Met with my plastic surgeon today..

I'm sorry that you have to make this very difficult decision. I actually had many of your same concerns (except the modeling ;-) ). I, too, had originally thought I'd do the least surgery and move on but ended up deciding on a BMX.

I didn't want to continue to watch some things in the good breast. I didn't want to have surgery on the good one to try to match the cancerous one. And I really didn't want to subject my body to radiation.

I agree that the results are generally much better for symmetry if you do both. I'm not sure if the recovery is really any harder. I guess the possible complications could be increased. But all of the scary things you listed are not as scary as cancer.

In the end - peace of mind is worth quite a bit. There is no right or wrong decision, but just what seems right to you. It is a horribly emotional time. I feel for you.

A couple of thoughts as I was considering this decision...

1) if you keep your breast, you will at least have a nipple for sexual arousal. That's an important pro to that side. because both my breasts were large and cystic I took both off. I miss my nipples, and would have liked to at least keep one for sex. Oh wells.

2) Symmetry is important, agreed. I was going to get implants - but experienced issues with the TEs. I also realized that there can be complications from DIEP, TRAM, LAT, etc. Some of these fail and then I'd have scars on more than just my chest for nothing.

3) I ended up going flat after having the TEs removed and it was the right choice for me. I'm slender and feel like a ballerina.

4) As for modeling, currently, if you have some diversity you can use that to your advantage... I know of a Flat model ROCKING the world right now. People want something new and different and flat is in. You don't need internal implants to model, you can always use foobs if the outfit needs it, but you can also wear stuff flat that is a designers dream.

In defense of implants - the notion that there is "maintenance" after a few years is not true. Most implants these days have warranties for their performance that are 10 years or more. And, unless there is a problem, there's no need to "replace" them or anything.

I went with implants because I wanted to have everything done as quickly as possible. I didn't want to subject another area if my body to surgery to create breasts. But that's just me.

Almost any surgery will possibly require other surgeries down the road. I was able to have nipple sparing, skin sparing surgery with direct to implants above the muscle. It was still hard. And fat grafting is recommended to me now.

It's a super hard decision. Probably the best thing is a PS that really listens to what you want and need and is realistic.

If you could do nipple sparing mastectomies, implant reconstruction can look very much like augmented breasts. My scars are completely hidden. The Inspira implants even have small diameter implants which would probably go well with your model's body frame.

Yes, there are risks with any surgery, medication or procedure. My PS sent me 90 pages of info to read before my revision. Yikes! All went well, though, as it has with all my cancer stuff so far. I even have a severe autoimmune disease and am medically immunosuppressed. If you are relatively healthy and don't smoke, the risks are very small.

Honestly, I have a lot of doubts about the DIEP for you. My BMI is 19.5 and no one would consider me for it, nor did I want it. The fat grafting alone has made a visible difference in my legs (in a good way) but now I only have a small pad of abdominal fat to use if I need more grafting. Thin women have somewhat limited options.

Good luck with your consults and decisions.

Fat grafting is used to soften the edges of the implants - often used after mastectomy since only skin and a tiny bit of fat are left after the breast tissue is removed. It helps to make everything look more natural. That's the plan anyway.

Implants above the muscle don't disturb the muscle, but the trade off can be that they aren't camouflaged as well, either. Fat grafting takes a small amount of fat from elsewhere (stomach, waist, thighs, etc) by liposuction, processes it, and places it under the skin of the breasts.

I think that probably most PS's recommend it. It's sometimes referred to as "stage two" of reconstruction, but I find that confusing since I think of that term in relation to exchanging TE's for implants. I would probably look better with it, but I look fine in clothes and even pretty good in a bathing suit. And I don't want to be bigger. And my BS would prefer if I waited.

I had my exchange two weeks ago, and the implants look good. Fat grafts were done to help secure the implants, with the grafts taken through the belly button. I am a little surprised two weeks out that my abdomen still hurts as much as it does. I've been wearing a compression band around the stomach, but even taking it off for just 10 minutes starts to cause pain. For those of you who have had fat grafts, how long did it take you to heal? My appointment last week with the PS was focused on the breasts, and we never discussed the grafts. Not sure if I should be concerned about still having pain?