Deciding To Go Flat
There are many reasons why people decide to go flat after a mastectomy. But skipping breast reconstruction with tissue flaps or implants and going flat instead is a completely valid choice, regardless of the reason. It’s important to choose what best suits your preferences and lifestyle.
Here are some reasons why people choose to go flat:
Having breasts is not a priority, nor do they feel they need to have breasts to feel whole.
They believe that neither breast implants nor breasts reconstructed with tissue flaps can ever look or feel the same as their own breasts.
They’d rather not go through a potentially lengthy, multi-step reconstruction process in addition to mastectomy and other cancer treatments they may need, such as radiation and chemotherapy. They also know that, in most cases, they can have breast reconstruction with tissue flaps or implants at a later time.
They want or need to resume their usual physical activities as soon as possible.
They’re not comfortable with the idea of getting breast implants because they don’t want anything artificial inside their bodies. 1
They’re concerned about scarring and side effects that can result from tissue flap reconstruction.
They know they have the option of wearing prosthetic breast forms if and when they want.
They have metastatic breast cancer — which means the cancer has spread to other parts of the body away from the breast — and prefer to focus on their ongoing treatment instead of breast reconstruction surgery with either tissue flaps or implants.
They want to avoid having future mammograms on reconstructed breasts, which is sometimes necessary and can heighten breast cancer-related anxiety.
They’re concerned about the potential health issues and complications associated with rebuilding the breasts. Studies have pointed to complications within two years of having reconstruction surgery to rebuild the breasts, including complications serious enough to require another surgery. 2
Sometimes people go flat for more practical reasons. For example, not everyone is a candidate for tissue flap reconstruction surgery because there isn’t enough extra tissue in the abdomen, thighs, or buttocks to create the flap. Some people may have other medical conditions that could make additional surgeries too risky or difficult. Still others may not be able to afford the out-of-pocket costs associated with breast reconstruction with tissue flaps or implants, or may not have access to a plastic surgeon.
Going flat after breast reconstruction
Rarely, tissue flap reconstruction surgery can fail because of complications. There may be problems with the blood supply to the flap used to reconstruct the breast, which can lead to tissue breakdown (also called necrosis). Other complications include infections and blood clots. These complications aren’t common. Still, when they occur, some women decide to go flat instead of having additional corrective surgeries.
Women who have reconstruction with breast implants sometimes decide to have the implants removed because of complications or simply because they’re not happy with the results. This procedure is called explant surgery. Although some women have tissue flap reconstruction after explant surgery, many others choose to go flat instead.
Written by: Kristine Conner, contributing writer
Baker JL, Dizon DS, Wenziger CM, et. al. “Going Flat” After Mastectomy: Patient-Reported Outcomes by Online Survey. Annals of Surgical Oncology. 2021. 28(5): 2493-2505. Available at: https://link.springer.com/article/10.1245/s10434-020-09448-9
Bennett KG, Qi J, Kim HM, et al. Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction. JAMA Surgery. 2018. 153(10): 901-908. Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/2685264
— Last updated on August 2, 2022, 9:04 PM