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Going Flat After A Mastectomy

Going Flat After A Mastectomy
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According to, 1 in 8 women in the USA will develop invasive breast cancer sometime in their lifetime. This year alone, nearly 247,000 such cases will be diagnosed and those women face some tough choices. Lumpectomy or full mastectomy, radiation vs. chemo are a few of them, but once the initial shock passes, another question may beg an answer: Do you want your breasts reconstructed or do you want to go “flat”?

Going flat, undergoing no reconstruction at all is increasingly the choice of women who have had a mastectomy. Breast reconstruction brings with it the risk of wound infection; fluid under the wound; flap failure (death of the tissue used to reconstruct the breast); implant leakage, hardening or shape change; and ongoing pain and discomfort.

Another alternative to breast reconstruction after a mastectomy are mastectomy bras with false breasts built right in; the wearing of “forms” made of silicone gel in a plastic skin which mimic the shape of the breast; and/or wearing stick-on nipples. None of these are ideal choices. The mastectomy bras are heavy and expensive, carrying and putting on/off the forms (especially while traveling) is inconvenient and the nipples don’t provide the shape of the breasts to fill out clothes the same way you did pre-surgery (though custom made nipples from such companies as Feeling Whole Again can perfectly match your remaining or former nipples and stay in place for long periods of time.)

Given these inconveniences and the dangers of reconstruction, more women are deciding to “go flat.” Besides the reasons listed above, going flat is now often chosen by women who, according to, “fell their changed bodies are just as beautiful as their pre-surgery ones and see no need to camouflage their new silhouettes.” A video of several of these women discussing their choices to go flat went viral on the Facebook Wisdo site. One woman, Paulette Leaphart took it a step (make that several steps) when she walked topless from Biloxi, Mississippi to Washington, DC this summer, saying, “Breasts aren’t what makes us a woman.”

If you are facing surgery and want to explore going flat, there are some questions you will want to ask your surgeon. These are suggested by

  • How many women in your practice have opted for no reconstruction?
  • May I see photos of such women?
  • Can you connect me with them so that I may discuss why they chose no reconstruction?

You may also have questions about the surgery itself since a flap of skin needn’t be left for a future reconstruction, how will the doctor make sure the scar lies flat against your skin; what type of feeling you will have in your chest area; how will the surgeon avoid “dog ears” (lumps of skin on either end of the scar)?

You should also discuss how going flat may affect your future sex life. (Many reconstructed breasts are numb and can’t play a role in physical sexual arousal. Some women find that their scalp and neck become erogenous zones after they have lost their breasts and nipples.) Ask for the name of a support group to talk out your fears and frustrations after surgery. Flat and Fabulous is one such group on-line.

Women with no reconstruction tend to heal faster after surgery, according to, and some scary statistics were mentioned in a recent New York Times article where it says up to one-third of women who undergo reconstruction have complications. In the article, Dr. Clara Lee, an associate professor of plastic surgery at Ohio State says, “That’s the dirty little secret of breast reconstruction: The risk of a major complication is higher than for the average elective surgery.”

Some doctors (many of them men) never even ask if you would prefer to go flat and avoid reconstructive surgery. The NYT article cites a woman in Florida who woke up after surgery to find her doctor determined for her (and against her wishes) that she would probably change her mind about having the surgery later and left an unsightly flap of skin she now must undergo another operation to remove. New York State now requires doctors to ask the woman if she wants to forgo breast reconstruction surgery before the operation, but not all states do, so speak up if you are interested and discuss all your options fully with your doctor.

Some women, who opt to go flat for safety reasons, still feel self-conscious about their appearance afterwards. offers these clothing tips to help:

  • Black or dark colors camouflage the fact you have no shadow underneath your breast.
  • Busy patterned fabrics (not too small a print) keep the eye moving and disguise the flatness.
  • Layering sweaters over a form-fitting t-shirt draws attention away from any unevenness
  • Scarves, shawls and jackets can be used to help cover your chest.
  • Show off your other assets, your legs in a slit skirt, your back in a lace up dress instead of going for the cleavage.

Other suggestions include going au naturel in the privacy of your own home until you get used to the feeling, restricting yourself to wearing the forms only when your breasts would normally be visible (like when you don your sports bra at the gym), or even getting the scar area tattooed.

Whether you choose reconstruction or to go flat, the thing to remember is having breasts or no breasts isn’t the thing upon which to focus. What is important is that you have survived. You are still alive —now go live your life.





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