One of the biggest decisions women have to make after a mastectomy is whether to have reconstructive surgery or remain flat. According to the American Society of Plastic Surgeons, the number of reconstructive procedures performed by their member surgeons was around 5.8 million per year from 2015 to 2017. This may be a little surprising considering that despite the 2015 Breast Cancer Patient Education Act (BCPEA), studies show that only 23 percent of women are aware of the range of breast reconstruction options available to them. But studies also show that an increasing number of women are saying no to reconstruction surgery.
Considerations for Going Flat
Choosing no reconstruction is a very personal option, but it is a viable one. There are several reasons why you might want to consider going flat, including:
- You may not want to have any additional surgery after a mastectomy.
- You may want to avoid the potential for chronic pain and other complications that sometimes result from breast reconstruction.
- You might have certain autoimmune or skin disorders (e.g., scleroderma) that make reconstruction concerning to you.
- You may be concerned that your reconstructed breasts will not look or feel as you had hoped.
- You may be concerned about the risk of infection after reconstruction surgery.
- You may wish to avoid scar tissue on parts of your body where tissue was removed to create the new breast mound.
- You may be concerned about tissue death (necrosis) after surgery.
- You may not want to have your other breast reshaped to match the reconstructed breast, and therefore choose to remove both.
- You may not want to go through a longer recovery time.
- You may simply feel that reconstruction is not important to you.
- You may welcome the freedom being flat offers – free to exercise as you choose, to wear (or not wear!) certain clothes, etc.
Everyone has different reasons. Meet Eliza, a guest on our Cancer-Kicking PowWow podcast who made the bold decision to opt against reconstruction after a double mastectomy – and she could not be happier with her choice.
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Making your Decision Known
If you do decide to stay flat, it’s important that you are very clear about this to your surgeon. If he or she tries to talk you out of staying flat, get a second opinion and do not choose another surgeon until you feel completely comfortable. Here are some tips for discussing going flat with your doctor.
- Chest contour: How will the contour of your chest look after mastectomy? If you’re planning on wearing tank tops or t-shirts after your surgery, you don’t want to have concave areas on your chest. Can an uneven contour be fixed with fat grafting?
- Chest uniformity: Will your chest wall have an overall uniform appearance? If you decide to go flat, you won’t want to have pockets of skin left on the sides of your chest that may show through your clothes.
- Scar placement: Where will the scars be after your surgery? This is important to know. Some women choose to have a decorative tattoo to cover the scars once they heal.
It’s a good idea to take a list of questions with you to your consultation so that you don’t forget. You can also take notes of any other questions that arise during your discussion with your surgeon.
Stay Connected
Stay Connected
You’re Not Alone
If you are considering going flat, accepting the inability to have breast reconstruction or you are currently living flat and would like talk to like-minded breast cancer survivors, check out Flat and Fabulous. This inspiring group’s mission is to stand by and empower women who wish to enjoy life without breast reconstruction after mastectomy. The group is comprised of women who embrace the fact that when it comes to comfort and beauty we do not live in a world where “one size fits all.”
Flat and Fabulous was founded by Barbie Ritzco and Sara Bartosiewicz-Hamilton, who met through their involvement with The SCAR Project. Some of their fellow members have had a bilateral mastectomy, while others have had unilateral surgery. Their reasons for rejecting reconstruction are many and every woman is supported and encouraged to feel comfortable living with their decision.
Being Beautiful as You Are
According to Dr. Kristi Funk, breast cancer surgeon and author of the bestselling book, Breasts: The Owner’s Manual, it is unthinkable that a surgeon overrules a patient’s clear directives arrived at after careful consideration. Choosing to live flat causes absolutely no harm and there is no reason for any surgeon to feel conflicted about this operation.
Most plastic surgeons never talk to their patients about opting out of reconstructive surgery. If you feel that your surgeon is resisting your choice to go flat and fabulous and is trying to coerce you into breast reconstruction surgery, don’t try to convince him or her otherwise – find another surgeon. You should not have to feel that you need to defend your choice to live flat. Remember that this is your body and you have the power to choose how you wish to live after breast cancer surgery.
