While most women choose to have some type of reconstruction, some women don’t want to have additional surgery. Some also don’t want to deal with special bras, magnets, or adhesive patches that hold a prosthesis in place. They choose no reconstruction and don’t wear a breast form most of the time. Many women and doctors call this “going flat” or “living flat.”
If you’ve had one breast removed and feel self-conscious about looking lopsided, try going without a breast form at home. Then try running an errand or going out for coffee without your prosthesis. You’ll probably find that people don’t notice the difference, or if they do, it’s not a big deal.
A 2014 study found that about 56% of women had reconstruction after mastectomy, which means that 44% didn’t have reconstruction. Women who choose not to reconstruct may do so for a number of reasons, including:
- health issues that make the one or more surgeries involved in reconstruction out of the question
- the need to more quickly resume daily activities
- concerns about losing muscle strength with autologous (or flap) reconstruction (although keep in mind that there are procedures that can avoid cutting muscle at the flap donor site, as well as the option for implant reconstruction)
- concerns about cost if you don’t have insurance coverage
The decision to reconstruct or not is very personal. There is no “right way” to approach mastectomy and reconstruction (or lack of it). There is only the way that is best for you, your preferences, and your healing.
Some women who want no reconstruction say their doctors just assumed they wanted reconstruction or that they’ve felt pressured by their doctors or family members to have reconstruction.
If you feel that your doctor isn’t fully listening to you or isn’t taking your choice of no reconstruction seriously, make an appointment with another surgeon to get a second opinion. Because the choice to reconstruct or not is very personal, you need a surgeon who listens to you and explains things in ways you can understand. It’s also important that you know all of your reconstructive options, especially if those initially presented to you aren’t appealing. Studies from the American Society of Plastic Surgeons have found that more than 70% of women aren’t fully informed about their reconstructive options before mastectomy.
If you’re having trouble explaining your decision to your spouse or other family members, a therapist, counselor, or social worker can help guide you through difficult conversations. Your doctor or nurse will likely have recommendations.
- Recovery and aesthetic issues
- Questions to ask your surgeon
- Sexuality and no reconstruction
- Dressing after no reconstruction
- Reconstruction Decisions: “Living Flat” After Breast Cancer
- A SWINGING PENDULUM
- A PROCESS, NOT A PROCEDURE
- NOTHING WORKS FOR EVERYBODY
- I felt empowered by choosing not to have a reconstruction
- I felt so well
- I knew nothing about breast cancer
- Having a mastectomy floored me
- It was assumed I’d have a reconstruction
- I realised I had a choice
- How would I feel without a breast?
- I felt a huge relief
- I feel empowered by my decision
- Juliet’s top tips if you’re thinking about breast reconstruction
- Going home
- What to know about mastectomy scars
- Why These Women Said ‘No’ to Breast Reconstruction After Mastectomy
- Jeannine Love
- Chiara D’Agostino
- Nikki Triplett
Recovery and aesthetic issues
Recovering from a mastectomy with no reconstruction is generally easier than recovering from mastectomy with reconstruction. If you have immediate reconstruction (reconstruction at the same time as surgery), the recovery time is longer than it is with no reconstruction. Depending on the type of procedure you have, there may be some muscle weakness and/or mobility issues as well, although some of the newer flap procedures minimize this risk by preserving the muscle structure at the tissue donor site. Generally, immediate reconstruction does lead to the most cosmetically pleasing results.
If you choose delayed reconstruction — reconstruction 6 or 12 months or more after mastectomy — your recovery from mastectomy should be a bit easier. If you choose implant reconstruction, your doctor may need to use a device called a tissue expander, which is used to create a pocket under the skin where the implant will eventually go. If you have a tissue flap reconstruction, the skin that was removed at mastectomy will be replaced with the skin that comes with the flap (if reconstruction is performed at the time of mastectomy, this skin replacement may not be necessary).
There are some aesthetic (appearance) issues to consider if you’re not having reconstruction after mastectomy. Some women, especially women who have large breasts or are overweight or obese, may end up with what are called “dog ears” under their arm. These are pockets of fat left behind after mastectomy. Also, if an incision ends abruptly, a “tab” of skin and/or fat may form a bulge at the end of the scar or under the incision. Most women prefer scars that lie flat, leaving their chest fairly smooth.
It can be helpful to show your surgeon pictures of women who’ve had mastectomy with no reconstruction with results you like. The website BreastFree has photographs of good no-reconstruction results.
Questions to ask your surgeon
If you’ve decided not to have reconstruction, here are some questions you may want to discuss with your surgeon:
- How many women in your practice have opted for no reconstruction?
- Do you have pictures of women who’ve had mastectomy with no reconstruction?
- How will you make sure that the mastectomy scar(s) lay flat against my chest?
- How will you make sure that I don’t have any dog ears or tabs?
- What results are realistic for me?
