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There was a time when Rhonda Williams loved her breasts \u2014 round, perky C cups that looked especially great in the tight, body-contouring dresses she often wore.\u00a0\u201cI think about them all the time,\u201d she told me. When she does, she remembers how confident they made her feel, and the pleasure of another person playing with them \u2014 especially with her nipples. It was once her biggest turn-on<\/a>. When she searches for a word to describe the breasts she used to have, \u201cfantastic\u201d is the one she returns to most often.<\/p>\n But then, in August 2018, they were gone. On a Monday, she was diagnosed with stage-three breast cancer. On the Friday of the following week, she had a double mastectomy<\/a>. She was only 41. The Sunday before her surgery, she came across an old friend from college while scrolling Tinder. An idea started to form. \u201cI\u2019m like, You know what? Somebody needs to play with these before they\u2019re gone,\u201d Williams said.<\/p>\n She went over to his house to have dinner and catch up. He told her how he\u2019d recently been diagnosed with type-one diabetes, and when she sympathized, he said, \u201cIt\u2019s okay \u2014 it\u2019s not like I have cancer.\u201d There was her opening. She told him everything, including about the sexy send-off for her breasts that she\u2019d been secretly yearning. He was game, and they had what amounted to an intentional one-night stand<\/a>. \u201cIt was great,\u201d Williams said simply. A few days later, alone in her bathroom, she hiked up her black cami and took a mirror selfie of her breasts. Her cancer was only in the left one, but the decision to have them both removed had come easily. What were they really for, anyway? Her younger self would be shocked at how much fun she\u2019d had with them, that\u2019s for sure. She grew up Mormon<\/a>, understanding the female body\u2019s greatest purpose as producing and nurturing children. Part of her still thought of her breasts that way. \u201cSo I don\u2019t need them,\u201d she told herself at the time, given how sure she was that she did not want kids. \u201cThey\u2019re pointless.\u201d It didn\u2019t feel like a big deal to let her breasts go, especially since she would replace them with a solid pair of dupes.<\/p>\n A few days later, she had her double mastectomy, and in the same surgery, her plastic surgeon began the reconstruction process. He placed tissue expanders underneath the skin that once held her breast tissue; these durable plastic pods \u2014 each with a magnet at its center \u2014 would gradually stretch her traumatized skin and muscle to create enough space for permanent silicone implants. Every few weeks (after her initial recovery from the surgery), her plastic surgeon would inject the expanders with saline until they reached the size of her desired breasts. After that, her incisions would be reopened and the expanders would be swapped out for implants.<\/p>\n In the weeks just after surgery, everything seemed fine. She\u2019d arranged to take five weeks off work \u2014 she was a recruiter at a big staffing agency, a job she\u2019d had and loved for nearly 20 years \u2014 and so she watched a lot of reality TV and posted to the private Instagram she used to keep her friends and family updated. In a photo taken a week after her expanders were placed, Williams grins as she poses in a pair of cute boxer shorts and a surgical bra. She holds up two surgical drainage bags filled with blood and pus, smiling. Honestly, she\u2019s kind of pulling the look off. (\u201cAll I see is your perfect brows and lashes,\u201d one friend commented.) Her biggest post-op annoyance was her sister and two close friends, who all stayed with her for a week and hovered over her every move.<\/p>\n Three and a half weeks after that photo, the trouble began. One morning, she was headed to the bathroom when she felt a stream of liquid running down her torso. \u201cI mean, fluid was just pouring out of my body,\u201d she said. She didn\u2019t know what to do \u2014 it just kept coming. It smelled awful, and it looked like the stuff that oozes out when you pop a zit. She ended up leaning over her bathtub so it could drain out. She had emergency surgery the next day, during which her doctor identified the culprit: MRSA. Her chest was full of it. The surgeon removed the expanders, leaving Williams\u2019s chest flat. He told her she would have to stay that way for about a year, through chemo and radiation and three more surgeries.<\/p>\n Being flat didn\u2019t faze Rhonda. All of it \u2014 including the cancer \u2014 felt like a temporary setback. She was determined to speed through cancer as quickly as possible so she could return to her life, looking almost exactly the way she\u2019d left it. \u201cI honestly thought this was going to be a blip on my radar,\u201d said Williams, who is now 48 and lives in Utah. \u201cI was like, Well, it\u2019s going to be a real crappy few months,\u201d she said. \u201cAnd then I get implants for free. Yay!\u201d She continued: \u201cAnd that is not how it went. That\u2019s not how it goes for almost anybody.