What It Means to “Go Flat” After A Mastectomy

Some patients prefer to have a breast mound for their womanhood identity. Breast reconstruction, on the other hand, necessitates multiple procedures, which can increase the amount of time spent in the operating room. For some women, avoiding breast reconstruction surgery and going flat allows them to lessen risks and difficulties while returning to their favorite hobbies faster. But what does it mean to “go flat” after a mastectomy? Let’s discuss.

Options After A Mastectomy

Simply put, there are two options to choose from after you have a mastectomy. After a mastectomy or double mastectomy, you might have breast reconstruction or go flat. Patients should also be aware that, according to a 2021 online survey, approximately 75% of women who choose a mastectomy without reconstruction are satisfied with the results.

If you’re considering going flat, you’ll want to consult with a surgeon who has performed aesthetic flat closures, a medical term adopted by the National Cancer Institute in 2020 for surgery that removes extra skin, fat, and other tissue in the breast area after mastectomy. The surgeon then tightens and smoothes the remaining tissue to make the chest wall look flat. When choosing the best path for you, it’s critical to meet with a plastic surgeon to completely understand your breast reconstruction alternatives. Even if you decide not to have breast reconstruction, you should discuss with your surgeon the optimal surgical approach, incision placement, suitable closure, and removal of redundant/sagging skin for the best possible outcome.

Why Would You “Go Flat”?

There are many reasons why you may choose to go flat. Just a few include:

You think that implants wouldn’t feel the same as your own breasts.
You want to avoid a potentially lengthy breast reconstruction process.
You want to return to physical activity as soon as possible.
You want to focus on future cancer treatment (if applicable) instead of reconstruction.
You don’t want to have future mammograms performed on reconstructed breasts.
You want to avoid potential complications of reconstruction.

For practical reasons, some people choose not to have reconstructive surgery. They may not have enough spare tissue to generate tissue flaps, may lack the necessary cash, or may have another disease that raises their risk of problems. There are so many different reasons to go flat, but truthfully, it’s no one else’s business but yours if that’s what you choose to do.

“Flat Denial”

Before we dive into more about going flat and the recovery from surgery, it’s also important to note that some women go through “flat denial”. Simply put, flat denial happens when a surgeon denies a patient an agreed-upon flat closure either through negligence or disregard. While this isn’t too common, it’s common enough to talk about.

Because most patients who go flat expect to be “one and done,” waking up to a surprisingly poor cosmetic result can be emotionally upsetting.

Flat denial produces egregiously poor results, not minor flaws. The level of competence and concern a surgeon has for flat closure greatly influences the outcome of their patient’s mastectomy. Most general surgeons are not educated specifically in flat closure and may lack technical proficiency. They may fail to perceive this constraint since they may not always prioritize the cosmetic outcome in the manner that the patient anticipates.

According to a 2021 UCLA study, approximately 15% of patients who choose flat face opposition from their surgeon, or are not informed of flat as an option at all. While this shouldn’t be a thing at all, it’s important that you understand that flat denial is not your fault or your problem. If you aren’t being listened to, find another surgeon.

What To Know Before You Make A Post-Mastectomy Decision

It is entirely up to you whether to undergo reconstruction or go flat. It’s critical to select a physician who will listen to you and respect your decision. Be sure to explain what you desire out of your surgery. Bring in images of the desired results, and don’t be afraid to get a second opinion. If your surgeon lacks experience conducting aesthetic flat closures, you should inquire whether it’s possible to bring in a plastic surgeon who does.

You should also ask the following questions:

Is there anything about my body and anatomy that will make you struggle to achieve a successful aesthetic flat closure?
What if radiation therapy harmed the quality of my breast skin and tissue?
How will you avoid “dog ears”?
Do you believe I’ll need a second surgery to achieve the desired outcome?
What are my options if I decide to get breast reconstruction following an aesthetic flat closure?

The most essential thing is to make an informed decision that is good for you — and that you will be satisfied with in the future.

Recovering After Going Flat

People usually require 3-4 weeks to recuperate from a mastectomy and an aesthetic flat closure. However, some people may require 6-8 weeks to recover. Overall, going flat after mastectomy typically has a quicker recovery period, less discomfort, and a decreased chance of problems when compared to breast reconstruction.

During recovery, there are quite a few resources that can help. This includes support groups like Not Putting on a Shirt and Flat Closure Now. You can also try to find a Breast Cancer Rehabilitation Center near you using a site like Living Beyond Breast Cancer.

Choosing To Reconstruct Later

Even if you’ve gone flat and had the surgery, you can always change your mind. If you decide later on that you want to reconstruct your breasts, it’s possible!

Keep in mind that you can have delayed reconstruction (done after the mastectomy) even if you don’t have immediate reconstruction (done at the same time as the mastectomy). Breast reconstruction can be performed six to twelve months following a mastectomy, or even later. However, immediate rebuilding typically produces the best effects.

If you do not want to have reconstruction but yet want to look like you have breasts while you wear clothes, you can utilize breast forms or prosthetics. You can use them whether you’ve had a single or double mastectomy, and they come in a variety of sizes and forms. To achieve optimal fit and avoid contour inconsistencies, you must be fitted by a trained mastectomy fitter.