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Going Flat After Mastectomy

Many people choose to skip breast reconstruction with tissue flaps or implants after breast cancer surgery and go flat or live flat instead.

When you choose to leave one or both sides of the chest flat after mastectomy — rather than have breast reconstruction surgery with tissue flaps or implants — it is known as going flat. People who go flat either live flat all the time or choose to use external breast forms however often they wish.

Doctors sometimes assume that, after mastectomy, women want to rebuild their breasts, using either a breast implant or tissue from another place on the body (called flap or autologous reconstruction). If your doctor doesn’t present going flat as an option, you may have to be your own advocate and start the discussion yourself.

Current research shows that women who choose to rebuild their breasts have no advantage in quality of life, body image, and sexuality over those who choose to go flat. 1

Talking to Your Doctor About Going Flat

Feb. 27, 2021
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If you’re considering going flat, there’s no single, right time to make a final decision. Many women decide right away that going flat after mastectomy is the best option for them. Other women decide to go flat after having breast reconstruction surgery with either tissue flaps or implants, especially if they’ve experienced pain, discomfort, or other surgery-related issues. The most important thing is for you to make an informed choice that is right for you.

 

Deciding to go flat

Making the decision to skip breast reconstruction with tissue flaps or implants after mastectomy and to go flat instead is a completely valid choice. It’s important to choose what best suits your preferences and lifestyle. 

Learn more about Deciding To Go Flat.

 

Aesthetic flat closure

Aesthetic flat closure is considered the gold standard for going flat and offers the best results. This procedure is sometimes also referred to as post-mastectomy chest wall reconstruction.

Learn more about Aesthetic Flat Closure

 

Talking to your surgical team about going flat

Some surgeons favor breast reconstruction with tissue flaps or implants. If you’ve decided to go flat, it’s important to find a surgeon who listens to and respects your choice.

Learn more about Talking to Your Surgical Team About Going Flat.

 

Talking with your loved ones about going flat

People who choose to go flat after mastectomy are becoming much more visible. Lending their support are celebrities who are also going flat after mastectomy, including actors Kathy Bates and Anjelica Huston and comedian Tig Notaro. 

Still, it’s entirely up to you whether you discuss your decision to go flat with your friends and loved ones. You may want to consider making a list that includes: 

  • the people you’d like to tell 

  • how you’d like to tell them — whether in person, over the phone, or in a group chat

  • exactly what you feel comfortable sharing

  • boundaries so they understand you may not necessary be willing to answer all their questions

Sex after going flat

For many people, breasts are an important part of sexual arousal and intimacy. So it’s natural to wonder — or even worry about — what sex might be like after a mastectomy with aesthetic flat closure. It’s important to know that sex after mastectomy with aesthetic flat closure can be just as fulfilling as it was before surgery.

Some people find it helpful to talk with a sexual health therapist who works with people who’ve been diagnosed with breast cancer.

A therapist or counselor can also offer guidance on: 

  • how to tell sexual partners about your decision to go flat

  • how to navigate the adjustment period after surgery as your figure out what you feel comfortable doing with a sexual partner

  • how to communicate your needs and desires to your sexual partners

You may also find it helpful to talk with others who have similar experiences. Organizations such as BreastFree, Not Putting on a Shirt, Flat Closure NOW, and Flat & Fabulous can be valuable resources, as can online discussion boards such as Living Without Reconstruction After a Mastectomy in our community. 

Above all, remember to be patient with yourself. Sex and intimacy happen one step at a time after mastectomy.

 

Recovery after mastectomy with no breast reconstruction

Physical recovery from a mastectomy with no breast reconstruction is usually easier than physical recovery from a mastectomy with breast reconstruction. People who have breast reconstruction with either tissue flaps or implants usually need at least two procedures to achieve the desired results — or even more to make the breasts evenly balanced (symmetrical). Going flat usually requires only one procedure, although sometimes more than one procedure is needed to achieve a flat closure. 

Before you have surgery, the surgeon explains the procedure and lets you know what to expect. For example, most women have numbness in the chest area after mastectomy. Your surgeon also should give you post-operative instructions to follow once you leave the hospital. It’s still a good idea to ask if there are any activities you should avoid after surgery, such as heavy lifting or intense exercise involving the chest and upper body. You also may want to ask whether a physical therapy program makes sense for you. 

 

Living flat after surgery

Some women report feeling a sense of grief and loss after going flat, at least initially. But others say they feel liberated because they no longer have a body part that threatens their health and well-being.

For some women, living flat or living asymmetrically (having one breast) feels natural, and they never or rarely use breast forms. Still, it can take some time to adjust to having a flat chest and to figure out what makes you feel comfortable. For example, you may prefer to wear a breast form most or all of the time. The important thing is to take your time and go at your own pace. 

Women who go flat sometimes choose to decorate their post-mastectomy chests with tattoos — either decorative artwork that typically camouflages the scar area or restorative tattoos that look like a nipple and areola. People who get decorative tattoos have to pay out of pocket, but some health insurance plans may provide partial coverage for nipple tattoos.

If you’d like something that looks and feels like a nipple, you may want to consider trying removable nipples made of polyurethane or silicone. These nipples have realistic textures and colors and often come with different levels of projection: mainly flat, semi-erect, or erect. To attach the nipples, you moisten the back and stick them on — like a little suction cup — or use a temporary adhesive that helps them cling to the skin. You can put them on and take them off as you like. 

 

Dressing with a flat chest

Some women who go flat are proud of their flat chests and prefer to dress in a way that accentuates the flatness. Other women who go flat feel more comfortable dressing in ways that draw attention away from the flatness. There’s no right or wrong way to dress. You can try experimenting with different styles and may even find that your preferences shift after you’ve lived flat for a while. If you search for terms such as going flat or flattie on Instagram, you can see all the different styles that women who live flat are wearing. If you’d prefer to wear clothes that camouflage a flat chest, you can find different clothing styles on flat advocacy websites and online support groups for people who go flat.

 

Using breast forms

Some women who choose to go flat decide to wear breast forms either all the time or just in certain situations.

 
 
 

Online support groups and advocacy organizations

If you’re interested in going flat and wondering what you might look like after surgery, it may be helpful to look at photos of women who have gone flat. In the United States, organizations such as BreastFree, Not Putting on a Shirt, Flat Closure NOW, and Flat & Fabulous provide information, tools, and resources such as photo galleries, brochures, and informational videos. On social media, there are many Instagram accounts and Facebook groups started by women who’ve chosen to go flat after mastectomy. Sometimes people who decide to go flat call themselves flat activists, flat advocates, or flatties. 

Written by: Kristine Conner, contributing writer

 
References
  1. Lee C, Sunu C, Pignone M. Patient-Reported Outcomes of Breast Reconstruction after Mastectomy: A Systematic Review. Journal of the American College of Surgeons. 2009. 209(1); 123-33. Available at: https://journals.lww.com/journalacs/Citation/2009/07000/Patient_Reported_Outcomes_of_Breast_Reconstruction.17.aspx

— Last updated on August 2, 2022, 10:02 PM

 
Center for Restorative Breast Surgery

This information made possible in part through the generous support of www.BreastCenter.com.

Reviewed by 3 medical advisers
 
Ergun Kocak, MD
Midwest Breast & Aesthetic Surgery, Gahanna, OH
Pankaj Tiwari, MD
Midwest Breast & Aesthetic Surgery, Gahanna, OH
Deanna Attai, MD
David Geffen School of Medicine at UCLA, Los Angeles, CA
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