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 wisdo.com, 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.