STEAMBOAT SPRINGS — One in three women who get reconstruction surgery after a mastectomy have complications, according to a 2018 study published in the Journal of the American Medical Association (JAMA).

One in five women require more surgery.

The study defined complications broadly, from minor wounds that took extra time to heal to horror stories involving multiple additional surgeries.

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South Routt resident Kathy James elected to get a double mastectomy because her mother was diagnosed with breast cancer at 40 and died at 55.

“I ended up taking care of her,” James said. “And that was a toll I didn’t want my kids to take. It wasn’t pretty.”

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After going through the mastectomy and a reconstruction process that refused to heal, she decided to get the implants removed entirely and go flat.

“Reconstruction surgery is a very personal decision,” James noted, “and one that should not be taken lightly.”

Her reconstruction failed miserably, she said. It was a long and painful process, both physically and emotionally.

“The key takeaway from this research is that these are complicated decisions,” said Dr. Edwin Wilkins, an author on the JAMA study. “These operations are not without risk.”

Another author, Dr. Andrea L. Pusic, chief of plastic surgery and reconstructive surgery at Brigham and Women’s Hospital in Boston, said the findings were not meant to be prescriptive.

“These papers aren’t saying women should have one operation or another,” she said. “They’re about filling in the blanks that aren’t always explained to women, so they know the pros and the cons and can make good decisions.”

At the UCHealth Gloria Gossard Breast Care Center, plastic and reconstructive surgeon Dr. Aaron Frye travels once a month from Fort Collins to perform reconstruction surgeries. He is a recent addition to the center.

Frye steps in after another surgeon performs the mastectomy.

Frye explained the different options for surgeries. One relates to timing — women can start the process during their mastectomy, or they can wait — six weeks, six months or not at all.

A benefit to starting during the mastectomy is to eliminate a surgery, he said. It also gives the women some volume right away.

There are also two types of surgery, Frye explained. One is implant based, while the other — called autologous — uses tissue transplanted from the patient’s belly area.

According to the JAMA study, the overall complication rate was much higher for the autologous reconstructions as for the tissue expander-implant surgeries.

Frye primarily does the implant surgeries, working with a tissue extender, which he said creates a pocket where the breast tissue was removed. This step, adding protection and layers, can help prevent infection and complications, he said. A lot depends on the quality of the existing skin flap left after the masectomy, he explained.

A pocket is created where later an implant will be placed.

Frye works to minimize risks as much as possible and sees fewer complications than the JAMA study — estimating about 7% to 10% of reconstructions result in a range of very minor to more serious complications. His surgeries in Steamboat thus far have gone well, he said.

James advises women to “talk to other people. A lot of people. Really get the pros and cons.”

Accepting herself without breasts hasn’t been easy, but she has no doubts about her decision.

James often wears “knitted knockers” — the lightweight prosthetic made of yarn and inserted into a bra.

When she goes out, people can’t tell the difference. Her boyfriend tells her not to wear them — “He says I’m beautiful without them,” she said.

But she still is very aware of what she has lost.

“It’s still hard to look at myself,”  she said.

James has now knitted thousands of knockers for other women. She even took a trip to Africa to teach women there how to make them.

There’s also a Facebook group, “Fabulously Flat,” James has found to be a great resource — not only for the camaraderie, but to learn from other women about their experiences. There are also the stories of how husbands react and how single women face the dating world.

To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.

To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.