Going flat or breast reconstruction

I wanted to have as close to the same body as possible- for me personally that was important and well worth going through the additional procedures (minor discomfort from those). Everyone has their own perspective on what’s most important to them in dealing with this - I encourage you to discuss your options and fully express your feelings to your breast and plastic surgeons. If you can, meet with more than one PS to make whatever you decide is best for you.

Hi @greatjoy. I’m so sorry you are having to be here with us, with these difficult decisions. It’s a lot to weigh out.

I think I felt similar to @abigailj in wanting to look as close to the same as possible. Since I was having a mastectomy anyway, here was my chance to actually go a bit smaller so I had a single mastectomy with tissue expander, then the eventual implant and the other side reduced.

I also wanted to continue being physically active and didn’t want any long term issues from surgeries that might limit me. Now that I’m finished with my surgeries and have healed, I’m so glad I did it. I’m glad my plastic surgeon nudged me to get fat grafting also. He could see the outcome from the start, whereas I had no clue. I hadn’t really even looked at pictures to get an idea and I realize now that I absolutely should have asked to see pictures of his work!! Thankfully it all turned out well but yikes, I was a bit trusting.

Healing takes time and it’s challenging to stay patient with it all … but eventually you will be healed and this will be in your rear view mirror so to speak. It’s strange but life really does move on. So how do you want to look/feel moving forward? My implant side looks a bit weird (with a hollow depression above the implant and a lot of visible rippling) but with a bra and clothes on, it’s good enough. I’m not self-conscious and I’m not constantly fiddling with my bra or clothes to make sure I look okay. It just looks normal with clothes on, and it even feels normal now. (Disclaimer: my vision has started to get worse so maybe I don’t look as normal as I think, ha ha).

I also knew I probably wouldn’t need radiation or chemo, so that had a bearing on being willing to do reconstruction. And I was otherwise very healthy so it seemed like I would tolerate the surgeries and heal well, and thankfully I did.

I know there’s a lot to consider as you make these decisions. I wish you all the best with whatever you decide!

Hello @greatjoy. I know this is really hard and scary. It’s so hard to make decisions under stress, and having a cancer diagnosis is pretty stressful!! And reading on here can be helpful yet overwhelming at the same time as many post about all the issues they have. You may have some of the same issues or none at all. We are all so unique.

I consider myself fairly wimpy and I dreaded all the pain and discomfort I expected to have. I was pleasantly surprised by how minimal the pain was … I know it’s so different for each person but I never had pain above a “3 out of 10” and most of the time it was a “0-1” during the weeks and months of healing. The discomfort on the other hand, that sometimes felt too much. It’s hard to explain. I keep trying to think of an appropriate analogy but haven’t found one yet.

Being totally honest, the tissue expander was very uncomfortable for me. Not painful so much as incredibly foreign feeling and not something my brain could ignore. It took my body many months to finally settle down and feel comfortable after each surgery. I had some issues with “cording” and internal scarring that contributed to my discomfort, then I started developing a “frozen” shoulder issue. So in the moment, I was sometimes very miserable from discomfort and annoyed at not being able to simply move on with my life, compounded by side effects from the hormone treatment. But once they started filling the tissue expander, I liked having a breast shape again and could see the potential. That helped me endure the discomfort, seeing the potential for a “new and improved” chest.

Another thing … I knew I would have lots of family support and flexibility with work during this whole process. Under other circumstances, I might have chosen to go flat to have the least amount of recovery time and a lesser amount of doctors’ appointments, to minimize the disruption of my life. I’m very practical by nature and this really felt sort of frivolous to spend so much effort on reconstructing my chest. I had such mixed feelings going into this. It’s interesting that I don’t have regrets though.

Have you been able to speak with others who have gone through something similar?

Hi @greatjoy ,

I think it’s a really good thing that your doctor talked to you about going flat. I’ve heard that some doctors don’t always present it as an option, and I think it’s so important to know all of your choices. I was scared and unsure of what to do as well, and honestly, no one can make that decision for you.