\u201d<\/p>\n Around 40 percent of mastectomy patients opt for reconstruction, according to a 2023 study<\/a> in the Annals of Surgical Oncology. That\u2019s up from 8 percent<\/a> in 1995. The increase is often credited to the Women\u2019s Health and Cancer Rights Act, which passed in 1998 and requires health insurers to cover breast reconstruction. It can also likely be attributed, at least in part, to the rise of prophylactic mastectomies in women who have elevated genetic risks for breast cancer. Last year, a team of researchers published a review<\/a> of 99 studies on breast reconstruction and psychological well-being, most of which showed that reconstruction improves breast-cancer patients\u2019 overall mental health. Yet many patients say they felt underprepared by their doctors for the length and intensity of the breast-reconstruction process. Up to 40 percent<\/a> of women who undergo breast reconstruction end up dissatisfied with the results.<\/p>\n In 2018, Dr. Edwin Wilkins,<\/a> professor emeritus of plastic surgery at the University of Michigan Health, co-authored what is still considered by many in the field to be the best available research on complications<\/a> from breast reconstruction. It followed about 2,300 women who had breast reconstruction at 11 medical centers in the U.S. and Canada, finding that one in three women who have breast reconstruction will have some sort of complication, often requiring additional surgeries or hospital stays. Dr. Andrea Pusic,<\/a> chief of the division of plastic and reconstructive surgery at Mass General Brigham in Boston and another author on the study, now believes that number is probably more like one in four, crediting improvements in mastectomies, infection prevention, and patient selection.<\/p>\n \u201cTo me, the risk of a complication is the Achilles\u2019 heel of breast reconstruction,\u201d said Dr. Clara Lee<\/a>, a plastic surgeon and professor at UNC School of Medicine. \u201cIt\u2019s a really important operation. It has the potential to restore quality of life. It\u2019s critical to at least offer it to women who are candidates. But there\u2019s this relatively high complication risk, and we are doing things to make it better, but we haven\u2019t quite gotten there yet.\u201d For some women with breast cancer, that complication risk means undergoing multiple unplanned surgeries in pursuit of rebuilding the breasts they lost to cancer. And even if everything goes well, with minimal or even zero complications, almost all breast reconstructions will involve multiple \u201crevision\u201d operations. \u201cMastectomy reconstruction is rarely one and done,\u201d said Wilkins. \u201cThese are complex, multi-staged operations that require considerable skill from the surgeon and perseverance from the patient.\u201d<\/p>\n Just weeks ago The Home Edit\u2019s Clea Shearer posted on Instagram about her 15th reconstructive-breast surgery in three years \u2014 and her fourth in two months. \u201cIn the operating room, my doctor discovered my breast expander, and the surrounding area, was fully infected \u2026 I\u2019m back to being flat on my right side and have my drains back in. Needless to say, I\u2019m feeling pretty heartbroken right now,\u201d she wrote, then added, \u201cI WILL achieve reconstruction at some point, but nothing is more important than my health. I always say to prioritize it, and I\u2019m taking my own advice. Onward.\u201d Williams can relate to her seemingly unstoppable drive to reconstruct her breast. She, too, has had 12 surgeries related to breast reconstruction \u2014 but in the span of just two years.<\/p>\n What drives some women to persist through so many years of so many surgeries? Why prolong your time in Cancerland \u2014 or, if not exactly Cancerland, than in an adjacent world of hospitals, stitches, bandages and drains, bad sleep, and pain medication, not to mention days or weeks at a time away from work, friends, and family? It\u2019s difficult to understand unless you\u2019re in it, and even then many of the women I spoke to found it hard to articulate. Dr. Monique C. James<\/a> is a psychiatrist at Memorial Sloan Kettering Cancer Center who works with patients undergoing mastectomy and reconstruction; it\u2019s part of her job to help them understand their own motivation. \u201cWhere it gets hard,\u201d she said, \u201cis when people have assigned meanings to their breasts that connect to their identity.\u201d She starts her relationship with these patients by asking each one the same question: \u201cWhat do your breasts mean to you?\u201d Just like breast reconstruction, the question is often more complicated than it seems.<\/p>\n When you have breast cancer and need a mastectomy, well-meaning friends and family will often make the same well-intentioned joke: Hey, at least you get a free boob job! Many patients, too, assume at first that breast reconstruction will be just like breast augmentation. I asked Wilkins how often he has heard patients conflate the two. \u201cOh gosh. Constantly,\u201d he said. \u201cBut it\u2019s understandable, and even sophisticated, well-educated consumers don\u2019t, or at least can\u2019t initially, tell the difference.