dancingwhilstfacingthemusic, waving hello! I'm sorry you're going through all of this. I thought about going flat too, but in my case the surgeon thought the implant stretching the skin might help with radiation (my cancer was very close to the skin surface). She put the saline implant in during the mastectomy op, so I woke up with it in. Obviously that's curious as you have the shape of a breast still. I quite liked that though, as it was a bit less of a shock. The implant includes a port (placed under the skin, but I could feel it if I touched the skin). Post op they then use the port to slowly fill the implant with more saline until it's the right shape (that takes place in increments over a few weeks post mastectomy). I went onto chemo, then radiation and kept the saline through treatment/ rads, etc, but then down the line had another op to replace it with the more permanent silicone one (no port with that, so that gets taken out at that point too). You have to factor in that silicone ones don't last forever. Having said that I still have both of mine 14 years on. I'm going to get them checked soon though as I think one's beginning to fail.
It is undeniably a sod to need another op. In my case it was more than one as I had my mastectomies a year apart (second one elective). The implant ops are relatively routine though and I found them easy to recover from. Day case surgery and I was up and about working within a couple of days. I can't say implants are like having my old breasts as they're not, but I do like having the shape. My DH would have been fine if I'd gone flat chested, but he likes them too and says they're quite natural to touch. One major plus is that I don't wear a bra most of the time - no need to as my implants are so pert!
If you do go with implants, ask them about nipples. I still don't have any. Possibly they offer nipple reconstruction at the same time as implants now. I was told I could have nipples created, but it would have meant another op so I decided to do without. Feel free to ask me anything, but double check anything I say with your team - mine were 14 years ago now and things might have changed.