A Decision for Herself: Choosing a Single Mastectomy Without Reconstruction

A 45-year-old Canberra woman, Aarthi Ayyar-Biddle, has shared her journey following a diagnosis of invasive ductal carcinoma, detailing her decision to undergo a single mastectomy without breast reconstruction. Her choice was shaped by medical advice, personal considerations about future surgeries and physical fitness, and a desire to model body confidence for her children. Her experience was featured on the ABC podcast "Ladies, We Need to Talk."

Diagnosis and Treatment Timeline

Aarthi Ayyar-Biddle, who lives on Ngunnawal land, was diagnosed with invasive ductal carcinoma in her right breast after noticing a lump. The period from diagnosis to the start of her treatment was approximately two to three weeks, a timeline she described as "very, very fast."

Her treatment plan consisted of:

• Chemotherapy as an initial treatment, which she stated shrank the tumor.
• A single mastectomy of her right breast.
• Planned radiation treatment following surgery.

Medical Decisions and Considerations

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

Ayyar-Biddle opted against breast reconstruction surgery. Key factors in her decision included:

• Medical advice that, due to her need for radiation treatment, there was at least a 50% chance reconstruction would require further surgeries.
• A personal preference to avoid autologous reconstruction (often called flap surgery), which uses tissue from other areas of the body. She expressed concern about the recovery time and a desire to maintain her physical fitness, which she had worked to regain after a previous caesarean section.
• A stated principle that future surgeries should have the purpose of "saving or prolonging" her life.

"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."

Personal and Cultural Context

Ayyar-Biddle, a mother of two teenage boys, stated that modeling positive body image was a significant factor. She reported feeling pressure from societal and cultural ideals regarding the female form, noting her background as a South Asian woman. She also referenced a societal notion that "if you're having one removed, you might as well have both," but emphasized the importance of not rushing the decision to remove a healthy breast.

Other personal considerations she mentioned were:

• Enjoying sensation in her remaining breast during intimacy.
• Finding that having one natural breast helps secure a prosthesis when wearing a bra.
• Receiving support from her husband, who she said told her, "I will always love you for you, and you'll always be beautiful to me no matter what."

Broader Context and Aftermath

• According to the articles, approximately one-third of women in Australia who undergo a mastectomy choose to have breast reconstruction afterward.
• Ayyar-Biddle stated that gardening was an activity that helped her during treatment.
• She is considering getting body art related to nature and flowers to commemorate her experience.

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