I was diagnosed with breast cancer at age 35 and needed a mastectomy. I chose to have a double because of my family history and for symmetry reasons. I never considered implant reconstruction. The idea of having a foreign body under my skin felt wrong to me. I also read testimonials from women who had implant reconstruction about their “foobs” feeling cold, rippling, needing multiple revision surgeries, and suffering from capsular contracture especially after radiation (which I knew I needed as well). 
There was nothing about implants that appealed to me. And my breasts had served their purpose by feeding my two babies. I was ready to go flat and be done with it. Autologous reconstruction didn’t appeal to me for many of these same reasons, as well as the risk of complications at the donor site as I enjoy athletic pursuits and didn’t want to compromise function for the sake of form.
Unfortunately, after my mastectomy, I did end up needing additional surgery to remove excess skin my surgeon left against my consent “in case you change your mind” [about implants], which led to my advocacy work at NotPuttingonaShirt.org. We advocate for optimal aesthetic flat closure as a healthy, beautiful mastectomy choice. In the end, that’s really what it’s all about: choice.
While I know that many women are happy with their implant reconstruction, and that for some patients, replacing their original breasts is a priority and is worth the costs… for me, it just wasn’t. I’m happy flat, and I’ve never regretted my decision.