Going Flat

If you choose not to have your breasts reconstructed after a mastectomy, we support your decision. Learn how we can help if you opt to “go flat.”

After a mastectomy, most women choose to have breast reconstruction, However, some women who have a mastectomy choose not to have reconstruction and instead “go flat”.

There may be many different reasons for this choice, and none of them are wrong. Choosing to have—or not have—breast reconstruction is your decision, and only you can know what’s right for you. Regardless of your choice to have breast reconstruction or not, we recommend that you learn about all of your options before making a decision.

Deciding Not to Have Breast Reconstruction

For many women, breast reconstruction is part of their healing process after cancer surgery and helps make them feel whole again. There are many breast reconstruction options to choose from today. After going through the emotional and physical ordeal of breast cancer, additional, non-medically necessary surgery isn’t desirable for some women.

Women choose to go flat for a range of reasons, including:

  • Wishing to avoid additional surgery after mastectomy
  • Needing to get back to daily activities as quickly as possible
  • Being worried about the side effects of breast reconstruction, such as loss of muscle strength (but keep in mind there are surgical options that avoid cutting muscle tissue)
  • Not wanting to have a foreign substance in their bodies with implant reconstruction
  • Wanting to have a faster recovery from mastectomy
  • Having concerns about insurance coverage for the procedure. The Women’s Health and Cancer Rights Act (WHCRA) requires insurance to cover breast reconstruction after mastectomy
  • Needing to remove previous breast implants for medical reasons
  • Being unhappy with prior breast reconstruction and not wanting further breast surgery

What if I am Unsure? Can I Choose to Have Breast Reconstruction Later?

Choosing Delayed Reconstruction

Keep in mind that even if you don’t have immediate reconstruction (done at the same time as the mastectomy), you can have delayed reconstruction (done at a later date after the mastectomy). Breast reconstruction can be done 6-12 months after mastectomy, or even later. However, immediate reconstruction usually has the best cosmetic results.

Appearance

If you choose not to have reconstruction but want to have the appearance of breasts when wearing clothes, you can use breast forms. Whether you’ve had a single or double mastectomy, you can find comfortable breast forms that fit inside bras and swimsuits. Breast forms are available in many different sizes, shapes, and materials. It is important to be fit by a certified mastectomy fitter to ensure a proper fitting form and help minimize any contour irregularities.

A growing number of women are having the area around their incision site—or their entire chest—tattooed after mastectomy. Much like breast reconstruction, a beautiful new tattoo can be an important part of emotional and psychological healing for many women.

Do I Need a Plastic Surgeon if I Decide to go Flat?

It’s important to consult with a plastic surgeon to fully understand your options about breast reconstruction in your process of deciding the best direction for you. Even if you opt out of breast reconstruction, you might want to plan with your breast surgeon the best surgical approach, incision placement, appropriate closure, and removal of redundant/sagging skin for your best outcome.

Talk With Your Breast Surgeon

If you’ve decided against breast reconstruction, it’s very important to discuss your decision with your surgeon so that you both are clear on your wishes and your desired outcome. Tell your surgeon why you want to go flat. Ask your surgeon:

  • For photos of patients who have had mastectomy without reconstruction
  • How they will minimize contour irregularities and make sure the incision lies flat across your chest without leaving excess skin over the side of the chest (also known as “dog ears” or tabs)
  • What cosmetic results are realistic for you
  • To put you in touch with other women who have chosen not to have reconstruction

Things to Consider

During the mastectomy, some surgeons may leave extra skin at the incision site to make room for a new breast in case the patient changes her mind about reconstruction later. After surgery, the extra skin sags on the chest. If you don’t want extra skin left, make this very clear to your surgeon. If you want the sagging skin surgically corrected after the mastectomy, your insurance company very likely won’t pay for the procedure.