I had a severe panic attack the night before surgery and again while they were prepping me. I chose to go flat because cancer had already taken a year of my life, and I just wanted to move forward and get back to feeling as “normal” as possible. I didn’t want to go through more surgeries, tissue expanders, and then have to replace implants years later (they’re usually recommended to be replaced about every 10 years).

When I woke up from surgery, the very first thing I said was, “I want to see what it looks like.” I tried to look, but everything was wrapped, and I could only see a little. The following week, when the drains were removed, I saw my chest for the first time. I had an idea of what it might look like from photos I’d seen online, but it was still a shock. It helped to have my surgeon there with me.

It didn’t really hit me until my first shower, and even now it can still be hard to look at. I’m still struggling a bit—it’s only been a little over a month. That said, I recently got my prosthetics and chose them one size smaller than what I used to be. They look and feel very real, and they’ve really helped boost my confidence and helped me feel like myself again. (check with your insurance, mine were covered and 4 bras).

There is also delayed reconstruction, so if you ever decide you want implants later on, that option is always there.

I hope this helps, even just a little. ♥️

I wish I was as decisive as you. I have an appointment next week with the plastic surgeon. I still don't know what I want to do. I big part of me wants to just be satisfied wearing my prosthetic and not have multiple more surgeries.

But it seems like everyone is encouraging me to have the implant. My breast surgeon said I'm strong and healthy enough for more surgeries. my breast care NP said she is very pleased with my healing. a friend I talked to said go for it. but as @risinggoddess said, there is a chance the implants would have to be replaced sooner or later. I raised this with the PS and he said it's no big deal. but I would potentially be quite old at that point.

the other thing I wrestle with is people who say that although they feel better with the reconstruction appearance-wise, the implant is not like a real breast and not even as nice as a woman who has cosmetic implants.

sigh…..will see how I feel when I see the doctor next week. he is very pleasant and not pushy at all about doing anything.

yes, I'm pretty happy with my prosthetic too….the one small minus is the prosthetic is lighter in weight that my breast on the other side so one side sags a bit. but I wear my tops loose so it's not noticeable. I got a camisole with built in bra that I liked so well I got two more. much more comfortable than the bras I got after surgery.

good for you for being so comfortable in your own skin. Personally I don't find the prosthetic at all uncomfortable. the most inconvenient part of wearing it is getting it into the pocket of my camisole.

I don't really want more surgery but earlier before I understood everything I do now, I had told my husband I could get liposuction and have the fat injected into my breast. at that time I don't think I fully understood that one fat injection would not be enough. the doctor could only get so much fat in there and some of it would dissipate. so I would likely have to have at least three surgeries. first one to do the liposuction and fat injection. then an implant. after that a lift on the surviving D cup on the other side.

My husband keeps going back to what I told him about the lipo and the injection. He thinks I would feel better about myself with reconstruction. maybe I would but there are risks. as you say - the implant may have to come out at some point and I'd be old. my doctor says that's no big deal. the consensus here from women who have had implants seems to be they don't regret it. they feel better about themselves. but they new "breasts" aren't like real breasts.

I wanted to keep my D cup due to proportions….I'm not what you'd call thin these days….but the PS may be able to achieve a small B with fat injection and this article makes me feel a bit better about that

https://airmail.news/look/issues/2026-1-2/breast-strokes

sorry having trouble posting link

story about how a lot of women are going for small implants

Thank you all for sharing your thoughts and experiences here! I had nipple-sparing double mastectomy in Sept 2025, and am nearing the end of my weekly Taxol infusions. I will continue with Kanjinti through next Sept. I too am trying to decide upon reconstruction. I am leaning towards staying flat, as I was quite small-busted to begin with. I think having the nipple-sparing surgery also plays a part in maintaining some semblance of "normal" appearance for me.