- How will my chest area feel to the touch?
- Will I have any feeling in my chest area?
- Can you connect me with other women who have opted for no reconstruction?
Sexuality and no reconstruction
You may be wondering about your sex life after mastectomy with no reconstruction. For a number of women, breasts are an important erogenous zone. You may be worried that the loss of your nipple and some of the feeling in the breast area may change your sex life for the worse. You might worry that your partner doesn’t find you attractive with only one or no breasts (if you’ve had a double mastectomy).
What do partners of breast cancer patients care most about? In spite of what you may imagine or fear, studies show that the answer is simply this: Their loved one is alive and feeling well. The loss or alteration of a breast is almost meaningless in contrast. “I don’t care what they take from you as long as I can see your face,” is a common sentiment. Most caring partners (both men and women) see their lovers as having many parts to love and as being more than the sum of those parts.
Sex after mastectomy with no reconstruction can be just as fulfilling as it was before surgery. But you may need to experiment or change some things:
- If you enjoyed wearing lacy, racy lingerie before your diagnosis, there are versions that can be worn with breast forms. If you’d rather not wear a prosthesis, then don’t — the whole point of lingerie is to make you feel alluring and special.
- Some women say that wearing a breast form in a sports bra helps them recapture the feeling of having breasts.
- Other women say that with the loss of one or both nipples, other erogenous areas, such as the neck or scalp, become more sensitive.
- Touching habits may change. You and your partner may be tentative about touching your chest and your scars. Many people find it helpful to talk about what kind of touching they’re comfortable with before any intimacy begins. If you’re comfortable with some touching but your partner isn’t, you may have to be assertive and show and tell your partner exactly what you do and don’t want.
Sex and intimacy happen one step at a time. Give yourself time, give yourself love and affection, and give yourself credit for your hard work and courage.
Dressing after no reconstruction
If you like the idea of going flat but are worried about looking lopsided in form-fitting clothing, choose styles that draw attention away from your chest area. BreastFree has some great clothing tips:
- fabrics with busy, irregular patterns that aren’t too small, such as florals and paisleys, keep the eye moving
- dark colors, especially black, camouflage the lack of shadow underneath the flat part of your chest
- crisp shirts with breast pockets mask your contours
- jackets and sweaters layered over form-fitting t-shirts draw attention away from your chest and hide any unevenness
- scarves and shawls can be used to cover part of your chest
- instead of plunging necklines, choose styles that show off your other assets, such as high necklines that bare your back or shorter/slit skirts that highlight your legs
If you’re worried about not having nipples, you can buy removable polyurethane nipples. These nipples are in a semi-erect position and are very close to a natural nipple’s texture and color. To attach the nipples, you moisten the back and stick them on — like a little suction cup. You can put them on and take them off as you’d like.
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Last modified on March 7, 2019 at 9:08 AM
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Reconstruction Decisions: “Living Flat” After Breast Cancer
SARA BARTOSIEWICZ-HAMILTON, after finding she was more comfortable without reconstructed breasts after mastectomy, founded the group Flat & Fabulous to help support others choosing to live flat. – PHOTO BY MARK BUGNASKI When Sara Bartosiewicz-Hamilton tested positive for the BRCA2 mutation at the age of 29, nothing could have prepared her for what the next few years would bring.
“I was scared out of my mind,” she says. “But I knew, when I submitted my blood for the test, that if I had the mutation, I was going to have a mastectomy.” According to the National Cancer Institute, a prophylactic mastectomy can reduce the risk of developing breast cancer in a woman with a BRCA gene mutation by 95 percent. For Hamilton, the decision to get the surgery was a no-brainer — as was the choice to go through reconstruction afterward.
“My plastic surgeon never talked to me about not going through reconstruction,” she says. “I kind of just presented myself to him and was agreeable to whatever he thought was best.”
Studies show that this experience is common: The American Society of Plastic Surgeons found that, before going through mastectomy, more than 70 percent of women aren’t fully informed of reconstructive options. Even more startling, many patients report that their doctors urged them to undergo reconstruction, making it feel like their only option. It’s a decision faced by all women who undergo mastectomy, whether the surgery is a prophylactice measure due to breast cancer risk or part of treatment for the disease.
Deanna Attai, M.D., an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, recalls a former patient who was choosing to undergo a prophylactic bilateral mastectomy due to a BRCA mutation. “She did not want reconstruction, but the first surgeon she saw wouldn’t do the mastectomy until she saw a psychiatrist,” Attai says. “She was a very educated woman, had clearly researched her options (and) she had known about her BRCA mutation (for years). She had thought about this for a long, long time. So, I think, sometimes, patients feel like they aren’t even allowed the option of not doing reconstruction.”
Following her mastectomy, Bartosiewicz-Hamilton underwent a series of surgeries to reconstruct her breasts. However, in the years that followed, she developed issues in her chest, which eventually culminated in a sensation she describes as an “electric shock” that never went away.
