Here's what 5 women have chosen to do

Catherine Guthrie, a journalist specializing in women's health, spent years writing about breast cancer and knew that lumpectomy was the least invasive option.

But the placement of the tumor and the relative size of its breast have lost this option at the table.

His surgeon recommended a single mastectomy and reconstruction of the dorsal dorsal flap. It is a technique using muscle and back tissue to rebuild the breasts.

"I was so caught off guard by the whole conversation," Guthrie said. "Fifteen minutes later, I realize that there will be no lumpectomy, we are talking about cutting the muscles and rearranging them.In fact, the natural breast does not fit the new one, so why not not implant it too. "

When she asked her surgeon if this muscle was needed, he replied that most women just wanted to look normal with clothes – they barely missed it.

Guthrie, author of "Flat: Reclaiming My Body from Breast Cancer," also has scoliosis.

"I had worked on back issues using yoga and I came to a point where I was strong and confident. Suddenly, all this was considered less important than appearing normal in his clothes. I thought that at the time I was asked to choose between physical strength and the perception of female normativity, "she explained.

"It was like he was saying that I should have a rebuild for other people, so I would be normal when other people would look at me." It was shocking and unbalanced me. Even though doctors say it's a big muscle and you can lose some of it, slicing a muscle is permanent. He was not given the weight that I think he should have, "she continued.

Guthrie said her thought process revolved around the type of body she wanted to occupy for the rest of her life.

She chose a double mastectomy without reconstruction. She was looking for symmetry and balance, which would be helpful for scoliosis and yoga. It would also avoid having to wear a bra and a prosthesis all the time.

And she does not hesitate to say that you can be flat and sexy.

"What makes me feel sexy, is to be strong, confident, pain free and bring it into the bedroom. That's the kind of love we all want – a confident, carefree man who feels good about his body, "she said.

Guthrie does not regret his choices.

"But in these conversations, it's important to recognize that you can be happy with your decision and mourn the loss of your breasts. It's an amputation. My breasts still miss me and their pleasure and shape in clothes, "she said.

Guthrie has a full range of moves and is able to do everything she's done before cancer.

"That alone, on a daily basis, makes me so happy," she said.

Some women choose to have a mastectomy and delay the decision to rebuild.

Carol Hartman was concerned about the long-term effects of implants. So when she had a mastectomy in 2010, she chose not to have immediate reconstruction.

Her surgeon left her skin loose so the procedure would be easier if she changed her mind. To date, she has not done it.

Hartman, who asked Healthline to use a pseudonym to identify him, said the remaining tissue was particularly sensitive.

"It takes time to get used to it. It really helps to wear a flexible prosthesis, even in bed at night, "she explained.

"I am very happy with my decision not to rebuild, although I admit that I have hesitated over the years. It was very difficult to get back to swimming because there were not many good prosthetic options in swimsuits. Other people have to watch me, but if it's a problem for them, it's their problem. I am going to swim! Hartman said.

Uninsured at the time of her mastectomy, Alisa Savoretti waited three years for reconstructive surgery.

"I was 38 at the time of my mastectomy, so I would say that in my case, as a young woman in her thirties and not yet married, I absolutely wanted a reconstructive surgery," she said. .

"When I finally received it, I was delighted, it is the least that can be said. When I looked in the mirror and I saw two breasts with a nipple and areola. I felt that it was the moment when I had finished my cancer treatment, "Savoretti told Healthline.

Since then, she has founded My Hope Chest, a non-profit organization that helps fund the breast reconstruction of uninsured and underinsured breast cancer survivors.

"For many women applying in our organization, they say they feel less than in their entirety. After being operated on, they tell us that they feel good again and that their body, mind and spirit have put an end to the disease. Resume the feeling of being yourself and closing this chapter is really what's best, "Savoretti explained.

Jamie Kastelic, owner and founder of Spero-Hope, LLC, underwent a bilateral mastectomy at 30 years of age.

She chose to delay the reconstruction until the end of the chemotherapy.

But about a month after implanting expansors of breast tissue, she developed a serious infection that brought her to the hospital. She decided to withdraw the extensors and abandon the reconstruction.

"I thought I had implants and that it would be a finish line, that the bad part of my life would be over," Kastelic told Healthline. "Once I knew I would not try again, I had to learn to live with that."

"To be quite honest, I was lying in my bed after removing expander. I picked up my phone and watched Facebook. There was a picture of a bald girl with a puppy, and then five years later, where she had long blond hair and where the puppy was a dog. She inspired me to get out of bed and move on, "she continued.

Kastelic says she's quite comfortable being flat and that she wears dentures about half the time.

"I have no regrets even if the reconstruction failed. I never look at myself in the mirror and I do not feel mutilated, "she said.

Kastelic knows other women who became depressed when it did not work. So she does not push her choice over others.