\u201d<\/p>\n Many patients who had undergone mastectomy told me they got this idea, at least in part, directly from their plastic surgeons. In consultations, their surgeons often used language that the patients associated with cosmetic procedures. Kerrin Engebretson, who\u2019s 42 and lives in Elk Grove, California, was excited about the idea of a flap reconstruction \u2014 with a tissue transfer from her thighs \u2014 after hearing her plastic surgeon describe it. \u201cShe told me, \u2018This will end up really helping the contour of your thighs, because it\u2019ll tighten them up,\u2019\u201d said Engebretson, who had the first surgery for her reconstruction immediately following her prophylactic double mastectomy in January 2024. \u201cAnd I was like, Oh, okay \u2014 kind of like getting a thigh-lift at the same time.\u201d Engebretson is happy with her results now, but she first had to get through five reconstruction-related surgeries, including multiple hospital stays and one incision infection that nearly put her into sepsis. For her, the comparison to a cosmetic procedure obscured the fact that many flap reconstructions require corrective surgeries.<\/p>\n Some surgeons are aware that using language associated with cosmetic surgery could compromise their ability to manage patients\u2019 expectations. <\/strong>\u201cI think the advantage of using those terms is that a lot of people understand what they mean,\u201d Lee said. It\u2019s nice to have any sort of shorthand, especially considering the fact that cancer treatment tends to move at a head-spinning pace. \u201cBut the downside,\u201d Lee added, \u201cis that people may then unconsciously start to associate breast reconstruction with these procedures, which they are not.\u201d<\/p>\n The real difference between breast augmentation and reconstruction is the cancer, obviously. But more specifically, the mastectomy is a big complicating factor. \u201cA breast augmentation takes a normal, lovely breast and then puts an implant behind it,\u201d said Pusic. With a mastectomy, the plastic surgeon is essentially starting from scratch. \u201cWe\u2019re taking out all the breast tissue and leaving behind only skin,\u201d Pusic said.<\/p>\n Through the 1960s and to some extent, into the \u201970s and \u201980s, mastectomy and breast reconstruction were routinely performed in separate surgeries, leaving an in-between period during which patients would have to live with what\u2019s known as the \u201cmastectomy defect,\u201d a period of being flat chested (or even concave) after the breasts are surgically removed. It wasn\u2019t until the 1990s that immediate reconstruction \u2014 when the breast surgeon removes the breast tissue and then the plastic surgeon comes in to begin the reconstruction, all within the same operation \u2014 became the norm. \u201cThe whole point of that is so women don\u2019t have to bear the brunt of the defect,\u201d said Dr. Carolyn De La Cruz,<\/a> chief of plastic surgery at UPMC Shadyside in Pittsburgh. \u201cWe don\u2019t want people to have to feel bad about their bodies \u2026 and so if people wake up and they have breasts and they never felt the grief or the loss, then we consider that a good thing.\u201d (For their part, patients told me that even without a period of complete flatness, the loss of their breasts is still blatantly apparent.)<\/p>\n The two surgeons \u2014 the breast surgeon and the plastic surgeon \u2014 have related but competing goals. The breast surgeon wants to excise the cancer and lessen the risk of recurrence, and to do that he must remove all the breast tissue. The plastic surgeon wants the breast surgeon to leave enough skin and subcutaneous tissue behind so he is able to use it to re-create natural-looking breasts. The tricky part for the breast surgeon is that breast tissue looks a lot like the subcutaneous tissue located right under the skin. \u201cA lot of times it\u2019s really hard to figure out which is which,\u201d said Dr. Laura Dominici<\/a>, a surgical oncologist at Dana-Farber Cancer Institute in Boston. To ensure all breast tissue has been removed, some breast surgeons may err on the side of taking too much subcutaneous tissue, leaving behind paper-thin skin.<\/p>\n Too-thin skin is more prone to infection and necrosis (skin death), because too much of the blood supply to the skin has been removed. \u201cIf the breast surgery destroys the skin, I\u2019m handcuffed. I can\u2019t do it,\u201d said Dr. David Song<\/a>, who is vice-president of medical affairs and chief medical officer at MedStar Georgetown University Hospital in Washington, D.C. He recalls instances during his career when he\u2019s worked with inexperienced breast surgeons, who didn\u2019t leave him enough to work with. \u201cI walk in, and the skin\u2019s remaining, but you can shine a light and read a magazine through it,\u201d he said. \u201cIn those situations, I\u2019ve had to abort the reconstruction.