“I felt like my chest was on fire all day, every day,” she says. “I had gone through so much to have reconstruction … and I just wanted to be done with it.”
At age 34, Bartosiewicz-Hamilton had her breasts removed for the second time, and she finally began to embrace a lifestyle that many women have come to identify with post-mastectomy. She began to live life flat.
A SWINGING PENDULUM
When it comes to reconstruction post-mastectomy, many describe the issue as a pendulum, a topic that oscillates between two extremes.
“When I first started in practice, getting reconstruction meant that your only option was a silicone implant … and most people didn’t do it. But as there were better options, women started feeling some pressure,” says Susan Love, M.D., M.B.A., chief visionary officer at Dr. Susan Love Research Foundation, an organization dedicated to mobilizing a future without breast cancer by igniting forward-thinking, collaborative research and a distinctive approach to education.
In 1998, only 15 percent of women opted for reconstruction within four months after mastectomy; in 2014, that number rose to 41 percent among women who underwent mastectomy and remained disease-free over a longer follow-up period.
“I think there was an assumption by mostly male surgeons at that time that women would absolutely want this … Coming from their vantage point, that seemed normal,” Love says. “But the trouble with reconstruction is that it doesn’t look normal and it doesn’t feel normal — maybe to them it does, but not to you.”
Within two months of having her implants removed, Bartosiewicz-Hamilton created an advocacy group called Flat & Fabulous, a space that seeks to “support and empower women to embrace life without reconstruction after mastectomy.”
“When I first founded Flat & Fabulous, women came to me all the time and said: ‘I thought I was the only person,’” she says. “There are women out there who don’t want to go through the pain and danger of reconstructive surgery, and that’s a valid choice.”
A year before Bartosiewicz-Hamilton received her diagnosis, Barbara Kriss went through a similar struggle. After being diagnosed with breast cancer for the second time at age 57, Kriss was advised to have a bilateral mastectomy. In 2007, she started BreastFree.org, which she believes is “the first website dedicated to offering information and support to women considering opting against reconstruction.”
“For some women, reconstruction is the right thing,” Kriss says. “But then there are others, like me, who really feel like they don’t need it.”
Now, with the help of advocacy groups such as these raising awareness and support for women who choose to go flat, the pendulum seems to be swinging back, settling somewhere in that middle space where women feel empowered to make their own decisions.
A PROCESS, NOT A PROCEDURE
Bartosiewicz-Hamilton’s lengthy and painful experience with reconstruction is more common than many realize. The risk of complication after reconstruction following a double mastectomy can be as high as 40 percent, according to Attai.
“Reconstruction is a process, not a procedure,” she says. “The more surgery we do, the higher the complication rate.”
BARBARA KRISS’S website, breastfree.org, helps women consider whether going flat after mastectomy is right for them. – PHOTO BY LEISE JONES Immediate complications from reconstruction may include bleeding, infection, fluid under the wound or flap or nipple necrosis, in which the nipple or flap of tissue used to make the new breast dies. Longer-term complications may include risks involving anesthesia; loss, hardening or changing shape of the implant; leakage of the implant fluid; abdominal hernias; “dog ears,” small folds of skin and fat that can develop at either end of the abdominal scar; or even chronic pain that affects other organs.
There is also the risk of unplanned additional surgeries. A 2015 study involving the impact of reconstruction and reoperation on long-term patient satisfaction reported that, although 83 percent of women responded that they were happy with their contralateral prophylactic mastectomy and would choose it again, immediate reconstruction patients demonstrated “significantly lower satisfaction and were less likely to choose CPM again.” Although 73 percent of the women overall said they would make the same choice again regarding reconstruction, among those who underwent that surgery, 39 percent needed one or more unplanned reoperations. That was “strongly associated with lower satisfaction, lower likelihood of choosing CPM again and lower likelihood of choosing reconstruction again,” the study authors said.
For many women, after the trauma of being diagnosed with cancer, undergoing treatment and facing the reality of a mastectomy, the thought of even more surgery with so many possible risks is just too much to bear.
“When you have cancer, it’s already so overwhelming (that) sometimes the last thing you want to do is make more decisions,” Love says. “But the great thing is, you don’t have to. You can actually take care of the breast cancer, and then, at your leisure, figure out what you want to do.”
Women who are undecided about reconstruction can delay the procedure for six to 12 months or more after mastectomy. This operation is usually accomplished by transferring some of the woman’s own tissue, often from her abdomen, to the breast area, rather than using implants. Possible complications are similar to those associated with immediate reconstruction but occur less often, and the delay in surgery results in a shorter procedure and generally faster healing.
