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After a mastectomy, most women choose to have breast reconstruction, However, some women who have a mastectomy choose not to have reconstruction and instead “go flat”.
There may be many different reasons for this choice, and none of them are wrong. Choosing to have—or not have—breast reconstruction is your decision, and only you can know what’s right for you. Regardless of your choice to have breast reconstruction or not, we recommend that you learn about all of your options before making a decision.
Deciding Not to Have Breast Reconstruction
- Wishing to avoid additional surgery after mastectomy
- Needing to get back to daily activities as quickly as possible
- Being worried about the side effects of breast reconstruction, such as loss of muscle strength (but keep in mind there are surgical options that avoid cutting muscle tissue)
- Not wanting to have a foreign substance in their bodies with implant reconstruction
- Wanting to have a faster recovery from mastectomy
- Having concerns about insurance coverage for the procedure. The Women’s Health and Cancer Rights Act (WHCRA) requires insurance to cover breast reconstruction after mastectomy
- Needing to remove previous breast implants for medical reasons
- Being unhappy with prior breast reconstruction and not wanting further breast surgery
Delaying your reconstruction
What if I am Unsure? Can I Choose to Have Breast Reconstruction Later?
Choosing Delayed Reconstruction
Keep in mind that even if you don’t have immediate reconstruction (done at the same time as the mastectomy), you can have delayed reconstruction (done at a later date after the mastectomy). Breast reconstruction can be done 6-12 months after mastectomy, or even later. However, immediate reconstruction usually has the best cosmetic results.
Consult with a plastic surgeon
Do I Need a Plastic Surgeon if I Decide to go Flat?
It’s important to consult with a plastic surgeon to fully understand your options about breast reconstruction in your process of deciding the best direction for you. Even if you opt out of breast reconstruction, you might want to plan with your breast surgeon the best surgical approach, incision placement, appropriate closure, and removal of redundant/sagging skin for your best outcome.
Talk With Your Breast Surgeon
- For photos of patients who have had mastectomy without reconstruction
- How they will minimize contour irregularities and make sure the incision lies flat across your chest without leaving excess skin over the side of the chest (also known as “dog ears” or tabs)
- What cosmetic results are realistic for you
- To put you in touch with other women who have chosen not to have reconstruction
Things to Consider
During the mastectomy, some surgeons may leave extra skin at the incision site to make room for a new breast in case the patient changes her mind about reconstruction later. After surgery, the extra skin sags on the chest. If you don’t want extra skin left, make this very clear to your surgeon. If you want the sagging skin surgically corrected after the mastectomy, your insurance company very likely won’t pay for the procedure.