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Going Flat: Saying No to Breast Reconstruction

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.
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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.

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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.

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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.

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Elizabeth JaramilloJudy ConstantineKaren BordenMary DurkLissa Poirot Recent comment authors
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Mary Durk
Mary Durk

I am having a mastectomy on October 23 with no reconstruction. I have read good and bad about it. I decided at 67 it’s not worth it.

Judy Constantine
Judy Constantine

Hope everything went smooth for you Mary!

Karen Borden
Karen Borden

I was diagnosed in June 2018 with bilateral DCIS. The cancerous masses in both breasts are large and therefore my chemo was front loaded. I will be finished in mid Dec. Next is my mastectomy. I am in the process of making this overwhelming decision of going flat or having implants. My gut is saying no implants as I have already been thru hell and I just don’t want to encounter more problems with implants. I am trying to wrap my head around the psychological ramifications of going flat and how will I handle viewing my body in a much different way. This has got to be the hardest decision thus far on my journey. I am in awe of those brave women that have gone flat and are comfortable in every way with the decision that they have made. I would love to hear from those that did this… Read more »

Elizabeth Jaramillo
Elizabeth Jaramillo

I went flat without even meaning to. I was supposed to have reconstruction the same day of the double mastectomy, but because I ended up needing chemo and radiation after all, I had to wait. For me, it turned out to be the best decision because my skin had a VERY BAD reaction to the radiation. So it would have ruined the surgery. By the time I was able to consider surgery, other issues came into play. So much time had gone by, that the thought of going through more surgery, pain and recovery freaked me out. I use prosthetics/inserts, and NO ONE notices. Everyone thinks I have had reconstruction.

Anne Danahy

Thanks so much for sharing this Corinna! I wasn’t aware of some of the reasons against reconstructive surgery. And I really love the idea of a tattoo to cover scars – it’s such a great way to feel empowered.

Iulia Filip
Iulia Filip

This is a very helpful road map for navigating one of the many difficult decisions that patients with breast cancer have to make. It’s important to know that there are support groups and resources that can help women before and after surgery, but it’s equally important to raise awareness that opting in or out of reconstructive surgery is a personal decision that should not involve any judgment or pressure. Great background information and tips!

Lissa Poirot

I chose to have reconstruction. I wound up with an infection during expansion period and had to remove the expanders and was able to see how conclave my chest was without reconstruction. It’s not just a flat chest; it’s conclave. I give major props for those who chose to go this route, but I was happy to resume my reconstruction once my infection was cleared.

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