“Initially, I assumed I’d have reconstruction,” says Megan Rutherford, who was diagnosed with stage 2 breast cancer in 2005. She describes her treatment as “long and arduous,” involving radiation and a three-drug chemotherapy regimen that included Adriamycin (doxorubicin), a drug known in the cancer community as “the red devil” because of its harsh side effects. Rutherford originally made an appointment for reconstruction, but ultimately decided to cancel after learning that her radiation excluded her from implants and that a deep inferior epigastric artery perforator (DIEP) flap, in which tissue would be moved from her abdomen to her chest, was “a lot of risk for a minimal effect.”
MEGAN RUTHERFORD decided that breast reconstruction after mastectomy was not worth the effort and risk. – PHOTO BY BEN HIDER “By the time I was done with everything, I was just ready to move on,” she says. “I really wanted to have a (life after cancer), and I didn’t want to put it off even further … I was just ready to be a regular person again.”
After experiencing life both with and without construction, Bartosiewicz-Hamilton learned that, while she initially thought she needed breasts to feel like herself, that was not true.
“As women, we’re self-conscious because we know we’re missing the part that society says makes us a woman,” she says. “But, eventually, I just embraced that this was me … My implants had never felt like a part of me. I had never embraced them; I never liked them; they just didn’t feel right. When I had them removed, I just felt like myself again.”
NOTHING WORKS FOR EVERYBODY
Although women choose to live life flat for numerous reasons, both surgeons and survivors agree on this: Nothing works for everybody.
“I think it’s really good that women have the option to go flat or to have reconstruction,” says Clara Lee, M.D., a plastic and reconstructive surgeon at Ohio State University Wexner Medical Center. “But the most important thing is that women should have options.”
Lee encourages women to become as knowledgeable as possible about reconstruction, including the pros and the cons. For example, while reconstruction requires more surgery, and therefore more risk, many women find the outcome more aesthetically pleasing. Choosing to go flat means less surgery and faster healing, but women might want or need to wear special bras, magnets or adhesive patches to hold a prosthesis in place, which can be a hassle and uncomfortable.
After educating themselves on both sides of the argument, women should go through a process of clarifying what matters most to them across a number of areas, Lee says.
“How strongly do you feel about having a breast shape when you’re not wearing clothing?” Lee asks. “How strongly do you feel about the risk of complications, more surgery or a longer recovery time? Ideally, we can connect these personal values to the various pros and cons of the procedures, and that will inform … whether or not reconstruction might be right for you.”
Studies have found that there is no significant difference in the rates of local recurrence, metastasis or survival among women who choose to reconstruct versus those who do not. Furthermore, while developing a new breast cancer after mastectomy is very unlikely, if one did occur, reconstruction would not make it harder to detect, according to the American Cancer Society. Finally, Lee says, a systematic review of mastectomy patients she conducted found that “the majority of measurements of quality of life, body image and sexuality did not find significant differences between mastectomy with reconstruction and mastectomy only.”
The biggest indicator in overall satisfaction among patients is simple: the ability to choose for themselves. “I really felt that this had to be my decision,” Kriss says. “As much as I love my husband and my kids, it really had to be what I felt the most comfortable with. A lot of times, women think about how their spouse will feel, or how they’ll feel in front of their spouse or partner or future boyfriend … but in my own experience, my family’s reaction … was that they just wanted me alive. They couldn’t care less. They just wanted me to do whatever was going to make me feel best.”
Attai says that, in her experience, most women ultimately feel good about their choice. “The majority of patients who have made the decision to not do reconstruction have been very happy with their decision. And the majority of patients who do opt for reconstruction also seem to be happy and comfortable with their decision,” she says. “It’s all about taking the time with our patients to really make sure that they’re getting multiple opinions, seeing more than one plastic surgeon and really thinking through their options.”
“There’s power in choosing something rather than feeling like you don’t have a choice,” Bartosiewicz- Hamilton says. “This is not about changing people’s minds. It’s about letting women empower themselves to make the choice that’s right for them.”
I felt empowered by choosing not to have a reconstruction
Juliet, from Hertfordshire, explains how she had thought that a breast reconstruction was inevitable, and how realising it wasn’t was a huge relief.
Photo by Sue Lacey
I felt so well
My breast cancer was picked up on my second routine screening in January 2016. I hadn’t felt any lump or seen other signs, so it was a major shock. I had felt so well, I wasn’t expecting it at all. After a biopsy and scans I was told I had a tumour in my left breast, that I would need a lumpectomy and radiotherapy.
I knew nothing about breast cancer
I had never known anyone who had been diagnosed. I felt clueless and panicked. I started searching around on the internet and came across Breast Cancer Care’s information. I called their Helpline, who were amazingly helpful, and listened to all of my concerns.
Having a mastectomy floored me
After surgery I was told that I would need to have another operation, this time a mastectomy – the second biggest shock of my life, after my diagnosis. I was devastated.
