Sun’s out, tits out… literally. Like they’re gone.
*Just a little warning that I share pictures of my recovery in this article. No full breast pics but you’ll see imperfections, bruising, and scarring.
I’ve come to embrace the fact that my breasts will forever live in the space between real and fake.
I had a prophylactic skin-sparing double mastectomy followed by a procedure called DIEP flap reconstruction on 11/5/24. Over twelve hours, my internal breast tissue was removed completely (leaving the skin intact) and my belly fat was used to replace the breasts. Pretty cool, huh? I wanted to avoid implants (no shade to those who choose them) and this provided that option. Some women go flat. I was 39 and didn’t want that either.
The new breasts are “mine” in the sense that autologous1 tissue was used to create them, but sometimes it’s still weird to think about how the OGs are gone and someone’s excess belly fat is in their place (even though that someone is me).
The source of my babies’ milk no longer exists, and the imposters don’t even have the decency to regain full sensation back! I don’t even have nipples anymore!
Despite awareness of the negative consequences of this surgery, I did choose it and I don’t regret it. I am beyond grateful for how it turned out—it was pretty much the best case scenario given the circumstances. I can’t say it doesn’t hit me at intermittent times with a pang of grief, though, for what I’ve lost and for the weirdness left in its place.
It’s weird to not quite be able to feel parts of your body. It’s weird to have itches that cannot be reached or satisfied (phantom itching) and it’s weird to feel like a combination of Barbie and Ken, and not in the good ways.
HAVE I SAID IT’S WEIRD?
Sure, it’s cool that technically I got a cosmetic upgrade regarding fullness and shape,2 and I’ve gotten used to the lack of nipples staring back at me when I get out of the shower (a la Barbie). But there’s also this phenomenon called the “Ken doll” where many women who have had this surgery notice a fuller mons pubis area afterwards— a friendly reminder that this was not, in fact, a cosmetic surgery. WEIRD.
I acknowledge that reconstruction is rooted in wanting to look a certain way (aka to continue having breasts), but aesthetics was not the focus here—cancer prevention was—and I knew that going in. But afterwards many women (myself included) end up feeling like they were just tossed back together and zipped up like a middle schooler’s gym bag. We know we will need more surgeries if we want things to look better cosmetically, but it’s a “first things first” mentality with this, which I respect.
The priority in DIEP flap reconstruction is to make sure the belly fat that is split and used to create new breasts is successfully transplanted with blood supply attached. This is not a sure thing or a perfect science yet. Close monitoring is done for 2-3 days after surgery to make sure the flaps don’t fail, which is a real risk. Surgery tends to be long, with a lot of opportunity for complications. Even in my “excellent candidate” scenario, there was a complication during my surgery that extended it by two hours and resulted in the requirement of an extra skin graft when one of my skin circles failed.3 They almost lost one of the new breasts altogether.
Thankfully, both were saved, the new skin graft took (eventually, after turning blue and purple and gray) and I was out of the woods. Two years later, they still look great.
Spring 2026, 3 months after Phase 2
I am done having surgeries for this (at least I think so). The initial surgery is often referred to a Phase 1, and then any subsequent revisions are numbered accordingly. I chose to have Phase 2 surgery thirteen months after my first one, and that was intended to fix some minor cosmetic things. It was “covered” as part of the surgical process, though it did come with a copay.
When breast tissue is removed during a mastectomy, the removal is extensive. We can have breast tissue up and over to the level of our armpits, so when the flaps replace the tissue, it cannot possibly fill out the whole area. This results in divots, often above where the flap is.
During Phase 2, I had liposuction to my flanks (love handles) and that fat was injected into the divots to fill them out. That fat, though injected through a needle and not surgically grafted, still has to establish its own blood supply. Otherwise, it can reabsorb into the body, leaving you with 50% or less of the tissue placed there! What a bummer after going through another surgery.
My plastic surgeon was adamant that upper body rest was crucial to maintain that tissue by allowing it time to revascularize on its own. If you move your arms too much or use those muscles, the tiny vessels trying to attach and establish a blood supply can tear, and the tissue goes away. I am happy to report that I did my very best to do nothing (lol), and it paid off. I have little to no volume loss in the year since Phase 2.
The other part of Phase 2 was to tuck in the ends of my abdominal incision, which are affectionately called “dog ears.” Aren’t these little nicknames fun? My dog ears were not bad at all, but they tucked them right on in there. I’m side-eyeing this practice in my case, because after things have settled I still have tiny ones left over and my incision grew on each side by like 2 more inches in the process. Worth it? I’m not sure.
Overall, I am extremely satisfied with the outcome of my surgeries, and I do not regret the whole process in the least. I know how lucky I am to have been a great candidate, to have healed without wounds opening up, and to end up with symmetrical breasts that look fairly natural if you don’t know I have no nipples under there!
A note on jokes and bright-siding:
While what I had is NOT a traditional tummy tuck, the procedure isn’t terribly far off in the sense that I lost a chunka my belly that I do not miss. That’s one of the silver linings. I will say, though, if you have a friend going through this, please be careful with jokes about it being a boob job and/or a tummy tuck. Please don’t call it a Mommy Makeover. That is, unless she does and is okay with it.
Everyone has a different comfort level with medical humor and different sensitivities to the grief involved with this surgery. The vast majority of women going through it have been diagnosed with cancer, and reframing the surgery as positive without their buy-in might be received as making light of their diagnosis.
Health scares are tricky because, while many women try to make it seem like they’re fine on the outside, they could be having a really hard time. Someone coming in and saying, “Wow! Can I get insurance to cover my tummy tuck, too?!” could feel like a slap in the face. Acknowledging silver linings is great, but often the patient doesn’t need them pointed out. They are well aware and have already been bright-siding it to themselves. What they need from you is validation that this sucks and is hard, not “At least you get new boobs!”
Some will say, lighten up. Some will say they welcomed the jokes. I am someone who was fine with them, BUT I DIDN’T HAVE CANCER. I am in a DIEP flap support group on Facebook and this topic is a huge point of contention. So all I am saying is, tread lightly, because people remember how you treat them during a crisis.
My homegrown breasts filled out too late and were taken too early.
Those things continue to be true, but I have always been and continue to be breast cancer-free. My lifetime risk of getting it was reduced from 40% to 1-5% as a result of my DMX (double mastectomy). I have written a few articles on my precancerous lesion diagnosis, what led me to this drastic decision, and how I managed it all. I’ll link them below.
Thanks for being here. I am so happy that my initial surgery is two years in the rearview mirror and I appreciate you celebrating with me.
xo, Amy