THE ARIZONA REPUBLIC

Statistically, it is a decision one in 11 women will have to make. This year about 110,000 women will develop breast cancer. The solution is surgically simple but psychologically devastating: surgical removal of a breast. Mastectomy.

For many women, mastectomy is one of the dirtiest words in the language. This is supposedly the age of understanding between the sexes, the time when sexual roles are reversing and stereotypes falling. Yet for many women, the loss of one or both breast means the loss of sexual identity. With it, they feel, goes their attractiveness and allure.

"I think about it, the way I was," May Dyball, 40 says in a soft voice. She has had both breasts removed. "I would like to have two normal, healthy breasts back again. I still think about it. I try   not to dwell on it to the point of depression."

It is difficult for a post mastectomy woman not to be depressed. Suddenly it seems that the world is filled with plunging necklines on models in print ads and on television. Fashion advice turns to emphasizing the bust. Jiggle shows abound on television.

Before the mastectomy, the woman may have felt competitive when she saw these things, or mildly jealous. But now she feels a sense of loss which leads to her feelings of being sexless, ugly, scarred.

There are alternatives to the totally flat chest, of course. The most common in the past was the external prosthesis. They are to the breast what the artificial leg is to the amputee. Although with proper fit and proper clothing, a woman can use an external prosthesis and move through society without anyone knowing, they now. And feel the loss.

"I know when I saw myself after the (mastectomy) surgery, when I took a shower, I thought I was going to faint," Maxine Conrad said. "It looked that bad. It was devastating."

Mrs. Conrad had her mastectomy in 1968 and wore an external prosthesis for 12 years. "It was very warm to wear," she said. "If you leaned over, it kin of pulled your clothes if you wore a tank top or anything. I felt self conscious that people would notice."

The other alternative is plastic surgery to replace the breasts. The problem here was cost. Insurance companies would cover the cost of an external prosthesis, but not plastic surgery.

"We used to call the insurance companies and say, 'We have this lady who had a breast taken off and she'd like to have it remade,' said Dr. John Gibney, a plastic surgeon. "They'd say, 'Well tell her to get an external prosthesis.' Well, they don't want that. It's hot, it floats to the surface when they go swimming and whatever. It's not really a breast symbol and that's what we make, a breast symbol."

Like all businesses, insurance companies are out to make a profit, and they won't pay until they forced to pay. But, inevitable, the numbers game they play so well caught up with them.

Breast cancer can cause death. But unlike other forms, the survival rate of breast cancer patients is high,and rising. Each year about 110,000 women get breast cancer, and the five-year survival rate is 65 to 85 percent. So at any time, there are somewhere between 1 million and 1.24 million women who have mastectomies. With that many people needing the insurance payoff to get plastic surgery, the odds got the industry.

In 1980, the legislature passed a law stating that any licensed health insurance carrier has to provide the opportunity for the patient to have breast reconstruction. It had an immediate impact. In 1977-78, only 1,500 women had plastic surgery breast reconstruction. In 1982, the Plastic Surgery Society established that there were 20,000 breast reconstructions.

Until fairly recently, the method of plastic surgery for breast reconstruction was determined by how much of the breast was removed. The mastectomy could be anything from a radical mastectomy, where the surgeon takes the whole breast and the underlying muscles, to a subcutaceous mastectomy where the surgeon goes in under the skin and shells out the breast.