Why I Chose Flat Closure Surgery
At my first surgical consult after learning I would need a mastectomy, I was offered lots of information about reconstruction after breast cancer, part of the deluge of information that stuns you after diagnosis. I had spent much of the time since diagnosis crying, staring into space, and making phone calls to set up things like my first chemo infusion. Adding reconstruction to it all seemed like a lot of work, especially for someone whose life had just been compressed into chaos.
“What if I just want to be flat on one side?” I asked. “Can you do that?”
“It’s your choice, but we want to make you whole again,” the surgeon said.
I was stunned. My wholeness comes from inside me, not from what my body looks like. It felt insensitive for him to tie my state of being to my physical form, especially when my physical form was in peril. Out of chaos comes clarity, and this was one of the times in my life where I knew exactly what to say.
“There is nothing anyone could do to make me not whole,” I told him. That turned out to be truer than I knew at the time.
I had been diagnosed with stage 2 breast cancer at age 35, the day after my daughter’s first birthday. Even at the mammogram appointment where I learned I had cancer, when a radiologist took me into the viewing room to look at the tumors growing inside my breast and lymph nodes, my heart whispered what I knew was the truth: Rreconstruction was not for me. Looking at those images, I had a visceral feeling—I wanted this out of me as soon as possible, in the simplest and fastest way forward, no extras.
Before I could undergo surgical intervention, I needed chemotherapy. In between the rounds of treatment, I spent a lot of time soul-searching, thinking deeply about my options and their potential consequences and mourning the body I knew was going to change forever. While I considered all options and even attended a consult with a plastic surgeon for due diligence’s sake, I never really wavered—ultimately, I wanted to preserve as much of myself as possible. After giving birth via C-section in 2021, I wasn’t excited about DIEP flap surgery, where fat is taken from the abdominal region to form breasts, and implants turned me off because it felt like putting something inside me that wasn’t mine to begin with.
I also spent a lot of time online, learning from the experiences of other women in breast cancer groups. What I learned was shocking: While we often feel pressured by our family, friends, doctors, and society to “become whole,” a recent study of almost 85,000 women found that more than half opt not to pursue reconstruction. That study doesn’t include women who chose to explant (remove breast implants) after experiencing complications, discomfort, or illness post-reconstruction. There are tens of thousands of women—perhaps hundreds of thousands—who have chosen either single or double aesthetic flat closure, or AFC, and are living happily with that choice.
One major factor in my decision—and one I’ve seen come up again and again in breast cancer groups—was my commitment to being a joyful, active mommy. I want to be able to swing my daughter from side-to-side and let her dance on my feet for as long as I can, someone who is always ready to sweep her up into a big hug. Ultimately, I chose the surgical option that would expedite those big hugs. Knowing that I could be cleared to pick her up again after 10 days was an important factor.
So, in November 2022, I became a unicorn—in breast cancer survivor lingo, someone who opted not to undergo reconstructive surgery after her mastectomy and instead pursue single-side AFC. (Double AFC folks are often referred to as “flatties.”) I am completely flat on my left side, and I have a seven-inch scar that runs from my chest up into my armpit. It may seem strange at first glance (and, in fact, I have gotten a lot of strange first glances, especially at the beach), but I have no regrets.
There isn’t anything wrong with reconstruction. It’s also a valid choice, but it’s not the only choice. This is one of the most personal decisions you can ever make, and there’s no right way to be. However, patient access to information about AFC is lacking, which means plenty of women aren’t learning about something they might want during one of the most vulnerable points in their lives.
One study by the Medical College of Wisconsin found that many women surveyed learned about flat closure online, from other patients—not from their care team. AFC is a simpler surgery with a shorter recovery window (mine was done by a general surgeon, not a reconstructive surgeon), but it’s often seen as less desirable than reconstruction. Breasts are firmly tied to womanhood for a lot of people, and the idea of taking them away is often frowned upon.
A 2021 study found that nearly 75 percent of women surveyed who had no reconstruction were satisfied with the result, but almost 25 percent said their surgeons didn’t support their decision. There’s even an organization, Not Putting on a Shirt, that helps women find flat-friendly surgeons in their area—a direct response to hearing from so many women who got pushback while pursuing AFC.
It’s been almost a year since my surgery, and I still feel good about my decision. I spent the first six months feeling a bit self-conscious, looking around to see if anyone was staring at me, but it’s surprising how quickly you can get used to such a big change. I don’t wear a prosthetic breast, though many do. When I look at myself in the mirror, I see someone who will fight to the end of the Earth to stay alive for her family and herself. I am more deeply myself than I was when I had two breasts, kinder to myself after experiencing 15 months of trauma. I don’t care if people see what happened to me.
These days, I am experiencing a new kind of wholeness—one that transcends physicality. I like to joke that now that my left breast is gone, my heart is closer to the world. That feels like something worth sharing.
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