Why More Breast Cancer Survivors Are Going Flat
In 2014, when Sarah Brown of Vancouver, Washington, learned she'd tested positive for the BRCA2 gene mutation, she had no qualms about getting a double mastectomy. The idea of reconstruction, however, gave the 37-year-old small-business owner pause. Brown was fond of her 38Cs, primarily because they were hers, not surgically re-created, mostly numb breasts.
Still, Brown met with a plastic surgeon, who recommended a DIEP flap reconstruction, which involves creating new breasts out of skin and fat from the patient's lower belly. She also talked to her therapist and joined a discussion board for women undergoing mastectomy and DIEP flap—and cringed at the grueling recovery stories. Then Brown discovered Flat & Fabulous, a Facebook page where women who'd had a mastectomy posted pictures of their unreconstructed chests along with stories about how, after just a few weeks of discomfort, they were back to jogging, biking, and playing with their kids. Brown noted that instead of comparing notes about pain control and follow-up surgeries, these women were sharing fashion tips and cheering one another on. She was sold.
Nearly 25 percent of women in the U.S. who undergo bilateral mastectomy choose not to reconstruct (as do approximately 50 percent of women who undergo unilateral mastectomy)—motivated, in many cases, by a desire to minimize their surgeries, complications, and recovery time: It's not unheard of for the reconstruction process, which often follows months of chemo and radiation, to involve up to seven surgeries. There's also the risk of infection at the incision site and, in the case of DIEP flap and similar procedures, of the transplanted skin and tissue's failure to survive. (Up to 30 percent of patients will have a major complication in the year after reconstruction surgery, according to the Mastectomy Reconstruction Outcomes Consortium Study; that's compared to a 5 percent surgical site infection rate after a mastectomy only.) Implants present additional concerns: Research suggests they may interfere with a doctor's ability to diagnose a heart attack; certain types of implants are associated with a rare form of lymphoma; and the FDA recommends that women with silicone implants get an MRI three years after receiving them and then every two years afterward to check for "silent rupture." Even if all goes well, some women need surgery to replace their implants after ten years.
These are all compelling reasons to say no to reconstruction. Yet most women who've gone flat have kept their choice under wraps (and baggy T-shirts), opting to create curves using prosthetics or even socks stuffed in a bra. Now, though, in the age of social media, radical transparency, and embracing difference, some women are not only refusing to hide the smooth plane of their chest but also showing it off. "When we started this group four and a half years ago, we said we'd be excited if we got 12 women to join. Today we're at 3,100," says Sara Bartosiewicz-Hamilton, founder of Flat & Fabulous. "There's enormous power in knowing you're not alone."
The group's members don't want to be weighed down by implants and the issues they bring. "My breasts and I had some good times," says 29-year-old Elspeth Lucas. "But I love being flat. I can fit into extra-small tank tops. And so few people even notice my lack of breasts." Another group member, Kelly Shiraki, notes: "My breasts were size 40G. Since going flat, it's been easier to drive, I can sleep on my stomach, and I can wear lace and flowy shirts that looked boxy on my old shape. The drawback: There's nowhere to tuck my phone or lip gloss."
Surgeons are noting an uptick in the number of patients who express interest in staying flat. "A small but growing number of breast cancer patients in my practice, including younger ones, are saying no to reconstruction," says Deanna Attai, MD, an assistant clinical professor of surgery at UCLA's David Geffen School of Medicine. Says Julie Margenthaler, MD, a breast surgeon and professor of surgery at Washington University School of Medicine in St. Louis: "I saw a young patient this morning whose main reason for opting out of reconstruction rings true for most patients: to minimize the number of procedures and risks during and after surgery."
And now pop culture is getting in on the act. On the Amazon show Transparent, a character played by Anjelica Huston reveals her flat, scarred chest in a bedroom scene. Comedian Tig Notaro jokes about life without breasts and has even removed her shirt onstage. An Equinox gym ad features a topless, flat model getting tattooed.
"That kind of visibility not only demystifies flatness, but also fuels a conversation about socially acceptable options for women with breast cancer," says Steven Katz, MD, director of the Cancer Surveillance and Outcomes Research Team at the University of Michigan. "Flatness is fresh. There's no doubt about it."