I know two women who chose to go flat: One wore tight fitting tops to accent her cave in look, the other found blouses with structured designs or fluid, draping fabrics that float off the chest. Both made different choices after choosing the same door. I have another friend who chose a silicone implant which resulted in an infection that needed a second surgery. She looked great until she gained weight and is now totally asymmetrical. These three women made different choices about their bodies. The most important choice was to have the surgery and survive.
I love how you point out that even the two women you know who opted for going flat chose to wear clothing in different ways. One more way we are all different! I hadn't even thought about that. Sorry to hear about your friend with the implant who developed an infection. Hope she's doing alright.
Yes, the most important thing is to have the surgery that's needed and survive. First and foremost, it's about saving lives, not breasts.
Cancer has a way of forcing us to choose between options that start at not appealing, progress to less appealing, and end at "no way for me!" As you say so well, the absolute key for each woman with BC surgery looming is to be well-informed, have enough time to consider options, and make the choice that is best for her. No two patients and set of circumstances are the same. Societal pressures and patronizing doctors aside, we follow our hearts, and to an extent perhaps our fears, and hope for the best.
Factors in my decision to have bilateral mastectomy after my BC diagnosis with no reconstruction included:
-I had an elongated timeline with 6 months between my lumpectomy (surgery #1) and the mastectomies (surgery #3) (There was a failed re-excision between these, and also 4 rounds of chemo.) My decision became clearer as time went on. (An appointment with an arrogant and uncaring plastic surgeon in this time period left me feeling like "a piece of meat." It didn't really factor into my decision, but I will never forget how that made me feel.)
-I am a runner and was running marathons at the time. I wanted the best chance to keep running and run with less pain--other than that imposed by the late miles of a marathon-- so no reconstruction was the best option for me. I was only 43 and knew if I chose any type of reconstruction, I may be looking at more surgeries down the road. I am happy to report that following 5 marathons before my diagnosis, I ran 12 after. My first post-cancer marathon was 10 months to the day from my bilateral mastectomies.
-Nothing would replace the look and feel of the breasts I was given the first time around.
I have definitely been self-conscious at times, and have felt judged, but I like the flexibility of prosthetics when I want and flat when I choose.
I appreciate my doctors and that I did feel I could consider all the information they and others provided. My husband started out supportive and has never stopped. He told me the decision was mine and that what mattered most is me being here and healthy, not body parts.
I guess I had a lot to say. And I echo your efforts to not judge others who make choices different from mine. Thanks Nancy!
Yes, I guess you did have a lot to say, and that's great. By sharing your personal perspectives and experiences, you've added such depth to this conversation.
I love your opening sentence: 'Cancer has a way of forcing us to choose between options that start at not appealing, progress to less appealing, and end at "no way for me!"'
Women are judged harshly for many things, so it's no surprise they are judged regarding breast reconstruction choices too. It only makes the entire experience that much harder.
Thank you for being part of this discussion. I appreciate you.
Really tough decision to make, especially when dealing with cancer, too. My mother had breast cancer surgery on one breast and at the time was only given the option of a ‘fake’ breast which she wore inside her bra. I do know of one friend’s daughter who had a double mastectomy and chose no reconstruction. At first I was worried about reactions since she’s young, but her mother said the choice gave her a feeling of power and safety.
I'm sorry your mother dealt with breast cancer too. Ugh... I understand how your friend's daughter who had a a double mastectomy with no reconstruction would get a feeling of power and safety. That means she made the right decision for her. I hope she's doing well.
Thank you for sharing your thoughts. I appreciate you.
Nancy, what an excellent essay on a topic that I, too, am so painfully aware of, as you know. Each of the three choices you point out is problematic. Truth is, there's no substitute for our own healthy breasts. There just isn't.
But unfortunately, when one is diagnosed with breast cancer, and we are rushed to make a choice because time is of the essence, making a decision rather quickly about which direction to go is fraught with difficulties.
The following sentence in your essay really hit me: "The arrogance of assuming a woman doesn’t know what she wants reeks with patronization." YES, YES, YES. I have found the medical system to be quite patronizing, although I have had wonderful male doctors who understood the power of a woman's own empowerment.
