Why I'm Not Getting Reconstruction

Here's another question I've been asked since sharing my news. Why have I chosen no reconstruction?

Again, this is a super personal decision. For some women, it's not even a question, getting reconstruction is just a part of the process. Every person has to do what is best for them, no one else. There's no place for judgment when talking about body image, especially in the context of cancer treatment.

Along with being thorough and risk averse, I also value practicality and efficiency. I don't think it's about looking for the "easy" path, but the path of least inconveniences (which, generally speaking, I think actually tends to require more advanced planning).

Getting reconstruction typically means having a longer recovery period after surgery, and usually involves multiple surgeries over a long period of time. Over the years, complications are possible, and sometimes implants need to be replaced. This whole experience has been so disruptive and unpleasant that I just want it to be done. I don't want to have to think about multiple surgeries moving forward, or increasing the likelihood of complications of any kind.

Since it's still possible for breast cancer to recur even after a double mastectomy, my NP says I will have regular clinical exams to feel for palpable lumps under the skin. The same method is used even with reconstruction, and I just feel better knowing there is nothing obstructing the detection of new lumps. Some women who get reconstruction might still be recommended for routine breast imaging, depending on their risk factors. To me, that just translates as an added on-going inconvenience.

Beyond wanting to minimize procedures and complications, and wanting clear access to detect possible recurrence, of course there's the self-image factor. When I think about it, I don't feel like my breasts are a significant part of my self-identity. Of course, I won't know how I really feel until after the surgery...

I am apprehensive mostly about two things. First, that I might end up with "dog ears", little flaps of skin or fat that hang under your armpits and look like little dog ears. (Some women call them "side boobs"!) My breast surgeon assures me that if I do develop them, he or a plastic surgeon could do revision surgery to remove them. It would be unfortunate to have to have another procedure, but at least I'm prepared for the possibility.

Second, without breasts "rounding out" my body shape, my belly fat will be more noticeable. (Some women refer to having a "Buddha belly"!) I've mostly not been self-conscious about my weight gain over the years, I think because it's not super noticeable with my body type. But it will definitely be more noticeable without breasts. I am thinking I will want to make more of an effort to eat well and exercise to hopefully reduce that belly fat a bit. And as much as I am not a fan of shopping, I will need to find new clothes that fit and are flattering.

There is the option of wearing prosthetics, and I haven't ruled it out. I'm honestly not thinking about it too much just yet, as I want to see how I feel just being flat. Apparently there are all kinds of prosthetics available, so it will require more research if I go in that direction.

Finally, one related thought that has occurred to me is that I actually feel more uneasy about the possibility of needing chemotherapy than the idea of losing my breasts, because I don't want to lose my hair. Unlike my breasts, my hair feels very much tied to my sense of self. I love my hair. I would hate to lose it, and I know a wig would not feel the same.