For some, the choice was driven by a quest for normalcy. For others, it was a way to regain control. And for others still, the choice was to “go flat.” Eight brave women share their complex and personal journeys.

This Breast Cancer Awareness Month, we’re looking at the women behind the ribbon. Join the conversation on Breast Cancer Healthline — a free app for people living with breast cancer.

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The decision to go through the reconstructive process after a breast cancer diagnosis — or not — is incredibly personal. There’s a lot to think about, and the choice can bring up a lot of emotions.

Barring medical reasons, women who decide to have the surgery also need to think about their timing in relation to their mastectomies. Should they do it immediately after, or take some time to decide?

Healthline spoke with eight women about what they ultimately chose when it came to their reconstructive surgery options.

Katie Sitton

Currently awaiting surgery for reconstruction

Katie Sitton received her breast cancer diagnosis in March 2018 at 28 years old. She’s awaiting surgery as she finishes up chemotherapy.

“At first I didn’t want the reconstruction. I thought it was better cancerwise to get rid of [my breasts],” Katie explains. “But the more research I did, I learned that wasn’t true. Cancer has taken so much away from me, but this was something I could have a say in.”

Kelly Iverson

Double mastectomy + immediate reconstruction

At 25 and aware that she had the BRCA1 mutation, Kelly Iverson, a marketing manager with Mad Monkey Hostels, had two options presented to her: implants immediately following her mastectomy, or expanders put in under the chest muscle and another major surgery six weeks later.

“I guess it was never a question of if I would get reconstruction,” she says. “Aestheticwise, I definitely wanted to have something put back in there.”

Kelly felt if she wasn’t happy later on with how the implants looked, she could return for a fat-grafting surgery — a process where fat from her torso is put into her chest. It’s minimally invasive compared to a second expander surgery, and it’s covered under her insurance.

Tamara Iverson Pryor

Double mastectomy + no reconstruction

Tamara Iverson Pryor has received diagnoses and treatment for cancer three times since the age of 30. Her decision not to get reconstruction following a mastectomy involved multiple factors.

“To achieve optimum results would require removal of both of my latissimus dorsi muscles,” she explains. “The thought of yet another surgery that would adversely impact my upper body strength and mobility didn’t seem like a fair exchange for what I thought was not going to be an aesthetically pleasing result.”

Tiffany Dyba

Double mastectomy with expanders + future implants

Tiffany Dyba, author of the blog CDREAM, was given the option of a single or double mastectomy with immediate reconstruction at 35 years old, but remembers no one actually telling her she could also choose to “go flat.”

She has tissue expanders and will receive implants when she’s done with her treatment.

“In terms of reconstruction, I was actually never given an option to have it or not. There were no questions asked. I was so overwhelmed I didn’t even think twice about it,” she explains.

“For me, while I wasn’t attached to my breasts, normalcy was something I craved in this whole process. I knew that my life would change forever, so as much as I could at least look like my old self, that’s what I was striving for.”

Sarah DiMuro

Double mastectomy with expanders + later implants

At 41 and newly diagnosed, Sarah DiMuro, a writer, comedian, and actor who now vlogs for Rethink Breast Cancer, counted the days to her double mastectomy.

“I was never really attached to my breasts, and when I learned they were trying to kill me, I was ready to consult Dr. YouTube and remove them myself,” she says.

She never considered not having the surgery. “I wanted to have something to replace my lethal little mounds, and while I’m not exactly a pinup with my full B cups, I’m proud that I have them.”

Sabrina Scown

Watch + wait for prophylactic mastectomy

Sabrina Scown went through ovarian cancer as a child in 2004. When her mom received a diagnosis of breast cancer two years ago, they both underwent testing and found out they were positive for the BRCA2 gene.

During this time, Scown was also starting fertility treatments, so she opted to do self-checks and doctor exams while she focused on having a family — something her genetic counselor encouraged her to complete, since her risk of breast cancer would increase the older she got.

The mother of one now says, “I’m still deciding on having a second child, so until then, I will do the ‘watch and wait’ approach.”

Karen Kohnke

Double mastectomy + eventual reconstruction

In 2001 at 36 years old, Karen Kohnke received a breast cancer diagnosis and had a mastectomy. Over 15 years later, she’s now living with implants.

At the time, however, she chose to forgo reconstruction. Her main reason was due to her sister, who had died of cancer. “I thought if I end up dying anyway, I didn’t want to go through the more extensive reconstruction surgery,” she explains.

She was curious to see what someone looked like without breasts, but found it wasn’t a common request. “Most didn’t ask questions about it. I’m very much an asker of questions. I like to research everything and look at all options,” she says.

Part of her decision to ultimately have reconstruction was based on her newly single status. “At least at first, I wouldn’t have to explain my history of breast cancer to my dates,” she says. “But the difference between real and artificial is obvious when one is naked.”

“One day I may choose to go without the implants,” she adds. “What they don’t tell you is that implants aren’t designed to last forever. If someone gets implants at such a young age, it is more likely that they will need a redo.”

Anna Crollman

Single mastectomies + later implants

Diagnosed at 27, Anna Crollman, author of the blog My Cancer Chic, saw reconstruction as the finish line in her breast cancer journey.

“I was so focused on the end goal of looking like me again that I overlooked the emotional trauma associated with my body changes,” she says.

“The reality is, breast reconstruction will never look like natural breasts. It’s been two years and over five surgeries, and while my body will never look like it did before, I’m proud of it. Every scar, lump, and imperfection represents how far I’ve come.”

Risa Kerslake, BSN, is a registered nurse and freelance writer living in the Midwest with her husband and young daughter. She writes extensively on fertility, health, and parenting issues. You can connect with her through her website Risa Kerslake Writes, or on her Facebook page and Twitter.