Due to a very strong family history of breast cancer, I decided to have bilateral risk-reducing surgery when I was in my mid-forties. In the U.K., we are very fortunate that our national health service offers genetic testing and counseling, consultation with a psychologist, risk-reducing surgery, and reconstruction to women with a strong family history. I was referred by the geneticist to an excellent surgical team.
At the outset, because I have always been very athletic, and because feeling fit is more important to me than how I look, I was clear that I did not want reconstruction. The surgical team found that such an unusual attitude that they attempted to persuade me to have reconstruction. I initially agreed, but shortly before my operation, after much thought, I decided to go for a simple bilateral mastectomy without reconstruction.
I reached this decision with great difficulty. The surgical and breast-care-nurse team made it clear that, in their opinion, the cosmetic result would not be as good as with reconstruction. They also warned me that delayed reconstruction, if I changed my mind later, would be more complicated than immediate reconstruction. However, talking to my closest friends convinced me to have the courage of my convictions, particularly when one of them commented that the most healthy option was clearly to have the mastectomy but not reconstruction. That made sense to me, since my life revolves around fitness and health.
Ultimately, the idea of undergoing unnecessary additional surgery for purely cosmetic reasons and spending the rest of my life with implants under my muscles (which would have been my best reconstruction option, given my build) seemed worse than being flat-chested. I felt that I would be swapping one set of worries (developing breast cancer) for another (implant issues, implant-replacement surgery, muscle weakness, etc.), and I feared that if I found my functioning in any way compromised I would always regret having had the reconstruction. My husband, though initially pro-reconstruction, was fantastic about accepting my reasons for not wanting to go ahead with it.
One year on and I am very happy with my decision. I did wake up a few times soon after the surgery thinking Oh no, I should have gone for reconstruction, but that soon wore off and I am very glad now that I didn't. The scars and contours of my chest are very neat, and I am actually perfectly happy with the cosmetic result. Although I was given breast forms at the hospital, on the advice of the prosthetics officer I experimented with "booster" (padded) bras. Since I only had 36A breasts to begin with, I've found that the booster bras work just fine without forms, as do well-padded swimsuits.
My breast forms have been in their boxes for months. Increasingly, I go totally flat, which seems to provoke no reaction whatsoever. I can exercise exactly as I used to and feel no difference in strength or function. When I went back for a check-up soon after surgery, I told the surgical team that my body felt like my own body and I was happy that I had done no more than was necessary from a medical point of view.
For me, the decision not to reconstruct was absolutely the right one. I'm glad that, in the end, the fact that my excellent surgeons and breast-care nurses found it an odd decision didn't persuade me to choose reconstruction, a course which I knew instinctively would have been the wrong one for me.