While most women do choose to have some type of reconstruction, about 9% of patients don’t. Doctors call this “going flat” or “living flat.”
There are a variety of reasons for not wanting to have reconstruction after a mastectomy. Some women give age as a factor. Others see breast reconstruction as a purely cosmetic procedure and don’t think it’s necessary. And many patients feel that cancer treatment is challenging enough without plastic surgery added to the mix.
The decision to reconstruct or not is very personal. There is no “right way” to approach mastectomy and reconstruction (or lack of it). There is only the way that’s best for you, your preferences and your healing.
If a woman decides she’s not interested in ever having reconstruction, she can ask her surgeon to make her mastectomy site as cosmetically pleasing as possible, leaving no extra skin. Even if a woman feels certain at the time of her mastectomy that she won’t ever want reconstruction, she can still opt for delayed reconstruction in case she changes her mind in the future.
With or without reconstruction, there are no real differences in mobility or recovery after a mastectomy, and also no difference in the risk of lymphedema. Still, there are some aesthetic issues to consider when going flat.
Some women, especially women who have large breasts or are overweight or obese, may end up with what are called “dog ears” under their arm. These are pockets of fat left behind after mastectomy. Also, if an incision ends abruptly, a tab of skin and/or fat may form a bulge at the end of the scar or under the incision. Most women prefer scars that lie flat, leaving their chest fairly smooth.
Some questions you may want to discuss with your surgeon:
You may be wondering about your sex life after mastectomy with no reconstruction. For a number of women, breasts are an important erogenous zone. You may be worried that the loss of your nipple and some of the feeling in the breast area may change your sex life for the worst. You might worry that your partner won’t find you attractive with only one or no breasts (if you’ve had a double mastectomy).
Sex after mastectomy with no reconstruction can be just as fulfilling as it was before surgery. But you may need to experiment or change some things:
Sex and intimacy happen one step at a time. Give yourself time, love and affection, and most of all, give yourself credit for your hard work and courage.
If you like the idea of going flat but are worried about looking lopsided in form-fitting clothing, choose styles that draw attention away from your chest area.
Some clothing tips include wearing:
If you’re worried about not having nipples, you can buy removable polyurethane nipples. These nipples are in a semi-erect position and are very close to a natural nipple’s texture and color. To attach the nipples, you moisten the back and stick them on like a little suction cup. You can put them on and take them off as you like.