These women 'explanted' after being pressured by surgeons into post-mastectomy reconstruction: 'They just can't fathom why we wouldn't want b??bs'

In honor of Breast Cancer Awareness Month in October, Yahoo Lifestyle will be publishing first-person accounts of those who have been affected by the disease, which will be responsible for the deaths of an estimated 40,920 women (and nearly 500 men) this year. All women have about a 1 in 8 lifetime risk of developing some form of breast cancer. Awareness, screenings, and early detection can save lives. 

When Elizabeth Peppas was diagnosed with extensive, noninvasive breast cancer in 2007, she found herself heading into a devastating surgery: double mastectomy. But she, like so many other women, hoped that her loss would be soothed by having immediate reconstruction of both breasts. She opted for a popular, two-stage process, starting with the placement of temporary tissue expanders between the skin and chest muscle and ending with the swapping in of permanent silicone implants.

“Since I was recently remarried, and was a runner and really fit, I didn’t want to lose that femininity,” Peppas, 60, tells Yahoo Lifestyle about her choice to have reconstruction. “But I would not make the same decision again.”

That’s because the two-stage process instead turned into a yearslong nightmare: near-constant pain, battles with a condescending surgeon who crushed her ribs by overfilling her expanders, and a dizzying series of five surgeries, including one to fix ruptured implants and another to investigate and remove a mass that turned out to be a lymph node filled with leaked silicone.

The saga didn’t end until August 2018, when Peppas decided to “explant,” or have her implants removed, once and for all.

“I absolutely hated them. They felt like shot puts. Every breath I took was horrible,” the North Carolina retiree recalls, adding that she intends to urge others to think long and hard before opting for a process that she believes has more to do with societal pressure than mental or physical health. “When I heal a bit more, I will definitely be a voice to reckon with.”

Peppas is part of an increasingly vocal chorus of women who, for a range of reasons — pain or discomfort, complications, epiphanies about the possible health-compromising effects of silicone — are choosing to explant following post-mastectomy reconstruction. And these women are just a part of the growing movement of women who have embraced “going flat,” or living breast-free, after what many say was undue pressure from surgeons to reconstruct in the first place.

Of course, explanting is not the whole story. Reconstruction can be a godsend for women, with many reporting overall satisfaction with their new breasts, as well as high levels of psychosocial and sexual wellbeing — something being especially touted this week for Breast Reconstruction Awareness Day (Oct. 17), a collaborative campaign of the American Society of Plastic Surgeons, the Plastic Surgery Foundation, and silicone-implant makers Mentor and Allergan. “Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition,” the website notes. “The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life.”

That has been true for Victoria Heller, 54, of New York City, who had a double mastectomy with implant reconstruction after being diagnosed with extensive noninvasive breast cancer in 2017. “I couldn’t have faced going flat,” she tells Yahoo Lifestyle. “I love what I have … and they have given me an enormous confidence boost. I was topless everywhere this summer, and feel so much better about my body in general. I consider my new breasts to be something nice to have come out of something that was so horrible.”

She echoes the positive experiences of other women who spoke with Yahoo Lifestyle about their reconstruction, including a 48-year-old Rhode Island mother of two who notes, “I lost what was, but I still have breasts [implants] — and though they’re different, they do feel like mine.” Another woman, 49, of Boston, tells Yahoo Lifestyle that after her unilateral mastectomy and implant reconstruction this past summer, “I’m super-happy. My boob rocks.”

Still, those who explant are crucial examples of an oft-glossed-over fact: Reconstruction is not always the good-as-real replacement option — or sanity-saving necessity — it’s often made out to be.

In 2018, an estimated 266,120 women will be diagnosed with some form of invasive breast cancer, along with 63,960 with noninvasive (in situ) breast cancer, as was the case with Peppas. That, combined with the growing numbers of women being tested for BRCA genetic mutations (which vastly increase the risk for breast cancer) and choosing to have preventative mastectomies if they test positive, has led to a sharp rise in the surgery. While there are no precise national counts of mastectomies in any specific year, the overall rate of the surgery, combining both single and double amputations, has increased by 36 percent in recent years — from 66 per 100,000 women in 2005 to 90 per 100,000 women in 2013 — according to one study.

And while plenty of women reject breast reconstruction — about 25 percent of double mastectomy patients and nearly half of single decide to go flat, according to one study — the rise in mastectomies has brought an increase of women being offered and choosing it.

It’s a process that can take various forms: expanders and breast implants (either silicone or saline) placed under or over the muscle; natural tissue flaps, called “autologous” reconstruction (using skin, fat, or muscle from elsewhere on a woman’s body, typically the belly or back); or a combination of those methods, usually depending on an individual’s body type.

Results vary, as a comprehensive new study of patient-reported outcomes, published in JAMA, found (with those who used tissue-flap methods over implants reporting slightly higher degrees of overall satisfaction two and four years out). But reconstruction always brings with it a lack of sensation — something that come as a disconcerting shock, as the fact of expected numbness is not always made clear by surgeons.

Still, according to one report, published in 2017, the rate of women choosing post-mastectomy reconstruction rose 62 percent between 2009 and 2014. The question is: At what price?