I was given a lot of information around the surgery and shown a series of photos of what my body might look like after the mastectomy and then after a breast reconstruction. But I was in shock and didn’t absorb it properly. I just remember flicking through a gallery of photos of different people’s chests.
It was assumed I’d have a reconstruction
I was large breasted, and one option was to have a DIEP flap. The nurse explained how it would work, taking fat from my stomach to help rebuild my left breast. Everything was spoken about as though it was next step in my treatment, as though it was inevitable.
It was recommended not to have immediate reconstruction at the same time as the mastectomy because I would have radiotherapy soon after, but they said they’d make the appointment with the plastic surgeon and a year later I’d have my ‘lovely new breast’.
I knew no different – I didn’t know anyone who’d had a reconstruction or even breast cancer, and I had got so used to following what the medical professionals told me to do.
I came away thinking ‘Ok, I don’t want to do this, but it’s what I have to do.’
I realised I had a choice
After a few days I started thinking more about the situation. I’d always been a bit worried about the very long operation. I didn’t like the idea of any surgery at all, so it concerned me quite a lot.
I then started thinking, what if I don’t have one? What would that be like, or look like? Ideas and thoughts started going around my head. One day I Googled, ‘not having a reconstruction after breast cancer’. I found blogs and stories, and a group called Flat Friends. I suddenly realised I didn’t have to have a reconstruction.
A lightbulb went on in my head, ‘I don’t have to go through with it.’ It wasn’t inevitable. I spoke to my husband about what he thought, and he was brilliant. He said, ‘what you decide is right for you, and that’s fine for me.’
How would I feel without a breast?
I realised I wouldn’t know until it happened. I went to see the plastic surgeon anyway to talk through my options. But in my pre-surgery consultation before my mastectomy I proposed the idea of not having a reconstruction, and removing both breasts. I thought if one was going, I could have the other side removed too.
However, it’s not straightforward having a mastectomy on the other side if there is no evidence of cancer there, or you don’t have a significantly increased risk of developing breast cancer on that side. There are lots of things to consider for both the surgeon and the patient. In my case, after lots of discussion and because of my individual circumstances, the surgeon agreed, and the following year I had my other breast removed.
I felt a huge relief
Photo by Sue Lacey
After my breasts were removed I didn’t feel happy, as I was still losing my breasts, but I was definitely relieved. I had been able to make the decision around my own body. Once that happened I felt a lot happier, and my head was a lot clearer.
Two years ago I would never have thought I would feel happy or at ease with myself without having breasts. I feel for me, I’ve made the best of a bad situation. I feel happy and confident in my own body.
I feel empowered by my decision
I’ve drawn a lot of strength and empowerment from my decision. I think I’m now a more positive ‘me’, and feel so much more like myself after the rocky road through treatment.
Juliet’s top tips if you’re thinking about breast reconstruction
1. Take all the time you need – don’t let yourself be rushed into making a decision. It can be difficult to see clearly when you’re in the midst of diagnosis and active treatment.
2. Ask for advice – there are many trusted sources who can talk through your options with you, including Breast Cancer Care’s nurses or people who have had different experiences of reconstruction.
3. Be true to yourself – don’t let others influence what you want to do. At the end of the day, it’s your body that will be affected.
Juliet also writes for her own blog, Blooming Cancer.
If you’re considering whether or not to have a reconstruction, you can speak to our trained volunteers who have had different experiences through our Someone Like Me service.
Find out more
For women who’ve had mastectomies, what to do next is, increasingly, a matter of choice. And what some women are choosing to do may surprise you. Erin Moriarty of “48 Hours” takes a candid look:
Debbie Bowers, of Bethlehem, Pa., was diagnosed with breast cancer in 2014 and had a double mastectomy. Rebecca Pine was diagnosed in 2009 with breast cancer and had a double mastectomy.
Cancer is not just a killer. It is a thief.
“Yes, it’s a loss,” said Pine. “It’s certainly a loss. And you learn to deal with it in whatever way you can.”
Each of the women Braver met, ranging in age from 34 to 51, has lost breasts to cancer. And it’s how these women chose to deal with their loss that is sparking conversation.
A growing number of breast cancer survivors are deciding to
They call it “going flat.” Instead of replacing their curves with surgical implants, these women are embracing their scars, even baring them publicly.
“I never saw anybody like me,” said Bowers. “I never heard about anybody like me.”
Melanie Testa said she had never met a “flat” person before. “Like, ‘I don’t get it. Where are you?'”
That was how Testa felt six years ago when she chose not to have reconstructive surgery or to wear removable breast forms. “For me, I just don’t want to present two bodies. I don’t want to walk out of my home with a breasted body, and then return to my home and remove my breast and then have a flat body.”
From Miana Jun
“I didn’t choose to go flat; it chose me,” said Marianne Duquette Quoso. “That’s how I look at it.”
Quoso says that when she was diagnosed with breast cancer, she went from breast surgeon to plastic surgeon the same day.
