Some women de­cide against breast re­con­struc­tion after can­cer surgery,


Be­fore Deb­bie Bow­ers had surgery for breast can­cer, her doc­tor promised that in­sur­ance would pay for re­con­struc­tion, and said she could “even go up a cup size.” But Bow­ers did not want a sil­i­cone im­plant or big­ger breasts.

“Hav­ing some­thing for­eign in my body after a can­cer di­ag­no­sis is the last thing I wanted,” said Bow­ers, 45, of Beth­le­hem, Pa. “I just wanted to heal.”

While plas­tic sur­geons and on­col­o­gists ag­gres­sively pro­mote breast re­con­struc­tion as a way for women to “feel whole again,” some doc­tors say they are be­gin­ning to see re­sis­tance to the surgery. Pa­tients like Bow­ers are choos­ing to defy med­i­cal ad­vice and so­cial con­ven­tion and re­main breast­less after breast can­cer. They even have a name for the de­ci­sion to skip re­con­struc­tion: They call it “go­ing flat.”

“Re­con­struc­tion is not a sim­ple process,” said Dr. Deanna J. At­tai, a breast sur­geon in Bur­bank, Calif., and a past pres­i­dent of the Amer­i­can Society of Breast Sur­geons, adding that more of her pa­tients, espe­cially those with smaller breasts be­fore di­ag­no­sis, were opt­ing out.

So­cial me­dia has al­lowed these women to be­come more open about their de­ci­sion to live with­out breasts, as well as the chal­lenges, both phys­i­cal and emo­tional, that have fol­lowed. For a re­cent video cre­ated by, and widely shared on Face­book, Bow­ers and her friend Mar­i­anne DuQuette Cuozzo, 51, re­moved their shirts to show their scarred, flat chests. And Paulette Leaphart, 50, a New Or­leans woman whose clot­ting dis­or­der pre­vented her from hav­ing re­con­struc­tion after a dou­ble mas­tec­tomy, walked top­less from Biloxi, Miss., to Washington this sum­mer to raise aware­ness about the fi­nan­cial strug­gles of can­cer pa­tients.

“Breasts aren’t what make us a woman,” Leaphart said.

The nascent move­ment to “go flat” after mas­tec­tomies chal­lenges longheld as­sump­tions about fem­i­nin­ity and what it means to re­cover after breast can­cer. For years, med­i­cal pro­fes­sion­als have em­braced the idea that breast restora­tion is an in­te­gral part of can­cer treat­ment. Women’s health ad­vo­cates fought for and won ap­proval of the Women’s Health and Can­cer Rights Act of 1998. Since then, breast re­con­struc­tion has be­come stan­dard care. More than 106,000 re­con­struc­tive pro­ce­dures were done last year, a 35 per cent rise since 2000, ac­cord­ing to the Amer­i­can Society of Plas­tic Sur­geons.

In pro­mot­ing the surgery, doc­tors cite stud­ies that sug­gest breast re­con­struc­tion im­proves a woman’s qual­ity of life after can­cer. But some

“Breasts aren’t what make us a woman.” PAULETTE LEAPHART AD­VO­CATE

women say that doc­tors fo­cus too much on phys­i­cal ap­pear­ance, and not enough on the toll pro­longed re­con­struc­tive pro­ce­dures take on their bodies and their psy­ches.

“That’s the dirty lit­tle se­cret of breast re­con­struc­tion: the risk of a ma­jor com­pli­ca­tion is higher than for the average elec­tive surgery,” said Dr. Clara Lee, an as­so­ciate pro­fes­sor of plas­tic surgery at Ohio State Univer­sity who per­forms the pro­ce­dure.

Cuozzo spent a year hav­ing her breasts re­built after a dou­ble mas­tec­tomy, but after four in­fec­tions in five months, she had the im­plants re­moved.

Dr. David H. Song, chief of plas­tic surgery at the Univer­sity of Chicago and im­me­di­ate past pres­i­dent of the Amer­i­can Society of Plas­tic Sur­geons, said that the risk of com­pli­ca­tions was real, but that fo­cus­ing on them was like fo­cus­ing on plane crashes when “mil­lions of flights land safely.”

Given ad­vance­ments in sur­gi­cal tech­niques, “the es­thetic re­sult can be bet­ter than the na­tive breast,” Song said.

But it is that kind of talk — sug­gest­ing that a re­con­structed breast is an im­prove­ment on a woman’s nat­u­ral breast — that en­rages many women who have un­der­gone mas­tec­tomies. For starters, a re­con­structed breast is of­ten numb and can no longer play a role in sex­ual arousal. It of­ten lacks a nip­ple, since the nip­ple is usu­ally re­moved in a mas­tec­tomy.

After look­ing at pho­tos of re­con­structed breasts, “I was slightly hor­ri­fied,” said Char­lie Scheel, 48, of Brooklyn, who de­cided against im­plants after a dou­ble mas­tec­tomy.

Rebecca Pine, a can­cer sur­vivor from Long Is­land who co-founded a pho­tog­ra­phy and writ­ing pro­ject called “The Breast and the Sea,” said, “It’s a tremen­dous amount to put your body through, and it’s not like we’re go­ing to get our breasts back.”

Com­ing to terms with a flat chest after breast can­cer can be dif­fi­cult. While some women wear a pros­the­sis in their bra, it is not un­com­mon for them to stop us­ing it.

“They’re heavy, they’re un­com­fort­able, and they’re in a sen­si­tive area where you have scars,” Pine said.


Rebecca Pine co-founded the art pro­ject “The Breast and the Sea.”

Mar­i­anne DuQuette Cuozzo shared her ex­pe­ri­ence along­side Bow­ers.

Deb­bie Bow­ers shared her story in a video widely shared on Face­book.

Char­lie Scheel didn’t want im­plants after hav­ing a dou­ble mas­tec­tomy.

Paulette Leaphart has walked top­less to raise aware­ness.

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