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> If she is in a serious committed relationship, her partner's opinions will be really important to her decision-making process.

6 years since my wife's double mastectomy and honestly I'm only posting for potential benefit of anyone that reads this. Do/suggest/live-with/support what ever is least invasive for your wife/partner. I nearly steered my wife into a very invasive surgery due to it having more "real" outcome (she knew I wasn't really into implants in general and preferred natural). Honestly, I think she wanted that too - it's a hard time that leads you to this type of surgery and something that sounds "normal" is what you will gravitate towards. However, then I came to my senses/digested some research and realized how invasive the surgery was and how I didn't want her to have to go through it (+risks) and I had to kind of talk her out of it. It was the difference between, quickly adding some implants (couple hour surgery) and a procedure that required re-routing an artery, relocating some stomach muscles, and some other grueling things I don't recall (18 hour surgery).

After that ordeal, and a C section birth of my son, yah she has some scars. But they become invisible and life moves on and that's the best part.

I don't think "least invasive" should be the only criteria.

In our case, we choose the opposite way to you, i.e to have the DIEP reconstruction. Yes it's a lot more invasive, but also:

A) the results are more natural (moving tissue from one part of the body to another) and theoretically good forever. No need to worry about the state of your implants a few decades down the track.

B) In our case at least, it's a form of reconstruction that is a little bit leading edge, and exciting to the surgeons. I feel that's a good thing as there was a lot of focus by a lot of people on the surgery going well.

Instead of just "least invasive" I would suggest considering the long term maintenance as well.

FWIW we are super happy with our choice, mainly because it puts everything in the rear view mirror forever, and as just a single breast involved, from memory the surgery was more like 9 or 10 hours, not the 18 you are quoting.

Glad to hear this. I’ve actually never discussed with anyone that chose that procedure. Admit I might have mis-remembered the operation time, it was a long time ago and I’m not fact checking myself just went off memory. But was something long enough that I remember discussing with the doctor.

It’s all good points we did consider, that again I didn’t even recall at time of writing. She will have some maintenance operations like you said, we weighed that and felt ok with it (same maintenance that any person with implants will have, replacing every 10-20 years).

I agree with the leading edge and exciting part you mentioned. We had to find a surgeon that was young enough to know the procedure. It was our original plan, then when we told him we decided against it later you could see the excitement fade in his demeanor. (Cynically I say because he knew the pay day was smaller. But I work with a lot of doctors on the business end, and this is really how many of them think.) Also was a concern. I don’t remember the details, but what are long term implications of moving things around? This space is rife with examples of once cutting edge procedures that in hindsight are causing problems.

All that said, we had a thing happen to my wife where super routine procedure turned into her almost dying from loss of blood. She had to have transfusions and whatnot. It was horrible experience. So, we gained a strong aversion.

My main point is, whatever you chose, it’s really easy to get “used to” the scars and looks of it. Of course, some people don’t and it affects the sex life and all that. But I think using data about what MEN think on gut reaction can be harmful and misleading because it’s going to steer towards something that may not be the best decision for the patient. It’s difficult to design a survey that takes “getting used to it” time into account, but I feel like that would be more appropriate. I know my wife’s main concern was looking normal in clothes. But that was a proxy for symmetry and size and things she equates with “normal”.

> What is "aesthetically pleasing" to random strangers according to some survey is of little importance.

It's extremely important to most people. We go out of our way to look good. Just look at any shopping street. Clothes, makeup, gyms, etc.

For most people who aren't, say, professional models or actresses, what your bare breasts look like is something only a relatively small number of people are likely to know from first-hand experience.

It's important to be socially acceptable in public with how you look. But what your breasts look like when you are naked is really not important to your social life per se.

Someone I knew who chose to not have reconstructive surgery after a mastectomy once said about a mutual acquaintance who had a lot of cosmetic surgery for various reasons "She is covered in scars and only looks good in her clothes." The unstated subtext there being "I also look good in my clothes, even though I only have one breast."

If your life partner is okay with it and you are okay with it, the rest of the world can butt out. It's a more complicated question for a relatively young single woman who needs to wonder about future potential romantic partners.

I was quite plump at one time. There are men who like it like that and I have been fortunate to know such men.

At the time, I was getting a lot of ugly feedback from "random internet strangers" about how desperately important it is for a woman to be thin.

That experience informs my opinion that "What random internet strangers think about your naked body is of little consequence compared to actual intimate partners in your life."

FWIW and all that.

> It's extremely important to most people. We go out of our way to look good. Just look at any shopping street. Clothes, makeup, gyms, etc.

It's a continuum, and I don't think it's 'extremely important' to many people at all in my experience.

Far more people are not shopping and don't go to gyms, and shopping and gyms serve other purposes too. Also, when someone does those things to enhance appearance it doesn't mean it's 'extremely important' to them; I watched a sporting event over the weekend, went grocery shopping, and I post on HN, but none of those tings are extremely important or even important to me (beyond avoiding starvation).

It's not binary; humans cover a very wide range - much wider than you or I experience or imagine.

The goal of not caring what other people think about your physical appearance is noble but naive and I'm not even really certain it's ideal.

It's definitely something that people say in situations like this but if you'd ask literally anybody who's had a mastectomy if they could keep their breasts looking exactly the same before surgery as they did before, I guarantee that nearly all of them would want that.

I think it's much more important to help people be confident in themselves with their new appearance than it is to tell them they are just the same as they were before. I think it's misguided to try and convince people that they didn't lose something.

I agree with most of your comment.

About the arms, I guess the problem is that for internal use in a Medicine class it is usual to make the torso without arms. For example half of these images don't have arms https://www.google.com/search?q=torso+medicine&rlz=1C1CHBF_e...

If the survey was about hand reconstruction if a machine destroys your thumb, and they move a finger to the thumb position, I guess the image would have only the hand without the arm.

Perhaps this can be solved with a more smart cropping. (The images don't have legs, but that part is cropped so it is not weird.)

> Scarring is not just about aesthetics. It's about pain and swelling and limited movement and things like that.

In some images I notice the scar and though: "More symmetric is better, but that means an additional surgery. I don't like surgeries unless they are absolutely necessary." I don't remember what I selected, but it was a difficult choice because the question in the survey and my preferences have a different answers. I probably answer half following the instructions and half my opinion.

I agree that cropping could go a long way towards solving the arm issue. It's a small detail, but it could be handled more sensitively.

Some women experience a lot of swelling after a mastectomy and my general understanding is this can be impacted by how many lymph nodes get removed. This can make tight clothing a nightmare that causes bad swelling and a lot of pain.

This can be a really serious quality of life issue.