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Breast Cancer Surgery Part 2: Reconstruction or Flat?

Considerations for a breast cancer surgery decision on breast reconstruction or staying flat.


Editor's Note:

This blog is a part of a series written by a local breast cancer survivor, Rui Sasaki.

Click here for other articles in the series.


Part 2: Reconstruction or Flat?

If you are anything like me, you probably researched and read just about anything you can find on your breast cancer. There are a lot of resources out there – good and bad. I struggled to find a voice that was not from the mainland. This is a huge part of why I am sharing my experience with you.

We live in Hawaii – a group of islands in the middle of the Pacific Ocean. And while we are a city, we are also a village. The degree of separation from your friends, sisters, aunties, moms, and work-life can be very small. Since my diagnosis, I have met or learned about 9 women at various stages in their breast cancer journey. But I digress. I can only describe the first 30-45 days after the biopsy as a continuous change of what you understand to be reality. While you are confronting your mortality and have to make or come to terms with medical decisions, one of the decisions you will have to make if you have a mastectomy, is to get immediate reconstruction or to stay flat (and/or do reconstruction at a later date).

Know the law! You have options.

The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.

For more information, check out the Women's Health and Cancer Rights Act.

I am in my 40s, active, and love going to the beach. When I learned of my mastectomy it was difficult for me to imagine my body without boobs. I also thought that if I had fake boobies, I could hide my illness from people and pretend that I was okay (it’s not possible). It was a form of denial and wanting to hang on to some sense of normalcy. I opted for immediate reconstruction. In hindsight, would I have chosen differently? Perhaps. I don’t think either choice is easy but let me tell you the pros and cons.

Immediate reconstruction will cut down on the number of surgeries you have. Anesthesia is really rough on your body and when you’ve been through the wringer with chemo, it is extra unpleasant. What happens is your surgical oncologist will work with a plastic surgeon and it is a back-to-back surgery.

  1. First, the surgical oncologist will start the surgery and remove the cancer tumor, and your breast tissue, and take lymph nodes.

  2. Next, the plastic surgeon will take over and place spacers in place of where your breasts used to be.

Doctors have to place the spacers because after a mastectomy you will loose skin and tissue and these hold that space. They are more durable, hard, and have an internal port to inject saline to stretch your skin. This is important because if you need radiation the spacers will allow you to receive those treatments as normal breast implants will not withstand radiation.

Over the course of several months, I visited the plastic surgeon’s office to have my spacers expanded with saline to reach the size of breasts I wanted. One perk is if you had ever wanted bigger boobs, now’s your chance! Once I was finished with chemo and radiation and rested for a few months, I had my 2nd surgery and finished reconstruction by replacing the spacers with permanent fake boobs. The 2nd surgery was a walk in the park compared to the 1st one. This whole process from the 1st surgery, chemo, radiation, and 2nd surgery took about a year for me.

The downside is the spacers are extremely uncomfortable and I was in some degree of pain all the time. I could not sleep on my side and I lost range of motion in my arms as a result of them being in my body. I know this because as soon as I got the real implants, my range of motion returned. They feel like thick sandwich bags full of saline under your skin.

You can choose to stay flat. I do think this is the more comfortable option.

While you are recovering from a mastectomy, undergoing chemo and radiation: EVERYTHING HURTS.

A part of me wishes that I didn’t have to deal with the physical discomfort of spacers while that was happening. While it is more surgery, you can do breast reconstruction AFTER everything is finished. It is more time to get back to “normal” but it could be worth the wait. That said, I do not regret my choice. I wanted everything done as soon as possible so that I can move on with my life. The decision is not easy and whatever you decide there will be pros and cons to both paths.



mastectomy: breast cancer surgery that removes a breast. Return to article

immediate reconstruction: rebuilding the breast at the same time as the mastectomy. Return to article


The views and opinions of our blog writers represent their personal views and opinions and not those of Breast Cancer Hawaii. Through our blog, we merely seek to give individuals creative freedom to share their personal experiences. Do not rely on this information as a substitute for a professional's medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, please consult with a physician or other healthcare professional.


Rui Sasaki is a breast cancer survivor and volunteer with Breast Cancer Hawaii. She got involved with the organization hoping to help women in Hawaii by sharing her cancer journey. She also just accepted a position working for a medical group on Oahu and hopes to do better for the community.


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