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Why These Women Said ' No' to Breast Reconstruction After Mastectomy

Many women opt out of breast reconstruction, or “go flat,” after mastectomy, and are happy with their decision. By Sheryl KraftMedically Reviewed by Thomas Urban Marron, MD, PhDReviewed: October 2, 2017Medically ReviewedJeannine, Nikki, and and Chiara all opted to "go flat" and are happy with their decisions.Andrew Cohen of FifthEye PhotographyOne of the first questions for a woman who’s facing a mastectomy is whether to have reconstructive surgery or not. Though breast reconstruction has evolved through the years, not every woman opts in. In fact, one study published in October 2014 in the journal JAMA Surgery revealed that just 42 percent of the women enrolled in the study chose reconstructive surgery following their mastectomies. Their reasons varied from not wanting additional surgery to being fearful of the implants. “Reconstruction is a voluntary and deeply personal choice,” says Melissa L. Pilewskie, MD, a surgical breast oncologist at Memorial Sloan Kettering Cancer Center in New York City. While some women will undergo the surgery, others want a more minimal approach, she says. “They just want to get through treatment and not add anything else, or it’s simply not important to them.” The same study in JAMA Surgery found that — reconstruction or not — almost 87 percent of the women were satisfied with the decision they made. Here are three women who opted out of reconstruction and decided to go “flat,” without regrets.

Jeannine Love

40-year-old Jeannine Love, a college professor who teaches public administration and political science at Roosevelt University in Chicago, Illinois, proudly refers to herself as a “uniboober.” Love was diagnosed with cancer in her left breast in September 2016. She could have had a lumpectomy followed by radiation as a treatment option, but chose mastectomy over lumpectomy in order to avoid radiation. (Radiation therapy is generally not used for women newly diagnosed with stage I or II cancers who undergo mastectomy, but is recommended for patients who undergo lumpectomy in order to eradicate any cancer cells that might remain in breast tissue.) At her initial meeting with her breast surgeon, Love discovered that it was customary to make an appointment with a plastic surgeon for reconstructive surgery then and there. Love was already fairly certain that she did not want the surgery, but went along with making the appointment because she was so overwhelmed by everything that was happening. Plus “I wanted to make a fully-informed decision,“ she says. But she did an abrupt about-face when she watched a short educational video on YouTube detailing breast reconstruction options. “I could barely get through it. I immediately called to cancel ... there was no way I was going to do that to my body,” she says. Love realized she didn’t care about appearing “normal.” She just wanted to feel healthy. Love did feel a bit self-conscious about her appearance at first, especially since she chose to remove just one breast rather than both, which would have allowed for more symmetry. Since it’s hard to match one reconstructed breast to the unaffected breast, many women also opt to reconstruct the breast unaffected by breast cancer. But that feeling didn’t hang around for too long. These days, she’s comfortable dressing in all types of shirts, from tank tops to halter tops. “The only trick is finding tops that don’t have darts or cups for breasts,” she says. “But as a woman with a 32A-32B bust, I had this problem before mastectomy! Because I have a small bust, I tend to go without a bra.” For women who don’t have that option or would rather wear a bra, there are mastectomy bras specially made with pockets to hold breast prostheses. In fact, Love was just featured by the activewear brand Athleta, modeling their Empower Bra for women who’ve undergone mastectomy. Ironically, Love feels better about her body than ever. “If anything, this has made me more confident. My body is amazing; it’s gone through so much and yet it has thrived ... I am in awe.”

Chiara D Agostino

When former high school Italian teacher D’Agostino lost her left breast to cancer in 2014, she had reconstruction immediately. “The doctors told me, ‘we can fix that,’ and I was all for it,” says the resident of Montclair, New Jersey. “Going flat was never an option for me.” Six months later, she had the right breast prophylactically removed, in order to prevent a recurrence there, and got an implant on that side, too. But after repeated infections and six additional surgeries to replace the implants, the option to go flat became appealing. The surgeries left D’Agostino physically and emotionally drained, and depressed and resentful. She decided “no more,” and had the implants removed for good. Soon after her final surgery to remove the implants, D’Agostino came across an article in The New York Times that made her glad she’d followed the path she had. “It was all about women going flat after breast cancer; it featured strong, beautiful, and creative images,” she recalls. D’Agostino began to learn about — and reach out to — the many support groups that sprung out of the “going flat” movement, like the online forum Flat and Fabulous, where women boldly embrace their decisions to forgo reconstruction, declare their right to choose, and openly share their photos and stories. Inspired, she even started her own blog, Beauty Through the Beast. D’Agostino is presently undergoing treatment as part of a clinical drug trial for metastatic breast cancer. But she’s not letting that, or her flat chest, dampen her spirits. She recently fulfilled a lifelong dream of modeling, appearing in the October issue of O, The Oprah Magazine. In the full-page photo, she is nude, her torso sporting two red horizontal scars where each breast used to be. Head slightly tilted, her silky salt-and-pepper hair gently cascades over her shoulders. She is smiling, at ease. “I accept who I am. This is what breast cancer looks like,” she says. “I’m still beautiful, and it doesn’t matter what is on my chest. No plastic surgeon can ever alter that.”

Nikki Triplett

“I knew from the beginning I didn’t want reconstruction,” says Triplett, a 38-year-old Houston resident, who also answers to the name Trip. “No fake breasts for me.” Trip was unsurprised to be diagnosed with breast cancer in her left breast at age 36. She had a history of cysts in her breasts, plus one of her aunts died of breast cancer at the same age at which Trip was diagnosed, and her grandmother, still alive at 75, has fought it three different times. Trip had the breast removed, and because her cancer was aggressive, underwent a grueling regimen of chemotherapy and radiation treatments. “I walked around for a year with just one breast, and tried different things, like stuffing socks and silicone prosthetics into my bra. But nothing worked. The prosthetics were heavy and made me sweat. The sock was soft and more comfortable, but it kept slipping out of my bra and ending up near my neck,” she recalls. Trip ultimately decided it was more important to her to look symmetrical than to continue on with one breast, or have reconstruction. “Vanity went out of my mind,” says Trip. “I just wanted to look the same on both sides, and decided to rock the flat look.” And rock it, she did. Not only did Trip stock up on tight tank tops — “I love the way they look on me now” — but she also just took up swimming and surfing, for which she prefers a neoprene wetsuit to a bikini. “Cancer is a secret society; you never know what it’s like until you’re in it,” she says. “Strangely — and unexpectedly — being without breasts has gotten me so much more in touch with my femininity. I’ve turned into a girlie girl.” NEWSLETTERS

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Why These Women Said No to Breast Reconstruction After Mastectomy Everyday Health