Mom’s Favorite Skirt.

I remember I was wearing mom’s favorite long skirt with the red flowers when I sat knee-to-knee with my surgeon 7 years ago. He was explaining the process of surgery and reconstruction that would follow my cancer diagnosis. My mom had passed away 19 months earlier. She couldn’t afford reconstruction after either of her mastectomies but now insurance companies are required to cover it.

"Of course you'll want to reconstruct because you're so young still."
I nodded. Dazed. I should feel lucky.

Later that week I met with the plastic surgeon. I had done a bit of internet research into various reconstruction types—saline, silicon, diep flap, over the muscle, under the muscle, direct to implant, tissue expanders, nipple sparing, etc. They all made me very nervous. So much cutting. 3 to 12 month process.

My surgeon informed me right away that expanders followed by silicon implants was the only good kind of reconstruction for someone like me—the only kind of reconstruction that he did.
No options.

Does the silicon ever leak?
"It's very rare. It's better than saline because silicon is a gel so even if it leaks it all stays in one place. I know someone who has had her implants for 20 years and never needed to replace them".

What about going flat?
"Studies show that women who don't reconstruct have worse mental health outcomes. Don't worry, you're going to love your new breasts even better than your old ones".

The truth is, silicon breast implants leak all the time. Even if the capsule remains intact the silicon can be slowly siphoned out by the lymphatic system and wreak havoc in distant places in the body.

The truth is, implants have a 10 year life span and many need to be replaced long before then. When you have implants placed in your body, more surgery is a guarantee.

The truth is, the FDA recommends that for safety, breast implants must be inspected by MRI 3 years after placement and every 2 years after that (for those with an insurance deductible this is a ~$2,000 scan out of pocket).

The truth is, textured silicon implants are linked to ALCL (anaplastic large cell lymphoma) and in 2019 Allergan recalled its textured implants and women all over the world have been getting them removed ever since.

The truth is, no cancer survivor loves her foreign, plastic, numb breasts better than her real breasts. So don't ever suggest that that might be some kind of silver lining.
Reconstruction is not a free boob job. It is a long, painful, dangerous process. It can lead to years of revision surgeries, infections, pain syndromes, opioid dependency, breast implant illness, a second cancer diagnosis, implant failure, necrosis, and more.

So you can see why going flat is fast becoming a very popular option for breast cancer survivors:

Quick recovery.
Low risk.
Less damage to the pectoral muscles.
Better range of motion.
Less unpleasant sensations.
No further surgeries.
No further scans.
No foreign objects in your body.

Until more humane reconstruction options become available we need to normalize flatness.
Flat is beautiful.
Flatties don't need prosthetics or special clothes. We can wear anything we want.
Approximately 1 in 8 women will be diagnosed with breast cancer in the US, with comparable statistics in other countries. Be sure to remind the women in your life that going flat is a valid option if they are ever faced with a diagnosis. If a surgeon doesn't offer it, find a new surgeon.

There are numerous support groups on Facebook for women trying to sort out reconstruction options. Feel free to contact me if you are looking for one.

Going flat is a type of reconstruction. It's called "aesthetic flat closure". Us flatties are everywhere and our numbers are growing. We are made up of women, men, trans, and non-binary individuals.