Going flat

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:

How many women in your practice have opted for no reconstruction?

Do you have pictures of women who’ve had mastectomy with no reconstruction?

How will you make sure that the mastectomy scar(s) lie flat against my chest?

How will you make sure that I don’t have any dog ears or tabs?

What results are realistic for me?

How will my chest area feel to the touch?

Will I have any feeling in my chest area?

Can you connect me with other women who’ve opted for no reconstruction?

SEXUALITY

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:

If you enjoyed wearing racy lingerie before your diagnosis, there are versions that can be worn with breast forms. If you’d rather not wear a prosthesis, then don’t -– the whole point of lingerie is to make you feel alluring and special.

Some women say that wearing a breast form in a sports bra helps them recapture the feeling of having breasts.

Other women say that with the loss of one or both nipples, other erogenous areas, such as the neck or scalp, become more sensitive.

Touching habits may change. You and your partner may be tentative about touching your chest and your scars. Many people find it helpful to talk about what kind of touching they’re comfortable with before any intimacy begins. If you’re comfortable with some touching but your partner isn’t, you may have to be assertive and show and tell your partner exactly what you do and don’t want.

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.

DRESSING

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:

Fabrics with busy, irregular patterns that aren’t too small, such as florals and paisleys, to keep the eye moving

Dark colors, especially black, to camouflage the lack of shadow underneath the flat part of your chest

Crisp shirts with breast pockets to mask your contours

Jackets and sweaters layered over form-fitting t-shirts to draw attention away from your chest and hide any unevenness

Scarves and shawls to cover part of your chest

Styles that show off your other assets, such as high necklines that bare your back or shorter/slit skirts that highlight your legs

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.