After mastectomy some women don’t want to replace their breasts
Several of those who sought the procedure say they got pushback — and outright denial — from their doctors when they brought it up
So Attai did her own survey of close to 1,000 women who’d had a single or double mastectomy without reconstruction. Published last year in Annals of Surgical Oncology, it found that close to three-quarters of the women said they were satisfied with the outcome.
No government or organization tracks the number of flat closures each year. According to the National Breast Cancer Foundation, close to 277,000 cases occurred of invasive breast cancer in 2020 in the United States. The American Society of Plastic Surgeons, reported that about 140,000 mastectomies were done that year, about half of which involved further reconstructive surgery.
Flat closure has always been an option, but Anne Marie Champagne, a PhD student at Yale whose research is focused on this issue, says there was a change in attitudes about flat closures in online conversation beginning in 2012. Champagne, 53, who opted for flat closure after a 2009 mastectomy, says before 2012 there were only two posts about flat closure on the Breastcancer.org message board. “That year I saw a post by the founder of the advocacy group Flat Closure NOW! that read: I want to see you. I want to form a union. I wish it was acceptable to be flat … if that is your choice, I do hope that women who see me, flat as can be, see that reconstruction isn’t par for the course.”
What struck Champagne wasn’t just the post’s content, but the number of people who read it. “At most, Breastancer.org messages got a couple of thousand views,” Champagne says. “[That] message had 79,000 views and 3,500 comments within six months of posting.”
While many women still opt for breast reconstruction, as the numbers from the American Society of Plastic Surgeons make clear, Champagne and others engaged with the issue of flat closure tick off a list of reasons, including increased awareness of the option, for what cancer doctors and surgeons say is a growing interest in going flat.
“I definitely have seen more patients requesting to go flat after mastectomy, likely as they feel more empowered to make this decision,” says Roshni Rao, chief of breast surgery at Columbia University Medical Center in New York.
“A breast cancer diagnosis can be particularly overwhelming because there are so many decisions to be made in a short period of time including choices of doctors, a treatment plan and the woman’s post-mastectomy chest,” says Attai, in an email. There’s more awareness now that the process of reconstruction has risks. “Women who opt for reconstruction, whether a breast implant or their own tissue (called autologous reconstruction) could face multiple surgeries, post-surgery recovery, a 10 percent risk of infection which can get in the way of a chemotherapy or radiation schedule, and, occasionally, implant recalls and removals.”
For women who want to do reconstruction, Attai says, they often feel the effort and risk is worth it. “But for others, it isn’t.”
It wasn’t for Pepper Segal, of North Carolina, who was diagnosed with breast cancer three years ago, while pregnant, at age 31. She was induced to deliver her baby at 36 weeks, and started chemotherapy two weeks after that. But soon after, she felt a pain in her armpit that turned out to be the cancer spreading. Segal had an emergency mastectomy and decided to remove both breasts — and have a flat closure.
“I was told that if I wanted to have reconstruction I should wait two years, because my form of cancer has a high rate of recurrence and detecting it can be harder with implants or an autologous reconstruction,” she says. “But I decided on the flat closure. I didn’t want to put my body through anything else.”
Segal says she “thanks God for Billie Eilish” and her signature baggy clothes. “I can dress in baggy clothes, and it looks cool now.”
Expectations have changed
Sagit Meshulam-Derazon, a plastic surgeon at Rabin Medical Center in Tel Aviv who specializes in breast reconstruction, says she and her medical partner,…
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