But she publishes pictures of her online, scars and everything.

"If I summarize all this can help a person, it's worth it. As women, we have to raise each other up, "said Kastelic.

Rachael Ocello was only 21 years old when she underwent a double mastectomy and immediate reconstruction. Age was a big consideration.

"It was a very difficult decision. Having fake tits was never what I wanted. It took me two months to decide, but I did not consider not getting rebuilt. I did not want a flat chest, especially in my twenties, which is a very vulnerable period. Being so young and not having any breasts would have affected me more emotionally and mentally, "Ocello said.

She opted for silicone implants, which were placed on her muscles. In his case, there was no need for extensions or fat or tissue from another part of his body.

Ocello has some typical side effects such as numbness, tingling, itching or occasional acute pain. Minor back problems resolved once she's adjusted to the implants. She had no unexpected complications and is satisfied with the results.

"It gave me back my sense of femininity when it was taken away from me. It was the best choice for me and I stand by it, "she said.

Dr. Constance Mr. Chen is a certified plastic surgeon based in New York.

She uses natural techniques to optimize the medical and cosmetic results of breast reconstruction.

"According to the implant manufacturers themselves, approximately 50% of women who undergo breast reconstruction with implants will require a new procedure within seven years of their" final "implantation. Most often this is due to painful capsular contracture, infection or rupture. Breast implants also have a 10-year warranty because they must eventually be replaced. "

All interventions involve a risk of infection, bleeding and healing problems.

"If flap reconstruction is performed, there may be problems with blood flow to the flap and delayed healing at the donor site. With breast reconstruction, patients may need revision surgery to achieve the desired results, "said Zeineh.

According to Chen, natural breast reconstruction is a more complex but permanent operation.

"It creates living breasts that grow and shrink as a woman gains and loses weight," she said.

Chen explained that many factors, such as BMI over 30, smoking and uncontrolled diabetes, can increase the risk of healing problems. Cancer itself can increase the risk of blood clots and affect healing.

"There are many ways to prepare a woman for the best possible outcome after surgery, such as a mastectomy incision, but many surgeons are not trained to focus on the long-term aesthetic outcome," Chen said.

She noted that almost all women lose sensitivity in reconstructed breasts, especially those with implants.

Chen uses a technique called ReSensation, in which the nerves of the new breast are connected to the nerves of the chest wall. This is done with the donation of human peripheral nerve tissue (allograft nerve tissue) to bridge the nerve gap.

"Through sensory restoration, it also allows a woman to feel her breasts and truly pursue her life after breast cancer. For women with implant-based breast reconstruction, in order to possibly restore a sensation in their breasts, they would need to have their implants removed and replaced with natural tissue and by ReSensation, "said Chen. .

There are also a variety of ways to perform nipple reconstruction.

"This includes moving the patient's tissue to create a protruding nipple. After healing, tattooing of the nipple and areola is performed. Patients can also give up surgery and tattoo the areolar nipple to create a 3D effect, "said Zeineh.

Breast reconstruction is not always an option.

"In some cases, women with stage 4 breast cancer who had been in remission for some time could have undergone breast reconstruction. But this should only be done in consultation with their oncologist. Survival is obviously more important than reconstruction. Some of these women may also not be candidates for a mastectomy or a lumpectomy, "said Chen.

Zeineh added that long or multiple surgeries may not be in the best interest of patients who currently have unstable medical problems.

Zeineh recommends choosing a surgeon with whom you are comfortable and certified by the American Board of Plastic Surgery.

"It is important for the patient to be fully informed about her breast reconstruction options in order to choose the path that is right for her life and that will produce the desired result," Zeineh said.

When asked what they want newly diagnosed women to know, all the women interviewed for this story agree that these decisions are extremely personal. They should be made according to what you want for your body. This is not a decision you should make for someone else or for fear of what others may think.

As a journalist, Guthrie spoke to women who had been pressured into a reconstruction.

Others woke up after a surgical operation with excess skin pockets for later reconstruction – even though they had chosen to stay flat.

"Some surgeons do not trust them and do not respect women's choices. They are considered incapable of making solid decisions about their bodies. This is happening I do not think they are necessarily malicious. It is the cultural indoctrination of paternalism and misogyny in the world of medicine, "said Guthrie.

For the best results, she suggests looking for a surgeon whose main specialty is breast surgery.

And take your time.

"Women often have a sense of urgency to make all these decisions in the first few weeks. Most breast cancers are not so serious. You have some time to make decisions and you can go back to reconstruction. When that happened to me, I did not immediately decide to be flat for the rest of my life. But I put the reconstruction back on the board because I really wanted to beat cancer, go to the other side and think clearly about my options, "she said.

"If rebuilding your breasts gives you an impression of sex appeal, femininity, and power in your body to move around the world as you wish, rebuilding is a must. The same thing to go flat, "said Guthrie.