Going flat: How the questions started

I was diagnosed with breast cancer in 2009 at the age of 38. Ironically, writing about breast cancer was my bread and butter. I am a magazine journalist who writes about women’s health. Over the years, I’d covered the disease from every angle: how to treat it, how to talk about it, and how to survive it.

As for my own breasts, I hadn’t been particularly worried. I had no family history of breast cancer. I was a yoga teacher. I was healthy. Heck, I never thought it would happen to me, at least not in my 30s. But it did. If there was a bright side (I told myself) it was that I knew a lot about the disease.

But, it turned out, I didn’t know as much as I thought. I assumed I’d have a lumpectomy with radiation and get on with my life. But due to the location of my lump (high) and the size of my breast (small), the surgeon told me I wasn’t a candidate for lumpectomy. That’s the moment the questions about reconstruction started and, in some ways, they never stopped.

Wait, isn’t that muscle doing something?

The plastic surgeon told me he wanted to carve out a section of my back muscle, wrap it around my front, and tuck it over an implant. Called a latissimus dorsi flap, the surgery was the only reconstructive option that would work for my small frame. Worried about the structural integrity of my back, which was already made cranky by mild scoliosis, I asked, “Isn’t that muscle doing something?” He shrugged and said, “You’ll look normal in clothes. That’s all most women want.”

Can I go flat?

In some ways, my decision to go flat was fueled by my desire to squelch questions I imagined might linger down the road. Questions like: How safe are implants? What if it leaks? How will I know when to replace it? Will it make a breast cancer recurrence harder to detect? Not to mention…what about my upper-body strength? My favorite yoga pose was handstand and I wasn’t about to give that up!

Why didn’t anyone tell me going flat was an option?

In the 2 weeks after my breast cancer diagnosis, I saw four different breast surgeons and not a single one mentioned going flat was an option. I had to discover the option not to reconstruct (aka “go flat”) on my own and bring it up in the exam room. Considering I was absorbing a cancer diagnosis and treatment plan, coming up with my own surgical option wasn’t easy.

Luckily, when I said I wanted to “go flat” my surgeon didn’t try to talk me out of it. But I’ve since learned that many women’s surgeons do. Common pushbacks include “but you’re so young” or “but your husband will leave you,” or (worse), “no man will have you.”

Am I loveable without breasts?

In the 10 years since my double mastectomy, I’ve spent tons of time in online support groups for flat breast cancer survivors, and the lingering questions often involve body image and acceptance. Questions like, will I be able to find love? Will someone find me attractive? If you trace these questions to their root you’ll find fear. Being scared is normal. But making major life decisions based on fear is never a good idea.

Post-cancer sex will never be the same as pre-cancer sex because YOU are not the same. My partner and I struggled to regain intimacy after my double mastectomy. But it wasn’t because I’d lost my breasts; it was because I’d lost my confidence. Once she made it clear that body confidence was much sexier to her than breasts, I realized I’d been fixated on what I lost instead of what I had—a beautiful, vibrant, healthy body!

What if I change my mind?

Worth noting is that going flat is reversible! Knowing I could change my mind made it easier to go flat at first. But, again, my surgeon didn’t tell me I could reconstruct later. I had to come up with the idea and ask my surgeon who replied, “of course!” He wasn’t a bad person or a negligent doctor, he just lacked imagination.

Since then, I’ve spoken to many breast and plastic surgeons who’ve assured me that reconstruction can come later if a breast cancer survivor goes flat and then changes her mind. Caveat: Do keep in mind that radiation makes reconstruction more difficult; so, if you are facing radiation, weigh that information and discuss it thoroughly with your healthcare team.

How does time change things?

Today I’m 48 and more confident than ever about my decision not to reconstruct. What I love about being flat is its simplicity. I sleep on my stomach. I wake up, pull on jeans and a t-shirt or a sundress and am ready to go. Today I am as strong, mobile, and flexible as the day I was diagnosed. I’ve regained my confidence and then some.

Do you still have questions after reconstructive surgery? They will be answered at the 2019 Living Beyond Breast Cancer Conference: Sharing Wisdom, Sharing Strength breakout session Ask the Experts: Lingering Questions After Breast Reconstruction with panelists Minas Chrysopoulo, MD, FACS, and Tara Dunsmore-Williamson. Register, or check back in late September for a link to the recording.