Deciding not to Reconstruct

The Choices for Women Facing Mastectomy Surgery

For most women, a diagnosis of breast cancer brings shock and anxiety. If a woman then learns she needs a mastectomy to adequately treat her cancer, she may feel traumatized by the prospect of losing her breast. In the midst of this stress, she must decide whether or not to have immediate reconstruction, that is, reconstruction done at the same time as the mastectomy.

Immediate Reconstruction

Increasingly, doctors are steering their patients toward this option, since both procedures (mastectomy and reconstruction) can be done during a single surgery. But there are drawbacks to this approach.

  • Many women feel rushed into the reconstruction decision. Some women report that their doctors take it as a given that they want reconstruction. Since removing the cancer normally requires that surgery be scheduled as soon as possible, women often don't have time to adequately research the variety of reconstruction options, or to consider the alternative of not reconstructing.

  • Women may be referred to plastic surgeons who excel at particular types of reconstruction, so don't present all the options. There may be little time before surgery to seek a second opinion. Further, plastic surgeons tend to favor plastic surgery, so they're unlikely to even discuss the option of not reconstructing with their patients.

  • Sometimes, women go ahead with immediate reconstruction but learn afterwards, once the full pathology report is in, that they need radiation, which may put their reconstruction at risk, particularly if they've chosen implants.

  • Reconstruction can result in complications, including infections. Necessary cancer treatment, such as chemotherapy or radiation, may have to be delayed if an infection occurs after immediate reconstruction, until the infection clears up.

  • Some women proceed with a unilateral mastectomy and immediate reconstruction, only to wish later that they had chosen a bilateral mastectomy for peace of mind. If a woman has had one of the tissue reconstructions using abdominal tissue, either the TRAM or DIEP methods, she won't be able to repeat this procedure should she decide to have her other breast removed later.

Given these drawbacks, some women prefer not to have immediate reconstruction. Instead, some opt to delay their reconstruction, while others choose not to pursue reconstruction at all.

Delayed Reconstruction

If a woman decides to delay reconstruction, her breast surgeon can perform a skin-sparing mastectomy, leaving breast skin behind while removing the breast tissue underneath. With a skin-sparing mastectomy, reconstruction can easily be performed later. In the meantime, the patient can focus on battling her cancer without worrying about possible complications from reconstruction. For women who choose not to have immediate reconstruction, the surgery time is shorter and the healing time generally faster. Delayed reconstruction gives a woman the opportunity to live breast-free and see if it's right for her. While some women ultimately opt for reconstruction, others find they adjust well to the loss of one or both breasts and decide not to reconstruct.

Why Choose NOT to Reconstruct?

  • Women who choose NOT to reconstruct are able to quickly resume their normal activities. Mastectomy surgery without reconstruction takes less time and has fewer complications than mastectomy plus reconstruction.

  • Women who choose NOT to reconstruct don't have to deal with implants (internal prostheses) under their pectoral muscles. Instead, they can select from the huge variety of available breast forms (external prostheses) to find the perfect fit. Or, they can choose to go flat altogether.

  • Women who choose NOT to reconstruct don't have to deal with additional surgery to the abdomen, back, or buttocks to provide tissue for autologous tissue reconstruction. They don't risk loss of muscle function at those sites and don't wind up with additional scars.

  • Women who choose NOT to reconstruct feel confident that should their cancer recur, the recurrence will be easily detectable.

  • Women who choose NOT to reconstruct generally adjust quickly to their new normal. They find that they still look good in clothes and can still wear most styles. They realize that their husbands or partners still find them attractive.

If a woman decides she's not interested in ever having reconstruction, she can ask her surgeon to make her mastectomy site as cosmetically pleasing as possible, leaving no extra skin. Even if a woman feels certain at the time of her mastectomy surgery that she will never want reconstruction and even if her surgeon removes extra skin at her request, she can still opt for delayed reconstruction should she change her mind later on. Over time, however, many women who choose NOT to reconstruct come to feel more positive than ever about their decision to live breast-free.

To help you decide whether NOT reconstructing is the right choice for you, we've gathered Personal Stories and Photographs. We hope reading about the experiences of other women who have faced similar decisions and seeing photographs of women who have been through surgery without reconstruction will help you feel less isolated and better informed about what to expect as you make this very personal decision.