I know you are familiar with my story. When I was diagnosed, my surgeon gave me only two choices: lumpectomy with radiation or single mastectomy. That was it. I wanted to keep my breasts, and even more telling, he wanted me to keep my breasts, as it turns out he had a bias -- he was a breast conservationist. I felt pressured to get the lumpectomy, which turned out to be a mistake.
I also believe a woman should be able to choose what is done to HER body. Men and other women have no place in deciding what is best for a particular woman. This is why I am and will always be pro-choice. This leads some to think I am pro-abortion. I am not. If a woman wants to follow through with her pregnancy, even with potentially difficult outcomes, that's her choice. If a woman does not, that is her choice, as well.
Yes, I know you are painfully aware about all of this. Your story is compelling and your experience with doctors has not always been stellar. I love your book, by the way - "Calling the Shots in Your Medical Care". I hope I got the title right. It's been a while since I read it. It's so good.
This topic reminds of how women's rights are being attacked. I'm with you on being pro-choice. This doesn't mean I am pro-abortion. As you said, "If a woman wants to follow through with her pregnancy, even with potentially difficult outcomes, that's her choice. If a woman does not, that is her choice, as well." Amen to that.
Thank you for your ongoing support and for adding so much to this discussion. I appreciate you, my friend.
You have outlined this dilemma beautifully! I had my unilateral mastectomy at the age of 64. Initially, my first gut reaction, was to go flat. Keep it simple. After 40 years of marriage, why do I care about my "breasts"? However, it got it my head, that I should at least explore the options available to me. Additionally, I was concerned that I would have regret if I did not try for reconstruction. I knew that after the mastectomy, I would NOT go back and have the reconstruction done. Once I complete something--- I move on and live with the consequences--thats just how I roll.
So, I decided on an implant with a lat flap (skin moved from my back to the front, to cover the implant. I was not a candidate for 100% autologous--- as I have been radiated previously.)
Surgeons were able to complete the mastectomy and recon in one surgery.
Nearly, one year later (post chemo , post more radiation), I still have issues and often wonder whether or not the recon was worth it? I don't really regret the recon, however, in hindsight, my gut instincts are usually correct. Going forward, I'm honoring my gut more & more!
I love how you know yourself so well and how you roll. I'm glad you were able to have the mastectomy and reconstruction done in one surgery. You don't mention what your issues are, so I hope they aren't too bothersome. I have issues too. I'm pretty sure most of us do post mastectomy no matter which door we choose.
Here's to honoring your gut more! Thank you for sharing your experience. I appreciate you.
Oh Nancy, you bring such dignity to the impossible! For each "door" you describe carries its own grief, its own courage, its own cost ... and you’ve honoured that complexity with such grace. Thank you for trusting your readers with this story and for reminding us that a woman’s choice about her own body is sacred, personal and never up for debate.
My mother had breast cancer, clients have had breast cancer, friends have had breast cancer ... and every time I go for a mammogram the nurse or someone there tells me how rare it is, when I name at least a dozen women whose lives have been shaped by it. Each chose a different path. And honesty, I have no idea what door I would chose.
It may sound vain to say "it depends how old I am" but that’s the truth. Here in my early sixties, my answer would be very different than it would’ve been twenty years ago. And in another ten years, I’m not sure any kind of reconstruction would appeal. It’s a terribly difficult decision and as much as I’d like to give you a clear answer … I don’t think I can.
I love your point about each door carrying its own grief, its own courage, its own cost. Such truth in that. So many unintentionally downplay the big deal that it is having a mastectomy. Sometimes even the woman having one does. It's a huge loss and grief lasts a long time, even a lifetime as nothing can replace one's original breasts.
You are familiar with much of the bedlam and heartache breast cancer brings. It's interesting, but not surprising, that even the nurse makes comments like that when you have your mammogram.
It's certainly understandable you have no idea what door you would choose. I don't think anyone truly knows until facing those doors. Another reason why the judgment is completely out of line. I appreciate your honesty. I appreciate you, my poet friend. Thank you for adding to this conversation.
Nancy, this is such an important conversation you’ve opened so generously here for all your readers. I’ll admit, I caught myself berating my own indecision for a moment after reading ... wanting to choose a door and then realising I simply couldn’t. Thank you so much for naming that truth. It felt like you’d put a hand on my shoulder and said, "don’t worry, it’s okay."
