Women are forced to make countless treatment and personal decisions when diagnosed with breast cancer. Every cancer case is different, and each woman has to find her own way through a diagnosis.
I’m about a month beyond my bilateral mastectomy, and I’m happy with my choice not to reconstruct my breasts. There are five main reasons I am “going flat.”
If you are a woman trying to find her way through a breast cancer diagnosis, some of my experience might be of help, so this list is for you. (Some pictures are at the end of my list of reasons for living flat.)
1. I didn’t want more surgery or complications.
The typical “boob job” is breast augmentation. It’s a procedure that adds an implant to a healthy breast. Breast reconstruction following a mastectomy is totally different. Most people do not know that.
There are many variations of reconstruction, but the idea is to eventually refill the area where diseased breast tissue has been removed. (A full list of reconstruction options is here).
For reconstruction implants, the remaining skin over the chest must be stretched over time to accommodate the new material inside the replacement breast; additional surgeries often are needed for shifting; there is an infection risk; sometimes the body rejects the implant; there is a risk the implant will leak and need immediate treatment; implants must be replaced approximately every 10 years.
“Flap” reconstruction is another option for some women. Tissue from another part of the body is moved to the new, recreated breast. The biggest risk is total failure – meaning the rebuild didn’t work, the tissue is dead or dying, and the process has to start all over. Another risk: weakened muscles in areas where healthy tissue was taken.
So how often do things go wrong? One in three women need additional surgeries. In June 2018, the Journal of the American Medical Association released a long-awaited study that found one in three women have big complications with breast reconstruction. (Read the official study here; read a New York Times article on the study here.)
Not all doctors review the risks with their patients. Additionally, many doctors assume a woman wants to reconstruct her breast(s), and they don’t always present the flat option to their patients.
Other complications could have been emerged if I had needed additional cancer treatment after the bilateral mastectomy. I certainly didn’t want a long reconstruction process at the same time I could still be trying to kill cancer.
Some women delay reconstruction until after their treatment is over, but this was not appealing to me. I wanted to heal for good and move on. My goal was to resume my life as soon as possible.
I love that I am done with major surgery, and that we are making future travel plans without worry of additional cosmetic surgery.
2. Fake breasts would not look or feel real.
Mastectomy scars are always there. Nerves are cut away during breast removal, and so reconstructions have no feeling around implants and replants.
Women with reconstructed breasts say it’s odd not to feel such a large part of their bodies. Women who go flat also lose sensation, but there is a decent chance some feeling eventually will return.
Post-mastectomy reconstructed breasts often don’t have nipples. There are nipple-sparing mastectomies, but it takes a super-talented surgeon to save the nipple, and there is a chance cancer could be hiding in the nipple. For me, keeping a nipple that may have cancer defeats the point of having the mastectomy.
I am lucky on this point: my skin about a quarter-inch on either side of the incision lines already has feeling. I am loving that I can feel sensations on my chest.
3. My breasts are not essential to my sexual fulfillment.
I rarely saw this mentioned in any online searches I did about my decision, so I’m including this here. It’s a biological fact breasts are a secondary erogenous zone. Other women may have different experiences, but I do not need breasts to achieve sexual satisfaction. I knew this before I searched online, but I wanted to hear other women’s experiences with this.
Of course, to each her own in the world of sexual experimentation and fulfillment. And, of course, sexual expression will be different in my post-double mastectomy life – but it won’t be absent.
I’m lucky on this point as well. I am loving that my husband and I have a bond that so much larger than a pair of fake boobs. (I wouldn’t have married a small-minded man.)
4. I will rock whatever I wear – because I’m around to wear it.
Before my bilateral mastectomy, I did wonder how I would dress and feel good about myself out in the world. It didn’t take me too long to realize I had enough confidence – I just needed a little boost.
Easy tricks can help minimize flatness, should a woman chose to try to minimize it: ruffles, bold patterns, asymmetry, layers, statement necklaces, scarves, etc. A few stylish ladies with blogs helped me visualize how to rock clothes on my new body, including Flat Friends, Leave Me Breastless, and Flatter Fashion. There also are social media leaders and groups easily found through searches.
As travelers, my husband and I spend a fair amount of time on beaches, and finding flattering bathing suits for a breastless body is just about the only complaint flat women have about clothing available to them.
I can look at this two ways. I can lament the loss of my rockin’ 46-year-old bikini bod with boobs, or, I can rejoice in my rockin’ 46-year-old cancer-free bod without boobs. Guess which view I’m gonna take?
It’s been about a month since my bilateral mastectomy, and I’m still getting used to my breastless body. I realize I will have moments when I’m sad about not having my old beach body. But: I won’t ever regret my flat decision because I’m still here to float in Earth’s salt water, to snorkel with colorful fish, to swim laps in foreign bays.
Meanwhile, I’m loving that I don’t have to wear a bra in the heat wave gripping Eastern Europe as I write this.
5. I am so much more than my breasts.
Big or small breasts, floppy or firm breasts, one breast or no breasts – whatever I have or don’t have is my own business. Our society is breast-crazy because “sex sells” and women (unfortunately) accept that.
We are brainwashed to think the almighty bosom holds more value than our health — that we could never possibly be whole without breasts. Women accept additional surgeries, infection risks, pain, and heartache as the price for appearing ‘normal’. To me, that seems like unneeded suffering to please empty ideals.
Believe it or not, 44 percent of breast cancer patients opt not to reconstruct. And yet we never see an image of a flat-chested breast cancer survivor on any awareness campaign photo or video. To any woman considering “going flat” know that you are not alone — we are out here.
I recently read a short book by activist and feminist Audre Lorde called The Cancer Journals. I love this passage:
“I would lie if I did not also speak of loss. Any amputation is a physical and psychic reality that must be integrated into a new sense of self. The absence of my breast is a recurrent sadness, but certainly not one that dominates my life. I miss it, sometimes piercingly. When other one-breasted women hide behind the mask of prosthesis or the dangerous fantasy of reconstruction, I find little support in the broader female environment for my rejection of what feels like a cosmetic sham. But I believe that socially sanctioned prosthesis is merely another way of keeping women with breast cancer silent and separate from each other…”
I appreciate the women who’ve gone before me and embraced the lifestyle of “going flat.” We are women who chose to live flat, and we love life.
The information contained in this blog is not intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your doctor or other qualified health care provider.
- Diagnosis abroad: Breast cancer
- A digital mammogram and stereotactic biopsy in a foreign country
- How I found a breast cancer surgeon in a foreign country
- What it was like to have a bilateral mastectomy in a foreign country
- My DCIS had a secret nearby – an invasive tumor
- A gift of love through the curse of cancer