Many surgeons don’t ever actually state that going flat is an option. There are many women who don’t want to deal with the surgeries/potential complications of getting reconstruction, and are perfectly happy with saying “no” to reconstruction altogether and remaining flat post-mastectomy. This is absolutely an option to be considered!
Make sure that your surgeon is trained in flat closure (ask to see pictures!) so that you avoid dogears and other lumpiness to the chest
Not everyone is a candidate for DTI reconstruction. If you’re going up significantly in size, or are maintaining size and are already a C+ cup, DTI may not be an option. If you fall into this category, a breast reduction first may make DTI an option. Expanders are a great option for women with C+ cups who don’t want to do a breast reduction first, or women who want to go up in size, but have an increased risk of complications (leakage, infection, deflating expanders, etc.).
The choice of DTI vs. expanders is very surgeon dependent-- be sure to ask your team what they feel is safe for you!
UTM was the standard of breast implant reconstruction for a long time, but OTM is quickly becoming the newer, more advanced, potentially “better” reconstruction option.
If you are relatively “big” in size (e.g. C cup or above), it’s often advised to go smaller (e.g. A or B cup) due to higher risks of nipple necrosis (nipple dying) and infection. Some surgeons offer breast reductions + breast lifts as a separate surgery ~3 months prior to the mastectomy. This is typically a ~4hr outpatient procedure, and helps to prep the pocket for the mastectomy while maximizing chances of retaining the nipple and potentially maintaining sensation.
Most women lose sensation in their breasts after mastectomy because the nerves are cut during surgery. But there are options!
Some surgeons offer sensation-preserving techniques. If sensation is important to you, seek out surgeons either trained in microsurgery and nerve grafting/preservation, or surgeons trained in ReSensation. Be sure to confirm with your surgeon that they are trained in the above procedures and ask them about their results.