After mastectomy, you have a choice in what comes next. While you may need to delay reconstruction until you’re done with other cancer treatments, many people choose not to rebuild their breasts at all. Some people call this going flat.
It’s no small thing to remove one or both or your breasts due to cancer. But surveys show most people who get a mastectomy with no reconstruction are happy with their decision.
Tell your breast surgeon if you’re interested in going flat after surgery. They may assume you want reconstruction, so it’s important to be honest about how you want your chest to look and why. Here’s more about your options not to reconstruct after surgery.
Why Do People Go Flat After Mastectomy?
You may know right away that you don’t want to rebuild your breasts with tissue flaps or implants. For others, the decision may come after having a breast reconstruction surgery they’re unsatisfied with.
Here are some other reasons you may choose to go flat after removal of one or both of your breasts:
- You want to recover faster after breast cancer surgery.
- You don’t want a foreign object in your body.
- You don’t want more surgeries on top of cancer treatment.
- You want to avoid any breast implant-related problems.
- You don’t want multiple scars from flap reconstruction.
- You don’t link your self-esteem or body image to your breasts.
- You’re fine wearing an artificial breast form.
Not everyone has the choice to rebuild their breasts right away, if at all.
Your doctor may recommend delayed or no reconstruction if you have inflammatory breast cancer, need radiation therapy after surgery, or have health conditions that make extra surgeries risky.
Disparities in health care may also play a role. For instance, you may not have access to a skilled plastic surgeon in your area, or your insurance provider may not cover the full cost of certain procedures. Some people can’t afford childcare or to take time off from work to recover from added surgeries.
Studies show around 36% of people avoid reconstruction because they’re afraid of breast implants. Some people don’t understand the procedure. And while no one should pressure you to rebuild your breasts, it’s important to know that reconstruction with implants is generally considered safe and doesn’t make it more likely that the cancer will come back or harder to detect cancer down the road.
Talking to Your Doctor About Going Flat
Be clear with your surgical team about what you want. Bring in pictures of people who’ve gone flat if you’re not sure how to describe the look you’re going for. If you’re doctor doesn’t support your decision to go flat, it’s OK to get a second opinion.
If you get a mastectomy without reconstruction, your breast surgeon should remove extra skin and fat tissue after surgery without you having to ask. But you may need an aesthetic flat closure to smooth the surface of your chest. Mention this technique to your doctor if they don’t bring the topic up first.
When it comes to going flat after mastectomy, here are some questions you can ask your surgical team:
- Will the plastic surgeon do the flat closure at the same time as the mastectomy?
- Will I need to heal for a few months before I get flat closure surgery?
- Will the surgeon remove excess skin and fat tissue beside my breast, under my arm?
- Will radiation affect flat closure?
- Can you put me in touch with someone who’s gone flat?
- Will I need more surgery after flat closure?
- Is going flat more likely to make my chest feel numb?
Ask your cancer doctor or breast surgeon to refer you to a plastic surgeon with experience in flat closure. You can also search for specialists through the directory of “flat-friendly” surgeons on the Not Putting on a Shirt website.
Alternatives to Breast Reconstruction After Surgery
For some people, the choice to live flat is an easy one. You just dress your new body in way that feels comfortable. You may or may not decide to draw attention to your new chest.
But you may notice some balance problems or back pain if you have large breasts and you only had one removed through mastectomy.
Some women who opt for no reconstruction choose to:
Use a breast form (prosthesis). These come in silicone, foam, or another material that mimics the shape of a natural breast. You typically place them in a shelf inside a bra or bathing suit, but some you can stick directly on your body.
Ask your cancer care team how to get a prescription for a breast form and how find a certified mastectomy fitter. This is a health professional trained in how to fit breast prosthetics.
Your health insurer should pay for some or all of the cost of a breast form. But you’ll need to ask your provider about the kind of coverage you can get and if buying a prosthesis now affects coverage for reconstruction down the road.
Wear a realistic nipple. You can buy an artificial nipple that looks and feels like the real thing. These prosthetics are typically made of soft silicone and come in different shapes and skin tones. They may stick to your body on their own or with a special glue.
Get a chest or nipple tattoo. A skilled plastic surgeon or tattoo artist can use permanent pigment to restore the look of a nipple or areola. Some folks choose to tattoo their post-mastectomy chests with different designs.
What to Know About Reconstruction After Going Flat
Breast reconstruction is still an option for most people who go flat after a mastectomy, even months or years down the road. You can change your mind after you’ve already had surgery to go flat. But it’s best to ask a plastic surgeon about all your reconstruction options before your mastectomy.
If you have reconstruction after your chest is flat, you might need:
- Tissue expanders. These are inflatable sacs that go under the skin or muscle in your chest. Your surgeon will fill them with a saltwater mix on a regular basis, such as every 1 to 3 weeks. This will stretch your chest skin over the course of several months to make space for an implant.
- Flap surgery. This is a type of reconstruction that uses tissue from another part of your body (like your belly or thighs) to rebuild your breast. It’s something your doctor might suggest if you have radiation or you don’t have enough chest skin after your mastectomy.
It’s important to know that health insurers must cover breast reconstruction due to a mastectomy, even if you decide to rebuild your breasts years later. But you’ll want to find out about any out-of-pocket costs before your surgery. Coverage varies depending on the type of operation you have.
Support for Going Flat
It’s natural to go through a range of emotions after mastectomy. You may feel relieved to get rid of your cancer but also sad to lose one or both of your breasts.
No matter how you feel, give yourself time to adjust to your new body. You may find some peace of mind if you talk to others who’ve gone through a similar experience. Ask your doctor to connect you with one-one-one or group support in your area.
Many people who choose to go flat after mastectomy connect through Instagram and Facebook groups. Look for their stories on social media through hashtags that mention flat activists, flat advocates, or flatties.
You’ll find more information about alternatives to breast reconstruction through the American Cancer Society, BreastCancer.org, and groups such as:
- Facing Our Risk of Cancer Empowered (FORCE)
- Not Putting on a Shirt
- Breast Free
- Flat Closure Now
- Flat & Fabulous
Photo Credit: E+/Getty Images
Miraj Shah-Khan, MD, medical director of the Breast Health Program, Northwestern Medicine Palos Hospital, Palos Heights, IL.
Annals of Surgical Oncology: "'Going Flat' After Mastectomy: Patient-Reported Outcomes by Online Survey."
Breastcancer.org: “Going Flat After Mastectomy,” “Deciding to Go Flat,” “Talking to Your Doctor About Going Flat,” “Talking to Your Surgical Team About Going Flat,” “Types of Breast Forms,” “What to Expect From a Certified Mastectomy Fitter,” “Going Flat After Mastectomy,” “Paying for Reconstruction Procedures.”
JAMA Surgery: “Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making.”
National Cancer Institute: “Breast Reconstruction After Mastectomy.”
Cancer.Net: “What to Know About Mastectomy With Flat Closure After a Breast Cancer Diagnosis: A Survivor’s Story.”
Plastic and Reconstructive Surgery Open: “Not Just a Linear Closure: Aesthetic Flat Closure After Mastectomy.”
American Cancer Society: “Breast Reconstruction Alternatives,” “Reconstructing the Nipple and Areola after Breast Surgery,” “Breast Reconstruction Using Implants.”
Breast Cancer Now (UK): “Types of breast prosthesis.”
University of Colorado Medicine: “Breast Reconstruction or Going Flat: Options Provide Empowerment.”