Post-Mastectomy Options

Oct 24, 2013 | Updated Jan 23, 2014

The decision to have a mastectomy is not one to be taken lightly, and I do not know a woman out there who did not agonize over it, including myself. For me, it was the right decision, but that does not mean I came to it easily. I researched post-mastectomy options ad nauseum and got multiple opinions from physicians. The reason, however, that I decided to write this is because sometimes it helps to hear from someone who has been there and already compiled the information. When you are faced with a cancer diagnosis, it is hard to think rationally and collect the information you need to make an informed decision. I wish an objective party had done this for me at the time.

Once the decision to have a mastectomy has been made, you may (or may not) start thinking about reconstruction. Not everyone decides to have reconstruction. I think that is an important point. People automatically assume there is a second part to the story but, often times, there is not, and that is okay if that is what you decide. It is crucial that no one feels pressured into this decision. In retrospect, that option was never even offered to me. It just so happens that I wanted reconstruction, but I was so confused and overwhelmed at the time that I think I could have been easily misguided. Not intentionally, of course, but I was 37 years old and in shock after hearing my diagnosis. My mouth, still open from the trauma, my response to most of my physician's suggestions at the time was a brilliant, "uh huh." Nothing was really resonating with me yet.

If you decide to reconstruct your breasts, there are several options available to you. Of course, this depends on several factors. According to Dr. Chike-Obi, M.D. of

The most appropriate reconstruction for a woman after mastectomy depends on many moving variables -- her general surgeon (the surgeon who performs the cancer removal), her plastic surgeon (the surgeon who performs the reconstruction), the severity of her disease, whether she will need additional therapy such as radiation or chemotherapy, her body habitus. Traditionally, a reconstruction performed with the patient's own tissues (most commonly the abdomen) is felt by many surgeons to provide the most natural-feeling breast mound, compared to an implant-based reconstruction. Fat and skin can be harvested from the abdomen, back, inner thighs, buttocks, and shaped to reconstruct a breast after mastectomy ... also, the quality of implants today is dramatically better than it used to be. Additionally, the now-available anatomic cohesive gel implants (gummy bear and tear-drop shaped) allow surgeons to deliver a much more natural and supple implant-based reconstruction than was previously possible. With implant-based reconstruction, patients have the opportunity to avoid another surgery site. One potential disadvantage, however, is the common need to perform tissue expansion (an additional surgery) of the chest wall to create space for the implant. This requires an intermediate surgery and several office visits before the implant is finally placed.

Simply put, you have few options. There is something called a "flap" procedure that uses your own tissues (including fat and skin) to help create a new breast, but if you are on the thinner side, you may not be a candidate for this type of procedure. Further, you then have multiple surgical sites to look after. This is not necessarily an issue but is worth mentioning, in the interest of full disclosure, because the more incision sites the greater the chance of infection. Another option is to have expanders placed and slowly inject volume over time. The idea is to "overfill" so the skin can easily accommodate a breast implant. As Dr. Chike-Obi mentioned above, this involves multiple visits to your doctor to have fluid injected and, later, another surgery to have the expanders removed and replaced with an implant of your choosing. Again, new implants can provide a very realistic appearance and feel. Once again, in an effort to be as forthcoming as possible, the injection of fluid itself is not painful but the process can leave you feeling like you had a very intense workout. The stretching out of the area can ache and be uncomfortable for a day or two but there is no need to rush. If it is too painful, you can always ask your physician to slow things down and put in less volume each time. Remember to be your own advocate and let your doctor know how you are responding to your treatments.

I think the most important thing to remember when making this decision is to go at your own pace. Don't feel rushed. It is okay to stop and ask questions. If something comes to mind, day or night, write it down and bring it to your doctor on your next visit. It seems that I had most of my "insights" in the middle of the night so I took to leaving a notepad and pen on my nightstand. Then next thing you know, I had quite a long list of questions! Luckily, I had also shopped around for a doctor that was perfect for me and very receptive to my way of doing things.

Lastly, and perhaps most importantly, it is okay to recognize and experience feelings of loss. This may seem strange to some, but you have to acknowledge that you are losing a part of your body. Even if you intend to replace it, the fact remains, there is a certain amount of grieving that is to be expected throughout this process. I was very unprepared for this aspect of my recovery, which is why I feel compelled to mention it to you now. Much like phantom limb pain in patients that have lost a limb, there is a similar phenomena that can occur after a mastectomy. I joined a support group prior to having my surgery in anticipation of what was to come and found that my feelings of loss and grief were surprisingly common. The important thing to remember is that these feelings don't last forever. I highly recommend joining a support group because it is so important to understand that we are all in this together. Everyone respects everyone else's personal choices and no one judges. We are all just there to help each other. If you go to a group and you don't like it, just find a different one. There are times when you just need to talk to people who have been through exactly what you are going through because no one else quite "gets it." Just remember, you are not alone!

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