And as a small aside ... breast‑themed though it all is ... I couldn’t help noticing how sharing an image on Substack of a naked woman immediately triggered an "explicit" label. Since when did a mother’s breast become explicit?! Rant over. 🙏💖
It is definitely okay not to choose a door you think you might take. It's not really possible anyway until you're facing those doors. I'm glad you felt my hand on your shoulder. 🙂
And yes, I found it fascinating that a woman's breast was deemed explicit. Of course, this is something that happens on social platforms quite a lot.
It’s funny, really ... even those "explicit" labels feel like another door to stand before ... another moment of choosing how to meet what’s placed in front of us. Dare I open this? I'm the same when I see one. I think this is why it feels like there's a little bit of synchronicity dancing between our words this week. 🙏💖
Yes! I hesitated before opening. And there is indeed more than a bit of synchronicity dancing between our words this week. A woman's life is filled with "doors" and she is quite often judged no matter which door she chooses to walk through. It helps when we can rely on the wisdom of others who've passed through the same doors. Not just regarding cancer-related stuff but any big life decision. I felt that in your poem, too, somehow. The returning, mothering, saving, guiding, crone themes.
Thank you so much Nancy aka Sister Crone for your warm, wise words and for having this deeper conversation with me. I so appreciate you. What you write about women’s lives and those “countless doors” is so true! We know our place on the (symbolic) beach, our rescuing days are over. 🙏💖🌊🫂
Tough decision to be sure. I don't know what I would have done. I've had over 10 breast surgeries in my life, although I haven't been diagnosed with breast cancer. Just a lot of lumps removed and other things removed due to various problems. Crazy as it may seem, I was actually pushing my breast surgeon for a prophylactic mastectomy because I was getting so fearful of cancer. This was all in my 30s and 40s. I am glad he talked me out of it.
Wow, that is a lot of breast surgeries. All that must've been very stressful, and I completely understand why you pushed for having a prophylactic mastectomy. I'm glad you had a surgeon who listened and advised you through all that. I'm relieved you didn't have to go through a mastectomy after all.
I know two women who chose to go flat: One wore tight fitting tops to accent her cave in look, the other found blouses with structured designs or fluid, draping fabrics that float off the chest. Both made different choices after choosing the same door. I have another friend who chose a silicone implant which resulted in an infection that needed a second surgery. She looked great until she gained weight and is now totally asymmetrical. These three women made different choices about their bodies. The most important choice was to have the surgery and survive.
Hi Judith,
I love how you point out that even the two women you know who opted for going flat chose to wear clothing in different ways. One more way we are all different! I hadn't even thought about that. Sorry to hear about your friend with the implant who developed an infection. Hope she's doing alright.
Yes, the most important thing is to have the surgery that's needed and survive. First and foremost, it's about saving lives, not breasts.
Thank you for sharing. I appreciate you.
Cancer has a way of forcing us to choose between options that start at not appealing, progress to less appealing, and end at "no way for me!" As you say so well, the absolute key for each woman with BC surgery looming is to be well-informed, have enough time to consider options, and make the choice that is best for her. No two patients and set of circumstances are the same. Societal pressures and patronizing doctors aside, we follow our hearts, and to an extent perhaps our fears, and hope for the best.
Factors in my decision to have bilateral mastectomy after my BC diagnosis with no reconstruction included:
-I had an elongated timeline with 6 months between my lumpectomy (surgery #1) and the mastectomies (surgery #3) (There was a failed re-excision between these, and also 4 rounds of chemo.) My decision became clearer as time went on. (An appointment with an arrogant and uncaring plastic surgeon in this time period left me feeling like "a piece of meat." It didn't really factor into my decision, but I will never forget how that made me feel.)
-I am a runner and was running marathons at the time. I wanted the best chance to keep running and run with less pain--other than that imposed by the late miles of a marathon-- so no reconstruction was the best option for me. I was only 43 and knew if I chose any type of reconstruction, I may be looking at more surgeries down the road. I am happy to report that following 5 marathons before my diagnosis, I ran 12 after. My first post-cancer marathon was 10 months to the day from my bilateral mastectomies.
-Nothing would replace the look and feel of the breasts I was given the first time around.
I have definitely been self-conscious at times, and have felt judged, but I like the flexibility of prosthetics when I want and flat when I choose.
