CHOOSING TO GO FLAT

At age 46, in 2015, when I first heard the words, “You have breast cancer," my brain just screamed, “GET THEM OFF!” I quickly dismissed lumpectomy as an option because I couldn’t be left with the nagging thought, “Did they get it all?” But being a woman brought up in our hyper-sexualized world where Barbie’s figure has been the ideal, I initially thought I wanted a bilateral mastectomy with reconstructive surgery.

The scheduling for reconstruction would require coordination between both a general surgeon and plastic surgeon making the appointment several weeks out, whereas mastectomy alone could be done within days. I opted for sooner, thinking I could undergo reconstruction at a later date. After my surgery, chemo and radiation had been completed, I met with two plastic surgeons who described the brutal process I would endure should I choose reconstruction. I learned that some implants were known to actually cause women to develop certain types of lymphoma and that even today there appear to be additional links with other cancers, although more research is needed in this area. Women with implants can also experience Breast Implant Illness (BII). The body’s reaction to and rejection of implanted foreign objects can result in ongoing pain, auto-immune disorders, fatigue, rashes, and joint pain along with many other mystery ailments. Women are sometimes told these symptoms are “in their head” and they struggle to find a medical provider to believe them. In the end, I did not feel reconstruction was worth the risk and I ultimately decided to stay flat. This would also alleviate the need for future mammograms as well as more surgeries which are inevitable due to the limited lifespan of implants. I count myself lucky to have had a surgeon who respected my wish to simply remove my breasts. Major barriers, however, still exist for women considering mastectomy. Many women are not offered or educated on the option of Aesthetic Flat Closure (AFC) by their surgeons or healthcare providers. Patriarchy and lack of up-to-date information still plague the medical field. Even female surgeons struggle with their own internalized prejudices and traditional views of what they think women should want. ‘Flat denial’ is the term used to describe a surgeon's unilateral action, due to either negligence or intentional disregard, to deny their patient the agreed-upon flat closure. In a recent study, Dr. Deanna Attai, a breast surgeon at the University of California Los Angeles, found that over 20% of women who request flat closure experience flat denial. Some examples of things said to my flat friends by their surgeons have been, “You don’t really want to do that" “You won’t be happy with your result," and “You’re too pretty to throw in the towel.” Due to flat denial, many women have experienced horrible disfigurement and faced multiple surgeries to repair the damage.  Although steadfast in my decision to remain flat, I had much work to do for my self-acceptance and self-worth. We are all programmed from birth to fit into our specific gender roles and as women we are taught that much of our identity and self-worth are based on traditional beauty and sexuality. We are inundated with advertisements and media regarding fashion, beauty products, and cosmetic procedures that show and tell us what we should aspire to look like. We are taught to feel that we are never enough just as we are. With time, I found flat support groups on social media and a podcast that helped me overcome the negative thoughts I initially had about my physical appearance. Social media has been a huge help in connecting survivors and their stories, educating women on the dangers of implants, and getting out the message that flat closure is a legitimate option after a breast cancer diagnosis. Weighing all your options at diagnosis can be challenging and ultimately every woman needs to make the best decision for herself. Make sure you are comfortable with your surgeon and feel that they can and will genuinely deliver the best outcome according to your wishes. Advocate for yourself and ideally have someone with you who also advocates for you.  Since finding my way through not only cancer, but also societal programming and realizing my self-worth beyond what my body looks like, I have never felt more confident about my physical appearance. Letting go of what we think others think of us and being free from trying to meet the expectations of others is truly liberating. As horrible as cancer is, I have a newfound freedom from so many of the burdens I once carried. We are so much more than our breasts. Stacy has a Facebook page you are welcome to join; search for Flat AF in Iowa.