Hello all
I’m now 4 cycles in with chemo and at the point where I need to start thinking about surgery and reconstruction options. I feel totally overwhelmed by this and don’t know how on earth people make a decision when there are no great options and all have pros and cons. So I’ll set out my worries and hope you guys can give me your thoughts.
I am 49, have lobular breast cancer (65mm tumour), HER2+. I have 3 children and 2 step children, 9-16 years. I am very worried about looking at myself with only one boob. I feel like if I go flat, I will know what’s under my clothes and will massively lack confidence and identity around who I am, being a girlie girl, etc.
I am also worried about being in pain, recovery times and having to rely on others so much when our household is hectic and I am the person who ‘holds it all together’.
I am worried that what I might decide is the best option now, might change when the pathology results come back post-surgery (atm no sign of spread to lymph nodes on scan).
There is part of me that feels the reconstruction decision rests on whether my main focus is to live, or have a life! What I mean by that, is that if this thing has spread and I am fighting for my life, then I probably won’t care about reconstruction and would rather forego the pain, inconvenience and stress. But if it hasn’t spread to lymph nodes, I want to reverse the clock, feel attractive and glamorous, look the best I can and take the hit to do that.
I’m not keen on the idea of implants though I’m not wholly sure why. Maybe to do with having one boob perky on the beach and the other approaching my armpit! Maybe because I do like a natural lifestyle and look and I’ve always associated implants with a ‘plastic’ fake look 
. Also not sure I’d get used to having a foreign body in my system.
I’m aware this message is probably loaded with my own prejudices and ideals and sorry if it’s offensive to anyone. I know that everyone decides what works for them and I totally respect that, but need to think about my own mental wellbeing and how on earth to traverse this decision.
Thanks for reading x
Hallo @marge1
You have expressed yourself so eloquently and I wonder whether you might even have answered your own questions by writing it all out!
I definitely get what you mean about implants and their unnatural and negative connotations. For me personally, staying flat was the only thing I wasn’t willing to consider, for many of the same reasons that you have expressed. I was only given the option of a temporary expander implant during my mastectomy and lymph node removal surgery (cancer was found in 1/12) back in June 2023. The implant has not been without it’s issues, and I am on the waiting list for delayed DIEP reconstruction which is only done at a different hospital and so has a wait of 12-18 months. BUT, when I am dressed, I don’t look any different from before, and I know that I would have found it very traumatic be be flat on one side so the implant was the lesser of 2 evils, and the least unacceptable option, if that makes sense.
I think you will get many different viewpoints as it is such a personal choice, and of course, one we never thought we would have to make.
I would say firstly, congratulate yourself on what you have already got through, and maybe even talk to people you may be comfortable with. When it boils down to it though, it is your choice, and you will know what may be the least bad of the options you are presented with.
Sending you lots of love and keep posting xx
Hi
Can you take some times to think about? May be with a little more time you will see how things go, and than decide more tranquilly?
I personally decided to go flat, with an (unnecessary, but really wanted) double mastectomy, in 2018, age 34, as i didn’t feel to go through reconstruction, may be have a rejection, spend more time in the hospital…
I’m flat and still feel like a girly girl! I think it actually look nice on me for some reason…not sure why.
But is not the same for everybody, somebody prefere to just get done with it, have a nice reconstruction and than don’t think about it anymore, especially so they can still see themself just like before! I can totally understand that!
I will just take a little more time to think about, until you are sure what the best decision for you, phisically and mentally.
I agree with Amel. I had bilateral mastectomy after cancer in both breasts.
I was totally freaked out and couldn’t imagine waking up feeling not ‘normal’. I wanted immediate reconstruction but there was a none-week wait and I wanted the cancer out so I went with the thought of getting delayed reconstruction.
Six weeks on and I love being flat and will not be going for reconstruction. It’s the best thing for me - I’m very sporty and not missing my 34g breasts.
I also still feel really girly - I actually think my clothes hang better and look fabulous. Like Amel, I think it suits me and people have actually commented how good it looks.
It’s so strange for me as I was so against being flat.
Good luck in your treatment xx
It’s a really difficult decision. Does your hospital have any events where you can see the different options? Mine invited me to an event before my surgery where they had people who had volunteered to show their results and answer any questions. Maybe that would help?
I’ve had a single mastectomy with delayed reconstruction. Currently I’ve got the expander in and it’s honestly made me rethink whether or not I want to go through the whole DIEP flap procedure & long healing process. I don’t hate the way the expander looks or feels as much as I thought I would have. In clothes, you wouldn’t know that I had one implant and one natural boob and I don’t really FEEL much of a difference.
I’ve still got about 10 months to decide, plastic surgeon won’t swap the expander out before I’m done with treatment (had residual cancer in what came out, so I’ve got 14 cycles of Kadcyla instead of being done after I finish radio next week).
I think what makes it so difficult for me is that any decision is not likely to make a huge difference in my life long term. I’ll probably be fine and look fine with whatever I choose and no one will even notice after the initial healing is done.
Sometimes I just wish future me would just come and make the decision for me. Good luck with your decision making!