I appreciate my doctors and that I did feel I could consider all the information they and others provided. My husband started out supportive and has never stopped. He told me the decision was mine and that what mattered most is me being here and healthy, not body parts.
I guess I had a lot to say. And I echo your efforts to not judge others who make choices different from mine. Thanks Nancy!
Hi Lisa,
Yes, I guess you did have a lot to say, and that's great. By sharing your personal perspectives and experiences, you've added such depth to this conversation.
I love your opening sentence: 'Cancer has a way of forcing us to choose between options that start at not appealing, progress to less appealing, and end at "no way for me!"'
Women are judged harshly for many things, so it's no surprise they are judged regarding breast reconstruction choices too. It only makes the entire experience that much harder.
Thank you for being part of this discussion. I appreciate you.
Really tough decision to make, especially when dealing with cancer, too. My mother had breast cancer surgery on one breast and at the time was only given the option of a ‘fake’ breast which she wore inside her bra. I do know of one friend’s daughter who had a double mastectomy and chose no reconstruction. At first I was worried about reactions since she’s young, but her mother said the choice gave her a feeling of power and safety.
Hi Susan,
I'm sorry your mother dealt with breast cancer too. Ugh... I understand how your friend's daughter who had a a double mastectomy with no reconstruction would get a feeling of power and safety. That means she made the right decision for her. I hope she's doing well.
Thank you for sharing your thoughts. I appreciate you.
Nancy, what an excellent essay on a topic that I, too, am so painfully aware of, as you know. Each of the three choices you point out is problematic. Truth is, there's no substitute for our own healthy breasts. There just isn't.
But unfortunately, when one is diagnosed with breast cancer, and we are rushed to make a choice because time is of the essence, making a decision rather quickly about which direction to go is fraught with difficulties.
The following sentence in your essay really hit me: "The arrogance of assuming a woman doesn’t know what she wants reeks with patronization." YES, YES, YES. I have found the medical system to be quite patronizing, although I have had wonderful male doctors who understood the power of a woman's own empowerment.
I know you are familiar with my story. When I was diagnosed, my surgeon gave me only two choices: lumpectomy with radiation or single mastectomy. That was it. I wanted to keep my breasts, and even more telling, he wanted me to keep my breasts, as it turns out he had a bias -- he was a breast conservationist. I felt pressured to get the lumpectomy, which turned out to be a mistake.
I also believe a woman should be able to choose what is done to HER body. Men and other women have no place in deciding what is best for a particular woman. This is why I am and will always be pro-choice. This leads some to think I am pro-abortion. I am not. If a woman wants to follow through with her pregnancy, even with potentially difficult outcomes, that's her choice. If a woman does not, that is her choice, as well.
Excellent piece, Nancy.
Hi Beth,
Yes, I know you are painfully aware about all of this. Your story is compelling and your experience with doctors has not always been stellar. I love your book, by the way - "Calling the Shots in Your Medical Care". I hope I got the title right. It's been a while since I read it. It's so good.
This topic reminds of how women's rights are being attacked. I'm with you on being pro-choice. This doesn't mean I am pro-abortion. As you said, "If a woman wants to follow through with her pregnancy, even with potentially difficult outcomes, that's her choice. If a woman does not, that is her choice, as well." Amen to that.
Thank you for your ongoing support and for adding so much to this discussion. I appreciate you, my friend.
You have outlined this dilemma beautifully! I had my unilateral mastectomy at the age of 64. Initially, my first gut reaction, was to go flat. Keep it simple. After 40 years of marriage, why do I care about my "breasts"? However, it got it my head, that I should at least explore the options available to me. Additionally, I was concerned that I would have regret if I did not try for reconstruction. I knew that after the mastectomy, I would NOT go back and have the reconstruction done. Once I complete something--- I move on and live with the consequences--thats just how I roll.
So, I decided on an implant with a lat flap (skin moved from my back to the front, to cover the implant. I was not a candidate for 100% autologous--- as I have been radiated previously.)
Surgeons were able to complete the mastectomy and recon in one surgery.
Nearly, one year later (post chemo , post more radiation), I still have issues and often wonder whether or not the recon was worth it? I don't really regret the recon, however, in hindsight, my gut instincts are usually correct. Going forward, I'm honoring my gut more & more!