\u201d A hidden indicator of how successful a breast construction will ultimately be may be how well the breast surgeon and plastic surgeon work together. Dominici told me: \u201cPlastic surgeons are great. But sometimes they have varying levels of understanding about the cancer part of the operation.\u201d<\/p>\n In a reconstructed breast, as compared to an augmented breast, no breast tissue is left to support or hide the implant, and that \u2014 plus the potentially thinner skin \u2014 can increase the likelihood of aesthetic or structural problems. \u201cMy breasts look like deflated water balloons,\u201d Oksana, who\u2019s 30 and lives in Toronto, told me. By that, she means that she has a common problem known as rippling \u2014 where the implant\u2019s surface becomes visible under the skin, making the breast appear empty and wrinkled at the top. Her reconstructed breasts, which she got in March of last year, are saggier than she expected, too, possibly due to a lack of internal support for the implants. \u201cIt looks like I\u2019ve been breastfeeding,\u201d she said. She had a revision in mid-February and when we spoke in early June, she already knew she would be scheduling another.<\/p>\n She told me she has little interest in finding alternative ways to feel attractive. \u201cMy whole mentality is that I feel like I\u2019m too young to just accept not being happy with what my body looks like,\u201d she said. For now, she wears a bra practically at all times. Even during sleep. Even during sex. Her boyfriend, who she\u2019s been with for nearly six years, has only seen her breasts a handful of times since the reconstruction process began nearly a year and a half ago.<\/p>\n Photo: Courtesy of Rhonda Williams\n <\/p>\n Then there is the problem of the cancer treatment itself \u2014 particularly radiation, which can pose problems for reconstruction by damaging skin tissue. By the time Williams was cleared to restart the reconstruction process the summer of 2019, she had fewer options than she\u2019d had a year prior when her expanders were placed. \u201cMy skin had been radiated to shit,\u201d she said. In addition, the skin tissue on the right side of her chest \u2014 the non-cancer side \u2014 had been weakened after a relentless series of infections. Her surgeon laid out the remaining choices. A fat transfer from her stomach could get her to something around an A cup, and a transfer from her buttocks could get her to a small B. But it was also possible her skin was too paper-thin to support those options \u2014 and what Williams really wanted were her C cups back. For that, her best bet was a latissimus dorsi flap: Her surgeon would carve two crescent-moon-shaped slices of fat, muscle, and skin out of the biggest muscles in her back and tack them on to her pectoralis muscles in order to support her implants.<\/p>\n Williams started that process in August of that year when her surgeon removed the tissue from her back, attached it to her chest, and placed a new pair of tissue expanders to make room for additional implants. Most doctors recommend taking a minimum of four weeks off after a surgery of this nature, but Williams had promised her team she\u2019d be back in a week. It had been a weird year at work, she told me. She was good at her job, and she was well liked, but in January her boss had informed her that her team hadn\u2019t budgeted for her salary that year. After some confusion, she had landed on an adjacent team \u2014 in learning and talent development \u2014 and it wasn\u2019t going great. Williams ended up taking only three days off after the back surgery, working from her bed and propped up by a fortress of pillows.<\/p>\n A series of calamities followed that fall. One of the expanders sliced through the stitch, requiring yet another surgery. In October, midway through a surgery to swap out the expanders for implants, her surgeon deemed the skin on the right side of her chest too fragile. She put the left implant in, but kept the right side flat. Around this time, her doctors connected her repeated infections to one of her chemotherapy drugs, a known but rare side effect. It could take up to a year for the drug to fully leave her system, and until it had, her plastic surgeon refused to place the other implant. Williams had gone into that surgery, her seventh, believing it would be her last. Instead, for the next eight months she walked around with a reconstructed breast on her left side and a piece of her back muscle tacked on to her right. She got a prosthetic, which she used when she didn\u2019t want to answer nosy questions; she learned to strategically arrange big scarves.<\/p>\n Somewhere in the middle of all that, a close friend suggested that she take a break from all the surgeries. \u201c\u2018I think your body needs more time to recover,\u2019\u201d Williams remembers her saying in the group chat. She understood what her friend was trying to say, but still: She was highly annoyed. This friend had had a nose job plus multiple revisions; Williams had driven her to more than one of them. \u201cAnd I absolutely thought, That was unnecessary, but you didn\u2019t ask me my opinion, so I didn\u2019t give it,\u201d Williams remembers thinking. Why was one aesthetic quest okay and not another? Anyway, it wasn\u2019t like Williams was chasing a makeover; she just wanted back the breasts she once had \u2014 a result her surgeon still believed was possible and so she did, too. Williams and that friend no longer speak.