“Oh, I wanted breasts. I wanted what I had,” Quoso said. “They did a beautiful job and I was very happy with them.”
But Quoso, one of the estimated twenty percent (according to doctors) who suffer side effects, had infection after infection. So she decided, “Let’s get them out.”
Thedra Cullar-Ledford said, “It’s kind of a myth: ‘Well, they’re going to pop ’em in, it’s gonna be fine. It’ll be great.’ It’s a myth.”
Another myth, they say, is that reconstructed breasts will fell just like the real thing. “They don’t feel like real breasts,” Quoso said.
Cullar-Ledford added, “There’s no feeling, no nipple, there’s no sensation.”
On the other hand, Samantha West says after going flat, she gained sensation.
“In terms of sexuality, scars are very tender things, and there’s feeling in my chest,” West explained. “And it’s still an erogenous zone, which doesn’t happen with implants is this foreign thing.”
“When you just have a scar there, though, when you take a shower, look in the mirror, isn’t that a continual reminder that you had cancer?” Moriarty asked.
“Yeah, of course it is,” Testa replied.
“It’s the map of who we are,” said Cullar-Ledford. “And I don’t want to forget what I’ve done and what I have been through.”
Still, more than half of female breast cancer patients — nearly 60 percent — who are offered breast reconstruction take it.
Dr. Deborah Axelrod, a surgeon and the director of clinical breast services at New York University’s Perlmutter Cancer Center,” said, “I think for us as surgeons, we feel that if we’re going to take a body part off, that we should then replace it with something that looks just as good.”
She said reconstructive surgeries have greatly improved, and yet she agrees that looking good can have some unexpected drawbacks: “If you are a stomach sleeper and you have an implant, it’s like sleeping on a Frisbee sometimes.”
Dr. Axelrod now regularly discusses the option of going flat with her patients.
When asked if she thinks the majority of women will still choose reconstruction rather than go flat, she replied, “I do, ’cause it’s the image of our bodies. We want to be whole.”
These women hope to change that perception.
Rebecca Pine said, “Beauty is something in the mind and in the heart. We’re just as feminine, we’re just as much women as we were beforehand.”
There is a growing awareness and acceptance of going flat, they say. There is an ad campaign for a national gym, a recent fashion show, and websites that offer stories, selfies and a sisterhood.
“What it’s done for all of us, we can’t even express,” said Marianne Duquette Quoso.
Moriarty asked, “You’re emotional — why?”
“It was about the friendships that we’ve made.”
Friendships that have helped each woman accept what they have lost, and also what they’ve gained.
Melanie Testa said, “I love my body. I love my body more than I ever have before. I see the beauty, I see the strength. I see the strength of my conviction. I am not doing that to my body. My body is good enough.”
A growing number of breast cancer survivors are deciding to From “The Breast and the Sea Project” by Miana Jun
For more info:
- The Breast and the Sea: Transforming Our Scars – Project by photographer Miana Jun and Rebecca Pine
- Marianne Duquette Cuozzo – Art With Meaning
- Thedra Cullar-Ledford
- Melanie Testa
- Samantha Tiger West
- Mia Barkan Clarke (Instagram)
- Dr. Deborah Axelrod, New York University’s Perlmutter Cancer Center
- Flat and Fabulous
- Ivy Brown Gallery
- Wisdo.com – Search engine for life experiences
Video of Marianne Duquette Cuozo and Debbie Sue
Most people go home the day after their operation, although some feel well enough to go home on the same day.
If you’ve had breast reconstruction, you may need to stay in hospital for up to a week depending on how you’re recovering.
Before you leave hospital, your doctor or nurse will talk to you about what to do when you get home. You’ll probably feel more tired than usual for several weeks and will need a lot of rest, so try not to do too much.
The results of the operation and any further treatment will be discussed at a follow-up appointment around 2 weeks after the operation.
Arm exercises are recommended to encourage the full range of movement back to your arm and shoulder.
You can do gentle exercise as soon as you feel comfortable, usually around 3 to 4 weeks after surgery.
You may be given an exercise leaflet – here’s an example of an exercise routine from Breast Cancer Care (PDF, 1.7Mb). You may also be offered physiotherapy.
Avoid more strenuous exercise, including housework and heavy lifting, until you get the all-clear from your doctor or nurse.
Before leaving hospital, you’ll have the opportunity to be fitted with a lightweight breast shape (prosthesis) to wear inside your bra.
You’ll usually be fitted with a longer-term prosthesis and given advice on bra fitting 6 to 8 weeks after the operation.
Get advice from your doctor or nurse about when to start driving. Generally, you should be OK to drive if you can make an emergency stop without discomfort in the wound.
Some people are able to drive about 3 weeks after the operation, but it may be sooner or later than this depending on how you feel.