I am not 100% sure yet if I want reconstruction. I'll be meeting with my PS in a few weeks to discuss further. I appreciate that my recovery from the double mastectomy was relatively smooth. However I don't like the thought of going through multiple future reconstructive surgeries. Thank you for all of your insights about this!

When I was first diagnosed I had planned on having a double mastectomy and going flat. I've always felt my breast were the least important parts of my body and would have been fine without them, I think. However due the size of my tumor and that I have no one to help me even for the first few days and the fact that my surgeon and Onc all said my not having a reoccurrence were just as good with a lumpectomy I went with the lumpectomy and radiation. I've been regretting that choice since I have become somewhat obsessed with thoughts of reoccurrence. Has anyone had a mastectomy after lumpectomy and radiation? I don't know if my insurance would pay or if I could pay for help for a couple of days but I just keep thinking about it.

@greatjoy Thanks for the response. No one ever recommended a mastectomy. I've been told by one nurse that because of the radiation that I might be more prone to infections since I've had the radiation if I decided to have one now. I haven't had any problems with mammograms being painful and I've only had to have the one biopsy, which wasn't fun but was tolerable. I tried talking to my Onc's PA, who is about all I see any longer and she didn't seem to think it was warranted and that it was iffy as to whether insurance would pay for it. I haven't found any of my doctor's who I rarely see any longer or the nurses or PAs to be all that open to "what if" type of discussions. Guess I'll just keep worrying and waiting.

“But it seems like everyone is encouraging me to have the implant.”

Each patient must do what is right for HERSELF. It is a personal decision. Please let their encouragement serve as a palette of OPTIONS from which YOU get to choose.
Best wishes and I hope you landed on a peaceful decisions.

Perhaps you could ask your surgeon if he anticipates a single injection of fat after lipo will do the job? Or does he think it’ll require multiple separate injections to overcome any dissipation? Important to know realistically what’s anticipated. The answers may provide reassurance or may steer you toward another option.

Remember: If he doesn’t have the patience that you, the patient, require for your personal peace of mind then he may not be the right Dr for you.

Granted, it would cause a delay and be a headache, but you CAN change Drs if that’s what it takes to get you to an acceptable comfort level with your care plan. I’m sure you already know that, but it can be easy to feel unnecessarily “locked in”.

If you wish to even consider that possibility, you can get info by calling your insurance and asking who else and where else is in network for you and do they know if they’re accepting new patients. Sometimes an insurance concierge company (such as Quantum) will even call around for you and ask that question if you request. That’ll narrow the list. Then you can call a few and see how receptive they are to having a Nurse Navigator/similar staffer speak to you by phone about what your needs and concerns are. You might find a perfect fit that way, which can help you feel better about whatever course you choose.

Doing research doesn’t mean you’re committed to changing Drs, so no harm done if you choose to stay with you’re already with. You don’t even have to get off his schedule to do some research into other Drs if that’s something that would enhance your peace of mind. Just a thought.

But maybe your surgeon can answer additional questions that will be useful to you as you go through this challenging decision-making process.

My breast surgeon told me insurance was required by law to cover reconstructive surgery even if I waited and did it a year later. That fact may be worth confirming, in case you just want to take a break from all this for now and deal with it later. Sometimes the passing of time can offer clarity.

Sending you good vibes!! All the best to you!

I had a unilateral mastectomy with aesthetic flat closure. I have been very happy with my results - my surgeon left a clean scar and a smooth chest wall. I had one-and-done surgery, and I was on pain meds for less than a week. I had a great OT, and was at full range of motion and cleared to go back to work as a massage therapist after 8 weeks, although I started at part time and worked back up to full.

If you decide to go flat, be sure to specifically ask about Aesthetic Flat Closure. If you just say "No reconstruction", they may simply stitch you up with no real planning for what you will look like afterwards. AFC ensures that your final presentation is as aesthetically pleasing as possible, without dog-ears or excess folds of skin. I have also heard that a prosthetic breast is much more comfortable over a smooth chest than a lumpy one.