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Most Women Satisfied With Going Flat, Not Supported by Drs

Most Women Satisfied With Choice to Go Flat After Mastectomy, but Choice Not Supported by Many Surgeons
January 11, 2021

Nearly 75% of women surveyed who opted for mastectomy without reconstruction were satisfied with the results, but almost 25% said their decision to go flat was not supported by their surgeons. Read more...


  • LivinLife
    LivinLife Member Posts: 301
    edited January 2021

    Actually this is an interesting one. I have many docs so will be interested as I see them these next few months and their responses. The ones I was in contact with (in person or indirect communication) prior to my BMX in August seemed supportive of my BMX decision. Prior to my surgery a non-cancer specialist questioned me some on not wanting reconstruction and told me about this great local plastic surgeon....

    My reasons for going flat are primarily about not wanting reconstruction due to autoimmune and healing issues and my docs know this...I don't need or want more surgery. I still have cording from 3 weeks after surgery and I've been in P.T. and L.T. since then! I also do not need the extra weight (with some inserts), heat, etc with prosthetics or pads - anyone who knows me will know they are not real and I don't care what others think who do not know me. And.... I won't go into any of that with them... no purpose.... Then I saw my OBGYN in December (surgery was August) who asked if I was going to be getting reconstruction. I had portal messaged him prior to my surgery laying out my plans. I know they don't remember though they also don't get it - both were men.... I see the first specialist I mentioned next month - bet it comes up again.... these are truly kind men but.....they just don't get it. I'm clear this is their issue lol they just don't know what to make of going flat... foreign to them.... Saw my male PCP earlier this week - he acknowledged my BMX only b/c he wants to make sure I'm following up with someone - nothing else came up... sooooo nice that was that.....

  • moderators
    moderators Posts: 7,888
    edited January 2021

    Interesting, LivinLife -- we love when our reports spark a dialogue about important topics! Thank you for sharing, and we hope others chime in here, too, with their experiences!

    --The Mods

  • georgiarai
    georgiarai Member Posts: 60
    edited January 2021

    What a great study.

    It was hard being questioned repeatedly by my surgeons when I declined reconstruction. I was lucky that I had neo-adjuvant chemo - it gave me a few months to gather the knowledge and confidence I needed to stand up for myself. My plastic surgeon finally agreed to give me a flat closure with no excess skin, but I literally had to talk him into it!

    Almost 9 years out, and I've never doubted or regretted my decision. Hopefully the medical community is doing better at presenting women with ALL of their options, and respecting their choices.

  • Gamb
    Gamb Member Posts: 570
    edited January 2021

    Four appointments with my surgeon before double mastectomy each visit I told her no reconstruction for me, just wasn't interested in having fake boobs. Before my surgery she asked me again I said no thanks. Thank goodness she listened and did a great job on my mastectomies. Before being sent home, she gives me name of plastic surgeon, I said no thanks. Every 3 months last year she would asked me again about the reconstruction, the last visit, I said please don't not ask me again about reconstruction, if you do I am gonna scream as loud as I can for an she didn't ask. But let's get real, how dare anyone think any one of us can't decide what we want, the way we want and our choices should be respected. I feel she is tops in her field, but I deserved more respect and acknowledgment that I know what is best for me.

  • IllinoisNancy
    IllinoisNancy Member Posts: 99
    edited January 2021

    The biggest problem I have is my ribs are so much bigger than my chest. But when I had my implants, they were so uncomfortable. I sleep on my stomach and it was miserable. They were bad in the winter too because they would get cold and hard which was very uncomfortable. Being flat is ten times more comfortable. I had no choice so I'm just trying to find shirts that have pockets on both sides. It helps hide things:)

  • sunshine99
    sunshine99 Member Posts: 2,583
    edited January 2021

    Gamb, that's funny! I can picture you screaming for a solid hour! I met with a PS before my mastectomy (2007) and he creeped me out. PLUS, while I was waiting in the exam room and my husband arrived, I could hear the nurse and doctor ARGUING about whether or not my husband could come into the exam room with me. Sheesh! No thank you.

