My choice to delay breast reconstruction

It’s been just over a year since my double mastectomy. Faced with a multitude of choices and unknown paths for my treatment, I decided to delay breast reconstruction so have been “living flat” since my surgery. Having recently revisited options for reconstruction I have again decided to postpone any reconstruction, for the moment at least and potentially indefinitely!

In the next couple of posts I cover why – even a year on – I’m still undecided, what I believe has influenced my decision-making and why this process hasn’t been clear cut. But here, I explain the choices I had and the reasons I deferred decisions relating to reconstruction.

Reconstruction – my options

I spoke to a number of surgeons about two types of reconstruction – implant-based and a tissue based or fat transfer from another part of my body. As with most things, there are pros and cons to each and these differ from person to person. Here’s a simplified explanation of key points relevant to me for these two options:

• Implants: This would involve surgery to insert expanders, which gradually get inflated to slowly stretch the skin. The expanders are then replaced with a silicone implant. Damage to my skin from previous radiotherapy poses a potential risk. This is because the skin may be more fragile and may have issues healing or prevent the implant from staying in position. This risk could be reduced via fat grafting under the skin before the expanders stage but that adds another stage of surgery and isn’t guaranteed to help. Even with the multiple stages it offers the simplest procedure. It is less invasive and should have a faster recovery. The disadvantages at the forefront of my mind for this option are the risk of implant infection, the less natural outcome (in appearance and feeling), and I also feel uneasy about the idea of implants in my body.
• DIEP/TRAM – fat transfer: The results for this are often more natural and the long term outcomes can be better. However, it is a much longer initial surgery (potentially around 10-13 hours!). Consequently, there are more surgical risks and women often spend more time in hospital, sometimes in intensive care. I initially favoured the fat transfer option. Before knowing much about the procedure, it almost sounded like a perk – a natural outcome because it uses your own tissue and fat, and moves fat away from the tummy! However, this is MAJOR surgery with a much longer recovery period. This option would mean more scarring too, which is often worse with Asian skin due to the darker scar lines.

Saying no to immediate reconstruction

For me, not having reconstruction straight away meant:

• I didn’t have to decide on the type of reconstruction: the two types of reconstruction (implant based and DIEP/TRAM) I was considering both had pros and cons for me – there was no clear ‘winner’. I’m still not sure which I would prefer even one year later so I’m pleased I didn’t rush myself to make a decision amist all the other treatment plan decisions.
• One less decision to be made: At the time, there were so many (perhaps too many) choices that needed careful consideration. I had to decide whether to go through the public or private healthcare system, whether to have one mastectomy or two, whether to have fertility treatment, whether to return to the UK and sell/rent out the house we had bought (just one month prior to diagnosis!) or stay in Australia (and figure out finances for our new mortgage, new household bills having just arrived in Australia, undetermined medical costs and a drop in income while I didn’t work). With so many decisions to be made, it helped to deprioritise the ones that were – for me and my family – less urgent and perhaps more complex.
• Reducing the chance of complications: With the reconstructive surgery being more complex, there were higher risks of complications relative to a simple mastectomy. I wanted to minimise my time away from my children and wanted to be able to carry my daughter – who was two years old at the time – as soon as possible. Prior to surgery, I didn’t know whether the cancer had spread beyond my breast so I also wanted to avoid any delays in chemotheraphy. Dealing with the cancer was my priority (alongside thoughts about my hair if chemo was required!) but I didn’t have a strong opinion on what I wanted for my breasts.

I gave no consideration to the idea of ‘no reconstruction’ at all yet it is moving towards being my preferred choice (I’ll explain why in the next post). Perhaps if my circumstances were different my decision would have been too. The combination of these factors, plus the fact it was the second breast cancer, meant that deferring the decision and not opting for immediate reconstruction was the right for me and my family at the time. It might not be right for others and I have met lots of women who have no regrets about opting for immediate reconstruction and who have had amazing outcomes. However, I’m glad I didn’t rush into a surgery I wasn’t ready for. So for anyone who – like me – has doubts, I believe that a good decision can be to make no decision.

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