Last Updated on June 21, 2023 by Ellen
Breast cancer forces women to make countless treatment and personal decisions. Every cancer case is different, and each woman has to find her own way through a diagnosis. For me, one of the best choices I made was “living flat.”
I’m happy with my choice not to reconstruct my breasts. Five main reasons guided my decision that staying flat was right for me. I’m sharing this information here, because there wasn’t that much out there when I made my decision in 2018. Today, there are more women vocalizing their ‘flat’ choices.
If you are a woman who landed here because you are trying to find you 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.)
I made it through a bilateral mastectomy — in a foreign country while traveling. You’ll make it through, too. One day at a time.
5 reasons I’m “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; it’s possible the implant will leak and need immediate treatment; implants must be replaced approximately every 10 years.
“Flap” reconstruction is another option for some women. Surgoens move tissue from another part of the body 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: muscles are weakened 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 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 am done with major surgery, without any worry of possible additional cosmetic surgery — and I love that.
2. Fake breasts would not look or feel real.
Mastectomy scars are always there. Nerves are cut away during breast removal. 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 are living flat have also lost 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 might have had 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 has regained feeling. Actually, my chest has more sensation than I anticipated.
3. My breasts are not essential to my sexual fulfillment.
I rarely saw this reason for living flat mentioned in any online searches I did before my surgery, 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 is different in my post-double mastectomy life.
4. I will rock whatever I wear – because I’m around to wear it.
Before my bilateral mastectomy, I wondered 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.
One of my favorite groups was formed in the year after my double mastectomy. It’s called Flat Closure Now, and it has a photo gallery on its website of what breastless women look like. I didn’t have that available to me – and I think it’s awesome that it’s available to women now.
As travelers, my husband and I spend a fair amount of time on beaches. I have found a few flattering cuts of bathing suits that work for a breastless body.
I have found bathing suits with flaps work when I want a little frilly thing. But I’m also pretty comfortable in tops that show my flatness. It got easier with time.
Meanwhile, I’m loving that I don’t have to wear a bra. Some tops and dresses are actually more flattering without boobs.
(Funny thing: I no longer have “boob sweat”, but my chest still sweats in the heat.)
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-driven 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, until recently, we’ve never seen 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.
Final thoughts on living flat
I read a short book by activist and feminist Audre Lorde called The Cancer Journals. Here is one of my favorite passages:
“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…”Audre Lorde, The Cancer Journals
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.
This post was first published in the summer of 2015, some weeks after Ellen’s surgery. It was updated October 14, 2019, and again on June 21, 2023.
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.
Thanks for reading, “5 reasons I’m “living flat” after breast cancer.”
- 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
- A gift of love through the curse of cancer
Keep reading about our health care experiences overseas while traveling in early retirment.