UPDATE: You can download and print Not Putting on a Shirt‘s trifold brochure “Going Flat: How to Ensure You Get an Acceptable Surgical Result” here (published 11/8/18).
I am often asked, by a woman facing mastectomy and wanting a flat result, what steps can she take to protect herself from being left mutilated as so many women have been?
As I have learned – and this is *reprehensible* – there IS no one hundred percent sure protocol that you can follow that will ensure that your surgeon respects your wishes. However, there are several things that you CAN do to increase your chances of success.
First and foremost is choosing a competent, ethical surgeon. Consult with multiple surgeons, both oncology surgeons and plastic surgeons. Ask to see pictures of flat results they have achieved for previous patients. If they have none, move on to another surgeon. If they push back and say you’ll change your mind, get out of there. Trust your intuition.
Once you have a surgeon that you believe is competent and willing to achieve a flat result, you can take the following measures to protect yourself against the bait and switch:
1. Make sure that it is recorded in your medical record that you want a smooth flat result (or however you describe your desired aesthetic). Ideally, you want this to be in your surgical consent form, which is the form you sign consenting to the surgical procedure. Sometimes there is a space for you to add notes on that form, and if you see such a space, definitely make your flat wishes explicitly clear there. My form did not have space and defined the procedure simply as “bilateral breast wound closure,” which leaves room for interpretation – not good.
2. Ask again to see pictures of flat results that your surgeon has produced for women previously. Ask your surgeon to explain to you in detail, how they arranged for those incision patterns to ensure a flat result. Ask how far back towards your back your own incision will need to extend, in order to remove the excess tissue under your arms (“wraparound tissue”). Make sure your surgeon feels comfortable doing what it takes, and taking the time required, to give you a great flat result.
3. Bring a competent, supportive witness (husband, partner, sibling, friend) while you discuss your wishes to be flat in consult. Make sure you’re on the same page going in to the consult. This witness needs to back you up and reiterate to the surgeon that they expect your wishes to be respected.
4. Repeat your wishes to be flat to every single person that you encounter in the surgeons office, as well as on your way to the operating room on surgery day. The nurses, the anesthesiologist, the surgical assistant. Everyone.
5. For your consult, bring photos of your expected result that you have sourced yourself. Google image search and the Facebook support groups for going flat (primarily Flat & Fabulous) are good sources. You can also bring photos of what you DON’T want (skin sparing mastectomies, botched results, etc.) to discuss the specific results you’re trying to AVOID.
6. Ask for specifics on how to surgeon is going to account for the effects of gravity. Will they mark you up before the surgery, sitting up? Will they sit you up in the OR in order to assess symmetry/sagging before discharging you?
7. Write on your forehead or somewhere prominent with a sharpie “I want to be flat” or whatever your preferred phrase is for your desired result.
8. Consider telling your surgeon the story of what happened to me, and countless other women, and see how they respond. If they’re shocked, that’s good. If they try to make excuses for those other surgeons, that’s bad.
9. After your consult, email your surgeon(s) recapping what you discussed in consult. Attach the pictures you brought. Ask them to confirm that this is the mutual understanding of the goal of this surgery, in writing, by responding to your email. If they refuse, that’s another red flag.
… And if you get any pushback, at any time, when you perform these protective measures, your surgeon is waving a red flag in your face, that they may not respect your wishes. Which puts you at risk for what happened to me, happening to you. You will lose your one chance to be one and done in one surgery. Do not let any protective measure you can take, stay undone. Do everything you possibly can to make sure that this does not happen to you.
Unfortunately, even if you take all of these steps, your surgeon can still unilaterally decided to leave you with excess tissue, against your consent. And as we have seen from countless cases, the surgeon will suffer absolutely no repercussions. The sad truth right now is this:
It’s a gamble.
And it will continue to be a gamble until we force the surgical community to hold their bad actors accountable. Until that day, we will continue to fight. I personally will continue to fight. Godspeed to all of you facing this surgery and it’s potentially traumatic aftermath. Make sure your surgeon knows that women are not going to accept these horrific disfigurements anymore. That you are not going to stand for this continuing to happen to women.