    I was/am small breasted, so to be flat on one side and still small on the other is not a big deal. The bras I wear have enough shape so that I don't even wear an insert. Who cares???


  • LivinLife
    LivinLife Member Posts: 301
    edited January 2021

    Gamb I laughed out loud when you mentioned the screaming - It is maddening and truly disrespectful.... Screaming as loud as you can for an hour.... I will get mileage out of that. Sorry for taking up this space Mods - just couldn't let that go.... I'm still chuckling....

    Edited to add: So glad you chimed in on this too Sunshine!! : )

  • minustwo
    minustwo Member Posts: 13,070
    edited January 2021

    LivinLife - you're never just taking up space. It's a great visual and one I'm sure we all have felt about certain doctors. Thanks Gamb.

  • spookiesmom
    spookiesmom Member Posts: 8,167
    edited January 2021

    I told my guy from the first appointment I wanted both off. He mumbled some stats, I was insistent. He did, but my chest isn’t flat. I guess he thought he’d leave something for a PS in case I changed my mind. I haven’t, and won’t. Almost 9 years out from original dx, still happy to be flat.

  • 2019whatayear
    2019whatayear Member Posts: 464
    edited January 2021

    My BS is a woman and I think that helped. I thought long and hard about my decision. The only part I didn't appreciate was that in order for me to go flat they required that I go get a PS consult so I could give truly informed consent. So I had to go have an appointment where another random doctor had a feel my boobs and do measurements and explain procedures I'd already researched. I told him thanks for the info but no I didn't need to make a follow-up appt, I would not be doing reconstruction.

    Then I told my BS to make my surgery look as nice as possible and that she did. No extra skin, no dog ears. I was very satisfied and am very satisfied being flat. I appreciate my post-surgery body.

    One of the reasons I had no reconstruction was because for me I felt the few surgeries the better. One benefit to going flat, though certainly not a deciding factor, was that I was able to have surgery sooner and then start chemo sooner. I felt fewer surgeries, less time to initial surgery and a nice flat chest for radiation worked in my favor since I was already dealing with BRCA2.

  • nola70115
    nola70115 Member Posts: 61
    edited January 2021

    I had BMX six years ago. My natural breasts were extremely large and heavy. I wore a 38G and hated them. They'd been a source of embarrassment and shame since I was 13. I told the PS I wanted the smallest implant I could get that would make my chest not look caved in. I'd have been quite happy with an A cup. They gave me 550 cc high profile implants. They are still much smaller than my original breasts were, and I don't wear a bra anymore, but they are really uncomfortable. It feels like I have a weighted bra on all the time and like I have silicone implants stuffed into my armpits and sides too. I'm thinking about switching from subpectoral to prepectoral. I don't think I have the confidence to go completely flat, esp. because I'm tall and have a belly.

  • LivinLife
    LivinLife Member Posts: 301
    edited January 2021

    MinusTwo you made me laugh all over again!!!

  • idkwhatsnext
    idkwhatsnext Member Posts: 12
    edited March 2021

    I recently decided to go with an AFT/BMX. I switched to a different BS after learning that she had a bias toward other types of reconstruction for people my age. My plastic surgeon recommended a BS who had performed several AFTs but was less experienced. After learning that she had done her residency at MSK and had oncoplasty training, I felt more comfortable with the change. It turned out that she was also one of the co-authors of the research paper mentioned in this topic.

    I chose a NSM with a smile or u-shaped incision for my AFT, which is more similar to a FTM surgery but with a different placement of the nipples and no pectoral implants. My PS was willing to do a nipple skin graft after the BS finished the AFT part of the surgery.

    I found cyathea's posts helpful for my discussions with my BS and PS as well:

  • CHOCO1818
    CHOCO1818 Member Posts: 12
    edited March 2021

    my BS suggested bringing in a plastic surgeon (PS) to close since I wanted an "asthetic flat closure" meaning no excess skin, no dog ears.

    the PS told me "surprisingly more and more women are opting for flat closure instead of reconstruction". at my age 62 I didn't want to have to deal with more surgeries down the road in case of infection as in the case of Sandra Lee, the famed chef. I just want to be one and done. Good luck to all with your decision because it is a personal one and maybe I would feel differently if I was younger.