-Laura
Hi Laura,
I love how you know yourself so well and how you roll. I'm glad you were able to have the mastectomy and reconstruction done in one surgery. You don't mention what your issues are, so I hope they aren't too bothersome. I have issues too. I'm pretty sure most of us do post mastectomy no matter which door we choose.
Here's to honoring your gut more! Thank you for sharing your experience. I appreciate you.
Oh Nancy, you bring such dignity to the impossible! For each "door" you describe carries its own grief, its own courage, its own cost ... and you’ve honoured that complexity with such grace. Thank you for trusting your readers with this story and for reminding us that a woman’s choice about her own body is sacred, personal and never up for debate.
My mother had breast cancer, clients have had breast cancer, friends have had breast cancer ... and every time I go for a mammogram the nurse or someone there tells me how rare it is, when I name at least a dozen women whose lives have been shaped by it. Each chose a different path. And honesty, I have no idea what door I would chose.
It may sound vain to say "it depends how old I am" but that’s the truth. Here in my early sixties, my answer would be very different than it would’ve been twenty years ago. And in another ten years, I’m not sure any kind of reconstruction would appeal. It’s a terribly difficult decision and as much as I’d like to give you a clear answer … I don’t think I can.
Hi Deborah,
I love your point about each door carrying its own grief, its own courage, its own cost. Such truth in that. So many unintentionally downplay the big deal that it is having a mastectomy. Sometimes even the woman having one does. It's a huge loss and grief lasts a long time, even a lifetime as nothing can replace one's original breasts.
You are familiar with much of the bedlam and heartache breast cancer brings. It's interesting, but not surprising, that even the nurse makes comments like that when you have your mammogram.
It's certainly understandable you have no idea what door you would choose. I don't think anyone truly knows until facing those doors. Another reason why the judgment is completely out of line. I appreciate your honesty. I appreciate you, my poet friend. Thank you for adding to this conversation.
Nancy, this is such an important conversation you’ve opened so generously here for all your readers. I’ll admit, I caught myself berating my own indecision for a moment after reading ... wanting to choose a door and then realising I simply couldn’t. Thank you so much for naming that truth. It felt like you’d put a hand on my shoulder and said, "don’t worry, it’s okay."
And as a small aside ... breast‑themed though it all is ... I couldn’t help noticing how sharing an image on Substack of a naked woman immediately triggered an "explicit" label. Since when did a mother’s breast become explicit?! Rant over. 🙏💖
It is definitely okay not to choose a door you think you might take. It's not really possible anyway until you're facing those doors. I'm glad you felt my hand on your shoulder. 🙂
And yes, I found it fascinating that a woman's breast was deemed explicit. Of course, this is something that happens on social platforms quite a lot.
It’s funny, really ... even those "explicit" labels feel like another door to stand before ... another moment of choosing how to meet what’s placed in front of us. Dare I open this? I'm the same when I see one. I think this is why it feels like there's a little bit of synchronicity dancing between our words this week. 🙏💖
Yes! I hesitated before opening. And there is indeed more than a bit of synchronicity dancing between our words this week. A woman's life is filled with "doors" and she is quite often judged no matter which door she chooses to walk through. It helps when we can rely on the wisdom of others who've passed through the same doors. Not just regarding cancer-related stuff but any big life decision. I felt that in your poem, too, somehow. The returning, mothering, saving, guiding, crone themes.
Thank you so much Nancy aka Sister Crone for your warm, wise words and for having this deeper conversation with me. I so appreciate you. What you write about women’s lives and those “countless doors” is so true! We know our place on the (symbolic) beach, our rescuing days are over. 🙏💖🌊🫂
Tough decision to be sure. I don't know what I would have done. I've had over 10 breast surgeries in my life, although I haven't been diagnosed with breast cancer. Just a lot of lumps removed and other things removed due to various problems. Crazy as it may seem, I was actually pushing my breast surgeon for a prophylactic mastectomy because I was getting so fearful of cancer. This was all in my 30s and 40s. I am glad he talked me out of it.
Hi Nancy,
Wow, that is a lot of breast surgeries. All that must've been very stressful, and I completely understand why you pushed for having a prophylactic mastectomy. I'm glad you had a surgeon who listened and advised you through all that. I'm relieved you didn't have to go through a mastectomy after all.
Thank you for sharing. I appreciate you.
💕💕💕