It’s such a difficult decision and is different for different people and at different stages of life.
At 70 I decided to remain flat after a single mastectomy. I didn’t want an implant and DIEP was too big an operation for me. If I’d been younger my decision may have been different. In the end my surgeon said that a reconstruction would be unlikely to be successful anyway.
I made a pros and cons list which helped, discussed it with my bcn and at Maggie’s. There is a useful booklet on the Flat Friends website which looks at living flat. Resources and Information - Flat Friends
I have struggled accepting my new body and am having counselling but I don’t regret my decision. I need to find clothes that work and get used to the prosthetic. It will take time but with support I’ll get there.
It’s a very personal choice, no right or wrong, just what is right for you at this time. Wishing you well whatever you decide.
Thank you all so much for your responses. It is reassuring to hear about people going flat and not regretting it, despite initial worries. Yes, I’ll take a bit more time to think and speak to Maggie’s and BCNs. I have two more rounds of chemo first so we are still a couple of months away from surgery.
You have a great opportunity to see how you feel about being flat because you can change your mind and have a reconstruction later. Personally I think this should be the default anyway, it is by far the lowest risk option and I do not think we are in the right frame of mind at the particular time we need to make the decision.
Mine is a long story but to cut it short, I was initially horrified at the thought of being flat but it happened, one side only. All I can say is that I am grateful for the circumstances that brought me here and massively relieved that I didn’t go for reconstruction. Now, I cannot imagine the thought of putting myself through that and taking those additional risks and/or of having a foreign body in there. The softie in my bra makes me look completely ‘normal’ if I want it but I am generally happy as I am. I know we are all very different and I respect everyone’s choices but from my own experience I would recommend staying flat and I would say try it, you might like it! You can always change it if it isn’t for you but you won’t know if you don’t try it.
Good luck with your treatment
Elaine
I couldn’t have an immediate reconstruction due to Covid, I would prefer to be flat on both sides now, than have a reconstruction. My 1 and only op (the mastectomy) healed really well and I didn’t have any problems, I would worry it could be different if I decided to have the reconstruction now.
I’m having a single mastectomy on 23rd September for HER2 cancer . I’ve got very big boobs which at 52 are now obviously not the boobs I had at 16 
My surgeon showed me what my breast Woukd look like with an implant and I really didn’t like it . I have long covid too and have suffered with allergies and auto immune issues and I couidnt be sure I wouldn’t have issues with the implant .
My surgeon was also not convinced an implant Would be successful so I’m ok with going flat . I’m terrified of surgeries so I can’t see myself rushing for a reconstruction in the future and my surgeon said it’s unlikely anyone would want to do a DIEP on me due to health issues …
You could always ask for a delayed reconstruction? I know the DiEP ones have great results , my friend has one and you would never know it was not her original breast x
Thanks for replying arty1 and really hope all goes well for you on 23rd. Sounds like you have a huge amount going on healthwise and could do with getting this out of the way. I’ve an appointment with surgeon on Friday so will see what’s possible for me. Best of luck. Xx
Great to hear that it healed so well Lollyblue. Sounds like lots of people go flat and feel the outcome works for them. Xx
I can’t believe the change in me, I couldn’t even look at photos of mastectomys before it happened to me.
Hi @marge1 ive just had a diep reconstruction 2 weeks ago and have 2 kids aged 4 and 8. I went with this as, like yourself, I didn’t like the look of implants and was worried about reactions and upkeep. I was told as diep uses your own tissue, any weight gain/ loss will reflect in your reconstructed breast and it will age more naturally too. I stayed in the hospital for 3 days post surgery and it took me a couple of days before I managed to walk around. I’m still healing but really happy with the results so far, considering it’s still very red and scarred and covered in waterproof dressing! There is a tightness in my abdomen area and no feeling at all in my breast. Apart from this there is no soreness or pain and I did take painkillers for a week after (they recommend two, but I really didn’t need them!). I couldn’t lift my arms much the first week and a bit but my mobility and range of motion is improving daily. I really think being active prior to my surgery helped. You’ll need someone to help at home that first week whilst in hospital and after, and any prep you can do beforehand with frozen meals, adjusting kids activities etc would be really useful! Good luck with whatever your decision x
Hi zara_xo. Thanks so much for sharing your experience. Especially as you are going through recovery at the moment. Sounds like you are doing really well and maybe it wasn’t as scary as you thought?? I’m moving towards going for immediate reconstruction with diep though this wouldn’t be till December. Saw the breast surgeon today and he’s arranging for me to meet with plastics. Take care and wishing you a speedy recovery. Xx
It’s a hard time for you with so many decisions. I went for an implant with a version that meant it was in line with other boob! I will get the exact detail if you would like. As for the operation I couldn’t get over how seamless the operation was. I wasn’t in much pain at all and back in work in 6 weeks. The drains were annoying but easy to manage. The op was by far the easiest part of the whole journey (rads, node clearance, chemo, cold cap etc). I was stunned to wake up with no bruising and I felt like myself. I was delighted and very comfortable in bikinis. It’s a big decision so forums like these are very helpful. Good luck with whatever you decide.