  • wallycat
    wallycat Member Posts: 1,241
    edited April 2021

    My breast surgeon suggested I meet with a plastic surgeon...and a radiologist (to consider lumpectomy). He didn't pressure me. I think he wanted to make sure I knew all my options. I had larger breasts and I think most males cannot imagine amputation without replacement for sexual stuff. Like many here, I did not want to worry about chest wall mets that might be invisible, autoimmune stuff, more cancer from possible ruptures, replacement implants down the road, the discomfort...blah, blah...I would never get the sensation back so I just plain didn't feel like lugging around plastic/silicone inside me. If men/society can't wrap their brains around it, screw 'em.

  • tntnsd
    tntnsd Member Posts: 124
    edited April 2021

    When I was diagnosed with DCIS, I’m almost certain that that I would go with (single) mastectomy without reconstruction. That decision was confirmed with following MRI, and both my breast surgeon and radiation oncologist. The radiation oncologist did not pressure me at all to consider lumpectomy, which would probably need to be followed with radiation (I don’t want that on my left breast). My breast surgeon did want me to talk to plastic surgeon, before make up my mind about no reconstruction. I thought about it for about 1 day, about if I want to go BMX (which seems a bit too overwhelming for me given all my tests/mri/genetic test that my remaining breast is still clear. I can’t see myself happy with implants, it is just me. I am sure and know people alright with implants. So I called my breast surgeon and gracefully refused talking to plastic surgeon.

    Fast forward, almost 2 months after surgery, I am still very happy with my decision, I am recovering well, almost back to my old self. Yes, I need to pad my left side with fake boob. No one really notices the difference, unless I tell them. I still have my good breast, so my husband and I enjoy that :)), however more than once, he assured me that lopsided, flat or full does not define our love, or sexual life...

  • LivinLife
    LivinLife Member Posts: 301
    edited April 2021

    So I met recently with my onc for the first time in person - 2 other appointments telemed... It has been well documented by many docs, including my onc, that I am not interested in reconstruction.... She asked again : ( I like her and trust her very much - have to say that. I also do not want this to continue being a question most times I meet with any doc. I may have to use (can't remember whose) line in the near future that if I'm asked that question again I am going to scream as loud as I can for as long as I can.... something like that LOL I had just had my annual echo and pulmonary tests done and assuming she saw those results b/c when I responded I do not need or want additional surgery she commented on protecting my lungs.... My pulmonary pressures remain tippy top of high normal and we can't keep them down and it's showing up in my echo now or vice versa. I didn't know that at the time of that appointment though have seen the CD and reports since. I hope no-one asks me about this again....! I still have no regrets and am happy with my decision so why does it bother them so much????

  • cake8icing
    cake8icing Member Posts: 23
    edited April 2021
    I was lucky to have a female BS who never once questioned my decision to go flat after my single MX. I read about others of you with paternalistic surgeons requiring a consultation with a PS...OMG, I would have been so insulted! Perhaps my BS listened when I told her the horrible MRSA experience my sister had 12 years ago from her reconstruction and just knew not to go down that path. She did an amazing surgery, nice and flat. I’m comfortable with or without a bra, although I do wear a bra in polite company to keep other people from feeling uncomfortable. Oh, and here is a funny story. A couple of months ago, I had to have two moles removed. The dermatologist who found them on my full body check, left the practice, and his replacement had to do the actual procedure. She was all efficiency and focused as she looked at first the one mole on my back, and the other on my arm. Then said, I want you to be aware, these removals will leave a scar. Mind you, I’m standing in the exam room topless. So I said to her, well, clearly I don’t care about scars! She looked confused until I looked down at my MX scar, and then she did too. The poor thing, she blushed. I loved her for it; she was focused on her task at hand and not bothered by my MX scar at all. Which is how it should be for all of us, and for anyone who looks different than the norm.
  • kitkat703
    kitkat703 Member Posts: 6
    edited April 2021

    I just wanted to say God Bless you and commend you for making the best decision for yourself.