When I was meeting with my treatment team immediately after my diagnosis, the topic of reconstruction came up. “How do you want to handle reconstruction?“ I was taken aback. Me? I’m not a doctor! No one asked me how I wanted to handle chemo or radiation, they told me my treatment plan based off of the highest chance of survival with the lowest possible complications. So, I decided to take the same approach to my reconstruction. I asked what they suggested. Actually I asked, “What helps me achieve the highest likelihood of completing my treatment and being cancer free? What gives me the greatest chance of surviving?" My team suggested: single mastectomy and removal of all found lymph nodes in my left arm without immediate reconstruction.

You might be thinking, “Why wouldn’t you do reconstruction at the same time as your mastectomy?”  Well, let me tell you:

• My mastectomy showed I had residual disease in both my breast tissue and a lymph node (after my intravenous chemotherapy); therefore I was to begin additional chemo. Chemo increases your chance of infection, skin deterioration and complications in general. I could not risk adding another complication to my treatment plan.

• Radiation destroys reconstruction and I still needed to undergo 32 treatment sessions. My end results would have been less natural and aesthetically pleasing.

• Immediate reconstruction after a mastectomy requires 2 steps: an expander, waiting 6 weeks while slowly filling them to stretch your skin, and then surgery to exchange the expanders for your new implants. (FYI - there are also DIEP surgery options which entail using donor fat from your own body. Usually the abdomen, back or thighs.)

• If I was to have a complication from infection, skin cracking or deep burns I would have to stop my radiation treatment while my body healed.  Which meant I would not be giving my body the treatment regime it needed to best eradicate any remaining cancer cells.

• Adding a the other side mastectomy to my initial surgery raised the same complication concerns. What if my right side encountered an issue that forced me to stop or delay radiation?

Finally, I am a tall, thin woman. I never had large breasts except for breastfeeding (perhaps my husband’s most favorite 6 months). My boobs were never my identity or a large part of what made me feel feminine or beautiful. They just weren’t that important to me. Living, on the other hand, was.

I had a single mastectomy, waited to finish chemo and radiation, then had a mastectomy on the remaining side (so a double mastectomy just at different times to reduce my risk of infection or complications). Over three years after my diagnosis and I still haven’t had reconstruction. My decision isn’t the most popular, but it was the right one for me.  For me, this is a decision I will make when I’m at the 5-year mark of being clear of  cancer (a big milestone that also marks a greatly reduced risk of recurrence). I do not want to risk more and more surgery that may need to be un-done. It’s something I’ll decide when I feel that my cancer journey is officially “done.”  If and when I do have reconstruction I know that I will not be second-guessing my decision. Don’t worry; I’ll take you on that journey with me.