Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast reconstruction, limited research explores sexual minority women’s lived experience of mastectomy and decision making about reconstruction. Thirteen lesbian and/or bisexual women who had undergone mastectomy for treatment of breast cancer participated in individual qualitative interviews exploring decisions to have, or not have, breast reconstruction. Reasons for/against reconstruction reflected themes identified in prior studies among heterosexual women. Although participants described sexual, gender, and political identities and orientations as influences on their decision making, for most participants, experiences with physicians who encouraged reconstruction and concerns about stigmatization of illness in romantic, professional, and social contexts were also central. Findings are interpreted through feminist dis/ability, medicalization, and existential frameworks.