Over the past year, I’ve been collecting a list of things you shouldn’t say to a woman with breast cancer. One of them is:

“At least you get a free boob job.”

I know. Nobody is trying to be mean or hurtful by saying this. I get it, and I am not offended when I hear it. As a matter of fact, I take it for what it is — a well-intended comment meant to help me focus on the positive. But I’m coming at it from a different angle. I see things from another perspective, and I’m here to let you in on it. I can think of five reasons why breast reconstruction is not a free boob job.

#1 Boob jobs are elective, breast reconstruction isn’t.

Women choose to get boob jobs. Maybe they are unhappy with the size or shape of their breasts. Maybe they want to restore their pre-pregnancy breasts. Maybe they want male attention. Let’s face it, most men are suckers for breasts (no pun intended). Whatever the reason, they opt to have a breast lift, augmentation, reduction, or any other cosmetic procedure implied by the term “boob job” because they want it. They take the time to research their options, and then they look forward to the outcome.

That is not how breast reconstruction goes down. It’s more like:

They tell you that you have breast cancer.

You are devastated.

Then they tell you that you’ll need surgery, and if you want to have a breast reconstruction, you’ll have to find a plastic surgeon — fast.

If you are having surgery with immediate reconstruction followed by chemo, you have about two weeks to find a plastic surgeon. If you are having surgery after chemo, you’re in luck. You have some more time.

Unlike a boob job, breast reconstruction is shrouded in anxiety and distress. You don’t walk into it happy or anticipating beautiful results. If there’s anything to look forward to, it’s the last of your reconstructive surgeries, not the new breasts.

As I wrote in a previous post, I had considered a “boob job” after breastfeeding my children, but in the end, I decided that wasn’t the right choice for me. Yes, ladies and gentlemen, it took breast cancer for me to get implants!

#2 Boob jobs are relatively quick. Breast reconstruction takes months or even years.

Let’s not downplay surgery. Boob jobs can be unpleasant and painful for some women, especially if they are having implants placed under the muscle. Also, if they have a botched surgery, they may need more than one procedure. But for the most part, breast lifts and augmentations are a one-time procedure with a relatively short recovery period.

Breast reconstruction, on the other hand, can take 9 – 12 months under ideal circumstances. Longer if complications arise.

One of the options I was given for reconstruction was a delayed versus an immediate reconstruction. “Immediate reconstruction” is a misleading name. I thought that I would have a mastectomy immediately followed by reconstruction and that would be it. One surgery would take care of it all. But that’s not how it works. The “immediate” part just refers to the tissue expanders that are placed in your chest right after the mastectomy. About four weeks later, I started the expansion process which lasted five months. This entailed filling the expanders over a two month period, and then I had to leave them in place for three months before switching them out for implants. Fortunately, I was able to have a nipple sparing mastectomy, and my nipples survived. If not, the next step would be to reconstruct the nipple. Of course, the nipples are optional. Some women don’t get them redone, but if they do, this procedure takes place 3-4 months after the expanders were replaced with implants.

As you can see, even with immediate reconstruction and no complications, this is at least a nine month ordeal which involves frequent visits with the surgeon and multiple surgeries. Toward the end, I cared much less about the results. I just wanted to be done. I was dead set on having a pair of breasts when I started down this path, but now I can appreciate why some women simply get a mastectomy or lumpectomy and call it a day.

#3 Nipple loss and loss of sensation.

When women get a boob job, they get to keep their nipples. They might lose some sensation, but again, this is an elective procedure. If you choose to give up some sensation on your breasts, that’s a personal decision.

When you get a mastectomy and then reconstruct the breast, you completely lose sensation. Also, if the tumor is near the nipple, your nipple will have to go. These are not choices we make willingly. For me, losing sensation on my breasts, nipples and even the underarm area has been the most undesirable effect of the mastectomy. Parts of my underarms are always numb and tingling, and the areas that transition from numb to not numb hurt when touched, even if it’s a light touch. Sometimes, my breasts itch, and I can’t relieve the itching by scratching. My surgeon says the itching is inside, but since I have no sensation on the surface, scratching doesn’t help. This is so annoying!


However, what bothers me the most is that I don’t feel my nipples during sex. I miss that. I can remember what it feels like to be aroused through nipple stimulation, but I haven’t had that feeling in over six months. And I never will. Is this “free boob job” worth that? I don’t think so.

#4 Breast reconstruction leaves more scars than boob jobs.

When surgeons perform boob jobs, they carefully select the incision area so that scars will be less noticeable. They also make the incision as small as possible. With a mastectomy, surgeons still try to minimize scarring, but the goal is to remove as much breast tissue as possible, so the incisions are typically not small.

My incisions start at the areola and extend to my underarm. I took these pictures three months after my mastectomy. I still had the tissue expanders in place. As you can see, the scars are long, and they are visible with a bikini top. Toward the areola, the scars are redder. Perhaps because my skin is stretched out and thin over that area. Yet, I’m one of the lucky ones. Other women have even more scarring, as shown in the Miami Breast Center’s gallery of Mastectomy Reconstruction.

Some women do a flap reconstruction instead of using implants. They use tissue from another part of their body to recreate their breasts. There are benefits to this, but the scarring is even greater than with implants.

#5 Reconstruction with implants does not feel natural.

When I was trying to decide between silicone or saline implants, some of my friends with both types of implants let me feel their breasts so that I could see the difference. Now that I have implants of my own, I see that my breasts are not as soft and supple as theirs, and I can actually feel the shell of the implant in some places. I think this is because they still have their own breast tissue covering the implants, whereas I just have skin and muscle. My implants are definitely softer than the tissue expanders, and the shape is close to natural. However, they do not feel natural. So far, I have not experienced any rippling, but I’ve noticed that indentations will form on my breasts. For example, if a seam from my bra or clothing presses on them long enough, my breasts will take the shape of the seam and become indented. Another weird thing is that if I flex my chest muscle, my entire breast moves. Now, I don’t go around flexing my chest muscles, but if I have to open a jar, for example, my breasts will move up and down. Just a little odd, that’s all.

Of all the outcomes of reconstruction, this bothers me the least since I don’t mind firm breasts, I don’t see the indentations unless I look in the mirror, and I’m probably the only one who notices that my breasts move when I use my chest muscles.

So there you have it. At least five reasons why breast reconstruction is not a boob job. I’m sure other women who’ve had their breasts reconstructed can come up with other reasons, as these are just based on my own experience.

Now, don’t get me wrong. I am very grateful to be alive, and I am so thankful that I’ve been able to reconstruct my breasts. They are not “normal” but, cosmetically, the results have been better than I anticipated. I know that just a few years ago, women didn’t have all the options we have today for reconstructing breasts. Nonetheless, I still prefer my own. They were saggy and droopy. Not what I would call attractive. But I could feel them. And their appearance — well, that was just part of my life story. They were the breasts of a woman who breastfed her kids and despised bras. It’s only been six months, but I miss them already.

Have you had a breast reconstruction? If so, are there any other ways you can think of that a reconstruction is different from a “boob job”?