A Cancer Patient's Choice: One Mastectomy, No Reconstruction

"Having one breast really feels like the new normal, and I really feel like it's been the best possible decision for me."

A 45-year-old Canberra woman, Aarthi Ayyar-Biddle, has detailed the medical advice and personal considerations that led her to choose a single mastectomy without breast reconstruction following a breast cancer diagnosis. Her account provides insight into the decision-making process faced by women with breast cancer in Australia, where approximately one-third of women who undergo mastectomies choose to have reconstruction.

Diagnosis and Treatment Timeline

Ayyar-Biddle discovered a lump in her right breast and was subsequently diagnosed with invasive ductal carcinoma. She began chemotherapy approximately two to three weeks after the diagnosis. Following the chemotherapy, which reduced the tumor, she underwent a single mastectomy on her right breast. Her treatment plan included chemotherapy, surgery, and then radiation.

Medical Decision Making

Decision Against Double Mastectomy

Ayyar-Biddle stated she asked her doctors about having a double mastectomy but was advised to have a single procedure. Genetic testing showed she did not have BRCA gene mutations, which are associated with a lifetime breast cancer risk exceeding 70% for carriers. Medical professionals advised that a double mastectomy would increase infection risk and could delay recovery and subsequent radiation treatment.

Decision Against Reconstruction

Ayyar-Biddle decided against breast reconstruction surgery. She stated she was not interested in autologous reconstruction (flap surgery), which uses a patient's own tissue from areas like the abdomen, back, or thighs to rebuild a breast. She expressed concern that such surgery could compromise her physical fitness, which she had worked to regain after a previous caesarean section.

According to Ayyar-Biddle, breast cancer nurses informed her there was at least a 50% chance she would need additional surgeries if she had reconstruction before her planned radiation treatment.

"Every surgery I have from here on needs to be with the purpose of either saving or prolonging my life."

Personal Considerations

Family and Body Image

Ayyar-Biddle is a mother to two teenage sons, whom she breastfed. She stated she wanted to model positive body image with an asymmetrical body.

"I am mum of two teenage boys, who I had been able to breastfeed, and I really wanted to model to them what it meant to have a positive body image, with an asymmetrical body and being really confident in that."

Practical and Intimate Considerations

Ayyar-Biddle noted that keeping one breast allows for sensation during intimacy and helps secure a prosthesis when wearing a bra.

Support

She reported that her husband expressed support for her decision regardless of the outcome.

"I will always love you for you, and you'll always be beautiful to me no matter what."

Cultural and Social Context

Ayyar-Biddle identified as a South Asian woman and noted cultural ideals regarding the female form. She also reported feeling pressure from broader societal beauty standards and social media representations. She stated that she heard the idea that "if you're having one removed, you might as well have both," but emphasized that she pushed back against this notion.

Terminology & Commemoration

The term "uniboober" is used in some communities to describe having one breast, while "flatties" refers to women who have had mastectomies without reconstruction.

Ayyar-Biddle stated she is considering getting body art related to nature and flowers to commemorate her experience. She reported that gardening helped her during treatment.

Current Perspective

Ayyar-Biddle described having one breast as feeling like the "new normal."

"Having one breast really feels like the new normal, and I really feel like it's been the best possible decision for me."

Her story was featured on the ABC podcast "Ladies, We Need to Talk."