<\/p>\n When Natasha Genders thinks about her breasts and what they have meant to her, she mostly thinks about breastfeeding. In a very real way, breastfeeding her youngest child saved her life when what appeared to be a persistent case of mastitis turned out to be cancer. She was only 26. She opted for a double mastectomy, followed by reconstruction with implants.<\/p>\n About eight months later, she was at work when she realized something was wrong. She\u2019d recently gotten her nursing degree and was assisting in an orthopedic surgery, helping to transport a patient, when she felt a sharp, sudden pain in her right breast. \u201cIt felt like I\u2019d gotten shot in the chest,\u201d she said. The pop Genders felt was surgical mesh tearing away from its anchor point. \u201cSo [my implant] was just loose in there,\u201d she said. The tear was due to capsular contracture, a common<\/a> complication that causes scar tissue to tighten around an implant, and it would require another surgery to fix. Genders was told to take six weeks off work to recover. She was only able to take one.<\/p>\n Then, last winter, she was working in the ICU, trying to help intubate a patient. As she reached to hold down the patient\u2019s shoulders \u2014 pop! The same shot-in-the-chest sensation as before, only this time she knew what happened. A visit with her doctor confirmed it: The surgical mesh had detached again. She would need another surgery \u2014 her fourth \u2014 to correct it.<\/p>\n Not long ago, a thought occurred to her: Mastectomy is a necessary medical intervention. Breast reconstruction is optional. Already, she thinks she lost out on a job offer because she had to take so much time off work, and she suspects that being intubated during one of her surgeries caused a chipped tooth. \u201cNot being able to work, not being able to make money, pay my bills \u2014 it was all so overwhelming,\u201d she told me. \u201cAnd it\u2019s like, What am I fighting for?\u201d<\/p>\n Her objective was to speed through the reconstruction as fast as possible, so her kids wouldn\u2019t have to worry about her. She wonders now if that\u2019s why she didn\u2019t ask many questions about the reconstruction. Plus, she thought it was supposed to be the fun part. Of her plastic surgeon, she says: \u201cHe\u2019s all hyped up and excited. You know, \u2018You\u2019re getting new breasts!\u2019\u201d The optimism was a tonal shift from the dour conversations she\u2019d had with her medical team for the past year, and she started getting excited, too. Together, the two of them perused her implant options (\u201cThat part was cool,\u201d she said); the reconstruction, he promised, would quickly have her feeling and looking back to normal. \u201cHe was like, \u2018You got through the worst part \u2014 now you\u2019re almost at the end,\u2019\u201d said Genders, who is now 32 and lives in King George, Virginia.<\/p>\n In reality, the reconstruction has heavily prolonged cancer\u2019s imposition on her life. With her limited arm mobility caused by the capsular contracture, she has a hard time performing CPR at work (though she does it, anyway); at home, she can\u2019t practice baseball with her son or pick up her youngest daughter, who is 7. When the pain has gotten really bad, her oldest daughter, who is 14, has helped her get in and out of the shower. \u201cYou don\u2019t want your kids to see you like that,\u201d she said.<\/p>\n Genders wishes her first surgeon had emphasized the risks, especially the impact radiation could have on the outcome of a reconstruction. \u201cNot just the good parts,\u201d she said. Her next surgery will not be about aesthetics, or at least not entirely; without it, she won\u2019t regain full use of her right arm. Still, she\u2019s been putting off scheduling it. Her surgeon wants to try placing the implant under her pectoral muscle instead of on top of it, which could lessen the likelihood of capsular contracture occurring again. But this procedure requires a longer recovery time, and Genders has no idea how she\u2019ll be able to take three months off work.<\/p>\n So she\u2019s learning about other options: For one, she can have surgery to remove the implant and then have an aesthetic flat closure. She\u2019s also looked at the prosthetics on offer from her doctor, which would be worn under her clothes. They could be okay. Part of her wants to roll the dice and try one more time for reconstruction. \u201cIt could be the one time that\u2019s, like, Okay, it worked. And now I can go back to normal,\u201d Genders said. Another part of her wants what she\u2019s wanted all along: to move on.<\/p>\n![](\"https:\/\/www.europesays.com\/ie\/wp-content\/uploads\/2025\/10\/d4adc2e3e4eaea142f7049e404d6e91028-v2-breast-reconstruction-secondary.rhorizontal.w700.jpg\")
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