While I can only speak for myself and from my own experience, I may understand why some women opt out of breast reconstruction.  I think at first, the fright and shock of cancer just makes the patient's immediate response one of "get as much of the cancer out of me as possible." Therefore, reconstruction at that stage isn't as high a priority as getting healthy and getting treated to eliminate as much cancer as possible.  Later, I think that more bilaterial mastectomy patients may decline reconstruction altogether because it isn't life saving surgery and they are at least symmetrical, so they may feel it would be better to just go on with life, rather than submit to more surgeries.  For unilateral patients, I would expect more of them will desire reconstruction in order to achieve some sort of symmetry.  However, delayed reconstructions are difficult for someone who has gone through the fear and lengths to treat the cancer.  Left on their own to find a surgeon that they will be comfortable with to perform the surgery is a daunting task.  There are plenty of plastic surgeons out there who make a pretty penny doing breast enlargements and lifts.  For the cancer survivor, being herded through routines like exams and videos and forms, in a setting that obviously caters to the cosmetic surgeries, is a very uncomfortable and cold experience.   It is actually almost insulting.   As if having/being treated for cancer wasn't bad/hard/scary enough.  I think we need more surgeons who specialize in reconstruction or who have compassion dealing with cancer/reconstruction patients.