Some insurance companies will not insure drivers for a number of weeks after surgery, so you may want to check your policy.
Returning to work
You can return to work when you feel up to it. Taking 4 to 8 weeks off is fairly typical, but it varies from person to person.
The hospital staff or your GP can supply you with a medical note for your employer if needed.
What to know about mastectomy scars
While all forms of mastectomy will result in some scarring, the extent of scarring depends on the type.
Partial mastectomy or lumpectomy
A partial mastectomy involves removing the tumor and some surrounding breast tissue. Sometimes, the surgeon will also remove a section of the lining that covers the chest muscles.
A lumpectomy will usually leave a small linear scar on the breast. A surgeon may hide the scar by making the incision in the crease beneath the breast or around the nipple.
With a partial mastectomy, a surgeon often leaves the majority of the breast intact, and reconstruction is not usually necessary.
Depending on the size of the breast and amount of tissue removed, it is possible that the breast may be smaller than the one on the other side.
The resulting breast might also have a divot or depression if it is small and the mass removed is particularly large.
Women who have a lumpectomy will usually require radiation therapy after surgery.
Skin sparing mastectomy
A surgeon will usually choose this approach for women who want to follow the procedure with immediate breast reconstruction.
A skin sparing mastectomy involves removing the breast, areola, nipple, and one or more lymph nodes. However, the surgeon will preserve the remaining skin of the breast.
Saving most of the breast skin allows the surgeon to start immediate reconstruction with an implant or tissue from elsewhere in the body.
A skin sparing mastectomy usually leaves a visible, medium-to-large scar on the front of the breast.
Nipple sparing mastectomy
A person who is due to receive a preventive mastectomy or has early stage breast cancer may be a candidate for a nipple saving mastectomy. This procedure involves preserving the skin and areola.
People with smaller breasts are likely to benefit from this approach. It will result in a scar on the side or at the base of the breast. Placing the incision in the crease under the breast can hide the scar more.
Simple or total mastectomy
This type of mastectomy is a surgical approach that involves removing the breast, areola, and nipple. Sometimes, a surgeon will also remove the lymph nodes as well if they show signs of cancer.
They may also vary the amount of breast skin they remove during the procedure, depending on plans for reconstruction.
The surgeon typically makes an oval shaped incision that goes around the nipple and across the width of the breast, leaving a visible scar across the chest.
Modified radical mastectomy
Similar to a simple mastectomy, this approach involves removing all breast tissue plus lymph nodes in the breast and armpit. The surgeon often leaves the chest wall intact.
A modified radical mastectomy will result in a large, visible scar on the chest.
Share on PinterestRecovery can take weeks, and a person may require chemotherapy.
The goal of a mastectomy or any oncologic surgery is to remove only as much tissue as is necessary to treat cancer, which can help limit any scarring.
A breast surgeon and oncologist will discuss the options and help an individual reach the best decision in their case.
After surgery, a woman will likely have drainage tubes and need several weeks to recover.
Some procedures, such as a lumpectomy, do not typically require a stay in the hospital. Larger mastectomies, however, often mean a hospital stay.
The type of mastectomy and reconstruction often dictate the duration of the hospital stay and length of recovery time.
Following the mastectomy, a doctor may recommend radiation therapy or chemotherapy to shrink a tumor or destroy any remaining cancer cells. These treatments can also affect wound healing.
A woman should monitor the wound for signs of infection, such as warmth, redness, or discharge. A fever may also indicate a systemic infection.
Here, learn more about the different types of mastectomy.
Why These Women Said ‘No’ to Breast Reconstruction After Mastectomy
One of the first questions for a woman who’s facing a mastectomy is whether to have reconstructive surgery or not. Though breast reconstruction has evolved through the years, not every woman opts in. In fact, one study published in October 2014 in the journal JAMA Surgery revealed that just 42 percent of the women enrolled in the study chose reconstructive surgery following their mastectomies. Their reasons varied from not wanting additional surgery to being fearful of the implants.
“Reconstruction is a voluntary and deeply personal choice,” says Melissa L. Pilewskie, MD, a surgical breast oncologist at Memorial Sloan Kettering Cancer Center in New York City. While some women will undergo the surgery, others want a more minimal approach, she says. “They just want to get through treatment and not add anything else, or it’s simply not important to them.”
The same study in JAMA Surgery found that — reconstruction or not — almost 87 percent of the women were satisfied with the decision they made. Here are three women who opted out of reconstruction and decided to go “flat,” without regrets.
40-year-old Jeannine Love, a college professor who teaches public administration and political science at Roosevelt University in Chicago, Illinois, proudly refers to herself as a “uniboober.”
Love was diagnosed with cancer in her left breast in September 2016. She could have had a lumpectomy followed by radiation as a treatment option, but chose mastectomy over lumpectomy in order to avoid radiation. (Radiation therapy is generally not used for women newly diagnosed with stage I or II cancers who undergo mastectomy, but is recommended for patients who undergo lumpectomy in order to eradicate any cancer cells that might remain in breast tissue.)
