adjuvant chemo. So, I had more than 6 months to consider what I wanted. If I'd had surgery first, when I was first diagnosed, I probably would have reconstructed. It's just what everyone expects you to do. During chemo, I was able to really consider my options." She later consulted with a plastic surgeon to understand her options for delayed reconstruction. "However, I am completely satisfied and have no desire to reconstruct. In addition ... I just didn't want more medical intervention."We also had other women who commented that they're happy they decided on their reconstruction decisions.Susan: I had reconstruction simultaneously with mastectomy. I'm glad I did it then because I'm not sure I would have wanted to go through another surgery if I had waited. On the other hand, I wonder if radiation affected the final results. I waited 9 years before I matched up the other side. I figured if I was still around by then, I might as well do it.Audrey: I had reconstruction done 6 months after my radiation, 3 surgeries in total. First surgery was diep flap of the right side, second was symmetry (make the real one match the fake), & third was nipple reconstruction. I also went to have the nipple & area around the nipple tattooed. I am very pleased with all my results. The areola is hard to tell it's a tattoo. No regrets!I've also been following one woman's process of reconstruction through her blog at Chemobabe. She writes:"I have had a hard time writing about reconstruction. It doesn't quite fit the heroic cancer narrative of kicking ass and taking names. It's more personal and intimate. Reconstruction serves quite literally to rebuild not to cure, making it awkward for an audience." However, she does a great job of breaking down her decisions regarding whether to have reconstruction or not, the type of reconstruction, the pain she experiences, the multiple surgeries, the expanders, the psychological impact and her expectations. I highly recommend reading her post, "Reconstruction Q&A with Uneasy Pink."Another blogger contacted me about her decision not to have reconstruction. Phillipa has decided against reconstructing the breast that was removed during surgery and would like to remove the other one. Instead of reconstruction, she says, she wants to "deconstruct.""Discrimination and Deconstruction""I know that I am very fortunate that I did not need a double mastectomy so I feel that I should be thankful for having one breast intact. I realise that I am probably rather odd and ungrateful in my attitude towards my single breast, but that is the way I feel, I am afraid."I have a feeling that what Phillipa is feeling is not odd or uncommon. Even Kathy, our editor-at-large, struggled with the decision when she was first diagnosed 25 years ago. In "Reconstruction: shopping for a new boob," Kathy says she just wanted them off. "Reconstruction was the last thing on my mind when I had breast cancer 25 years ago...In fact, I told them I wanted them both off, but they wouldn't do it back then... I just didn't care about my breasts. They were trying to kill me, and I wanted to be around to raise my daughter."A year later, she did decide on reconstruction and all was fine until she was diagnosed with a second primary in 2007 and had even more decisions to make. The decision to reconstruct (or deconstruct) is as individualized as each woman. However, it's up to their medical team (and frankly, their support team, too) to provide them with as much information, resources, choices and support to make a decision that's right for them.

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