Empowered by My Choice: Nipple-Sparing Double Mastectomy with Implants

Getting a double mastectomy freed me from scanxiety, although I had cancer in only one breast. Now my breasts are symmetrical, and I’m happy with my results. 

• Procedure: nipple-sparing, skin-sparing double mastectomy; reconstruction with implants
• Reconstruction immediately postmastectomy: mastectomy and expanders placed the same day
• Years of procedures: 2023
• Age: 43 years old
• Race or ethnicity: white

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Diagnosis and surgery timeline

I paid for a baseline mammogram out of pocket when I was 35 years old because I had friends getting diagnosed with breast cancer. My doctor told me I had dense tissue and recommended I start getting ultrasounds too.

Before the cancer diagnosis, my breasts had shrunk to deflated balloons from breastfeeding two kids. I got silicone breast implants under my chest muscles in 2015.

In 2023, my mammogram was clear, but the ultrasound picked something up. I was diagnosed with triple-positive breast cancer at 43. And if I hadn’t had the ultrasound, I would’ve missed it for a year.

My decision process

My oncologist told me I’d be a good candidate for a lumpectomy, but I’d have to have radiation on the breast too. My original implants would have to be removed to avoid complications from radiation, such as encapsulation or hardening of tissue around the implant.

I decided to have a double mastectomy (DMX) because I knew I had an aggressive form of cancer. I wanted to save radiation as a treatment option if the cancer ever came back down the road.

I also wanted my breasts to be symmetrical. I had cancer in only one breast, but I think it’s easier for doctors to reconstruct two matching breasts.

Scanxiety, or fear of cancer-related scans, is also very real. I didn’t want to be worried every time I felt a lump or had a mammogram.

My double mastectomy experience

While finishing chemo, I scheduled consultations with multiple plastic surgeons. I chose a doctor who said he looks for realistic perfection, which I appreciated. He showed me example images from his previous surgeries and answered all my questions.

My surgeons recommended a skin-sparing and nipple-sparing procedure. My tumor was far enough from my nipples that I could save them.

Luckily, we coordinated both surgeons’ schedules in February 2023 so that after the breast surgeon removed my breast tissue, my plastic surgeon came into the operating room to immediately place the tissue expanders. He filled them with a bit of air so they wouldn’t be heavy on my healing chest.

The first 2 to 3 days postsurgery were painful. I’m not sure if it hurt more because they had to remove the original implants from under my chest muscles. My husband had to help me sit up and recline for the first few days. But life changes when you get your drains out — mine were removed 8 days later, and I was out and about.

When I visited my plastic surgeon 3 weeks later, he deflated the air in my expanders and started adding saline. I went back for three more fills over 4 months, and my implants were placed at the end of May 2023. That was a super easy surgery.

My surgeon also grafted a small amount of fat to fill in the space around the implants. It makes them look smoother, not like circular balloons on my chest.

My recovery

During my mastectomy, I had a few lymph nodes removed from my armpit. In response, my body developed scar tissue connecting my armpit to the side of my breast like a guitar string. It’s called axillary web syndrome, or cording, and it pulled when I moved. It felt like someone holding a lighter to the back of my arm.

I started physical therapy for it, and my symptoms totally disappeared within 4 weeks. Now my arm feels good. Cording is common but not talked about enough.

I don’t feel sensation in my nipples, but they still work. When I’m cold, they still function like headlights. That’s why doctors tell you not to ice your breasts after a mastectomy — you can’t feel how cold it is. You can get an ice burn.

I wish I’d asked about nerve reconstruction that can help women preserve sensation in the nipple and skin, but I don’t know how much of that would have been covered by health insurance. And honestly, I had decision fatigue.

My life in remission

Getting a double mastectomy made me feel empowered during a process where I had very little control, and I’m happy with my results. My breasts are symmetrical, and I’m glad I could avoid radiation.

Of course, it’s a very personal decision for every person, and there are risks.

I’ll likely do another round of fat grafting in the future for greater fullness and to hide some rippling that only I notice. For now, after a full year of chemo, surgery, and immunotherapy, I’m grateful to return to my life without scanxiety.

Why I’m sharing my story

When I was going through the process, I was starved for information. I couldn’t find many women who had implants before cancer. I wanted to hear as many other women’s stories as possible. I was scared but didn’t want to make the wrong decision.

It was overwhelming for me at first, so I broke it down into phases. Phase 1 was chemo, and phase 2 was my DMX, etc.

Don’t be afraid to ask questions — even ones you might be embarrassed about. Make sure you’re working with a plastic surgeon who works with cancer patients regularly.

And don’t feel rushed into making your decision. Be patient with yourself throughout the recovery process.