At her initial meeting with her breast surgeon, Love discovered that it was customary to make an appointment with a plastic surgeon for reconstructive surgery then and there. Love was already fairly certain that she did not want the surgery, but went along with making the appointment because she was so overwhelmed by everything that was happening. Plus “I wanted to make a fully-informed decision,“ she says.
But she did an abrupt about-face when she watched a short educational video on YouTube detailing breast reconstruction options. “I could barely get through it. I immediately called to cancel … there was no way I was going to do that to my body,” she says. Love realized she didn’t care about appearing “normal.” She just wanted to feel healthy.
Love did feel a bit self-conscious about her appearance at first, especially since she chose to remove just one breast rather than both, which would have allowed for more symmetry. Since it’s hard to match one reconstructed breast to the unaffected breast, many women also opt to reconstruct the breast unaffected by breast cancer.
But that feeling didn’t hang around for too long. These days, she’s comfortable dressing in all types of shirts, from tank tops to halter tops. “The only trick is finding tops that don’t have darts or cups for breasts,” she says. “But as a woman with a 32A-32B bust, I had this problem before mastectomy! Because I have a small bust, I tend to go without a bra.”
For women who don’t have that option or would rather wear a bra, there are mastectomy bras specially made with pockets to hold breast prostheses. In fact, Love was just featured by the activewear brand Athleta, modeling their Empower Bra for women who’ve undergone mastectomy.
Ironically, Love feels better about her body than ever. “If anything, this has made me more confident. My body is amazing; it’s gone through so much and yet it has thrived … I am in awe.”
When former high school Italian teacher D’Agostino lost her left breast to cancer in 2014, she had reconstruction immediately. “The doctors told me, ‘we can fix that,’ and I was all for it,” says the resident of Montclair, New Jersey. “Going flat was never an option for me.” Six months later, she had the right breast prophylactically removed, in order to prevent a recurrence there, and got an implant on that side, too.
But after repeated infections and six additional surgeries to replace the implants, the option to go flat became appealing. The surgeries left D’Agostino physically and emotionally drained, and depressed and resentful. She decided “no more,” and had the implants removed for good.
Soon after her final surgery to remove the implants, D’Agostino came across an article in The New York Times that made her glad she’d followed the path she had. “It was all about women going flat after breast cancer; it featured strong, beautiful, and creative images,” she recalls.
D’Agostino began to learn about — and reach out to — the many support groups that sprung out of the “going flat” movement, like the online forum Flat and Fabulous, where women boldly embrace their decisions to forgo reconstruction, declare their right to choose, and openly share their photos and stories. Inspired, she even started her own blog, Beauty Through the Beast.
D’Agostino is presently undergoing treatment as part of a clinical drug trial for metastatic breast cancer. But she’s not letting that, or her flat chest, dampen her spirits. She recently fulfilled a lifelong dream of modeling, appearing in the October issue of O, The Oprah Magazine.
In the full-page photo, she is nude, her torso sporting two red horizontal scars where each breast used to be. Head slightly tilted, her silky salt-and-pepper hair gently cascades over her shoulders. She is smiling, at ease.
“I accept who I am. This is what breast cancer looks like,” she says. “I’m still beautiful, and it doesn’t matter what is on my chest. No plastic surgeon can ever alter that.”
“I knew from the beginning I didn’t want reconstruction,” says Triplett, a 38-year-old Houston resident, who also answers to the name Trip. “No fake breasts for me.”
Trip was unsurprised to be diagnosed with breast cancer in her left breast at age 36. She had a history of cysts in her breasts, plus one of her aunts died of breast cancer at the same age at which Trip was diagnosed, and her grandmother, still alive at 75, has fought it three different times.
Trip had the breast removed, and because her cancer was aggressive, underwent a grueling regimen of chemotherapy and radiation treatments. “I walked around for a year with just one breast, and tried different things, like stuffing socks and silicone prosthetics into my bra. But nothing worked. The prosthetics were heavy and made me sweat. The sock was soft and more comfortable, but it kept slipping out of my bra and ending up near my neck,” she recalls.
Trip ultimately decided it was more important to her to look symmetrical than to continue on with one breast, or have reconstruction. “Vanity went out of my mind,” says Trip. “I just wanted to look the same on both sides, and decided to rock the flat look.”
And rock it, she did. Not only did Trip stock up on tight tank tops — “I love the way they look on me now” — but she also just took up swimming and surfing, for which she prefers a neoprene wetsuit to a bikini.
“Cancer is a secret society; you never know what it’s like until you’re in it,” she says. “Strangely — and unexpectedly — being without breasts has gotten me so much more in touch with my femininity. I’ve turned into a girlie girl.”