Sometimes having many options makes decision making more difficult rather than easier. And deciding whether or not to undergo a mastectomy only on the affected breast, as opposed to both breasts, can be as vexing a decision process as any. Add to this the fact that your head is already spinning from a dozen other issues surrounding your diagnosis of breast cancer, and it’s a wonder anyone reaches a decision.
Maybe we can help a little.
Thinking About Your Healthy Breast
Assuming that your breast surgeon said that you only need to remove the one affected breast, the decision then depends on what will make you more comfortable and content in your life. In other words, it’s not about living longer. It’s about living better, and living better depends on your wants and needs, not those of a research paper or someone else.
So, the most common comments women make regarding their decisions are:
1) “I just want them off. I don’t care about the science or logic. I just don’t want to have to think about this anymore.”
2) “I don’t want any more mammograms or biopsies in my life. It’s too stressful and I just want this behind me.”
3) “I want my breasts to look (and feel) the same, so I want them both removed and reconstructed.”
4) “I get a lot of enjoyment from my breasts. I want to at least keep one of them.”
5) “I can remove the other one if I get to that point in the future. Right now I just want to focus on my cancer care.”
Well, all of these feelings are legitimate.
Fear Is Not a Good Reason
For those thinking of double mastectomy, though, it’s just important to remember that while it’s true that there won’t be a need for mammograms or breast biopsies, it’s probably NOT a good idea to elect for a bilateral mastectomy if you think it’s in order to live a longer life or eliminate the risk of recurrence.
Nowadays, the length-of-life expectancy and risks of breast recurrence are so close, regardless of what decision you make here, that removing both breasts for “cancer treatment” just doesn’t quite add up, especially if you’re going to receive any chemotherapy or hormonal therapy.
Double Mastectomy for Symmetry?
All this takes us to reconstructive surgery. Should you remove both breasts for better symmetry? That depends on how much pleasure you get from your breasts and how hard it will be to make the reconstructed breast look like your natural breast. If you do get a great deal of pleasure from your breasts, then there’s an obvious upside in preserving the unaffected one. If you don’t get a lot of pleasure, or if you’re just feeling that your breasts will bring more anxiety than pleasure, then preserving the other side makes less sense.
To be sure, making a reconstructed breast look like a normal opposite breast can be challenging if not impossible. Implants, as much as they’ve improved over the last several years, simply don’t behave like normal breast tissue. Using your tummy tissue to reconstruct the breast is often better for symmetry than implants, but it’s a lot more surgery, and it too has its inadequacies. Finally, the more saggy and large you are, the more difficult it will be to match that with reconstruction. It’s true that you can reduce and lift the other side to try to make it match the reconstructed side, but even then, there’s a limit to just how equal the two sides will be. The smaller, less saggy, and more support you have in your bras, the easier it will be to look close to equal in clothing.
Reviewing Your Preferences
In summary, you might consider starting by asking your plastic surgeon how difficult it would be to make the reconstructed side match the natural side, with or without a lift on the natural side. From there, ask yourself how much pleasure you would get from preserving your other breast versus the stress of future mammograms and possible biopsies. Once you’ve figured out those two issues, the decision regarding a double mastectomy might become a bit more clear.
-Your Bicycling, Skiing Plastic Surgeon