New Study Looks at Trends in Going Flat After Mastectomy

A new study from the Medical College of Wisconsin, co-authored by Flat Friendly Directory surgeon Amanda Kong, was just published in the prestigious Annals of Surgical Oncology and looks at trends in rates of reconstruction vs. going flat from 2004-2019. We’ve been waiting for this analysis for some time! Previously, data on these rates was only available through 2014 which did not encompass the modern “flat movement” and its potential effects.

Figure 1. National trends in going flat from 2004 to 2019, all age groups (Kong et. al., 2023)

Figure 2. National trends in going flat from 2004 to 2019, by age group. (Kong et. al., 2023)

The authors discussed some potential (not definitive) explanations for the trends. They acknowledge that the literature shows no clear or significant psychosocial benefit to reconstruction, and that women are aware of the potential complications of reconstruction:

“Women who undergo PMBR may report dissatisfaction with their breast outcome due to asymmetry, cup size, lack of sensation, chest pain and weakness, changes in abdominal strength, and unexpected appearance. These issues may affect long-term quality of life, are particularly relevant to younger breast cancer patients, and may also contribute to the stabilizing rates in PMBR. Additional reasons for changes in PMBR rates may be rising concerns regarding the risks of complications with PMBR which have been reported to be as high as 33% in some series.”

The influence of information found online and through social media was discussed:

“Information found online and through social media can significantly influence patients’ decision-making processes, with one survey finding 23% of patients reported that the internet affected their reconstruction decision and 16% were influenced by social
media. Another survey study found that in patients who went flat, many reported learning about this option through their own independent research and 40% expressed they
would like physicians to provide more information on options following mastectomy.”

Rising awareness about the specific risks of implant-based reconstruction, including BIA-ALCL (67.6 times increased risk with implants relative to the general population) was also mentioned as a potential contributing factor.

Thanks to Dr. Kong and her colleagues for this important study!

Published by Not Putting on a Shirt

Founder of Not Putting on a Shirt, a mastectomy patients' rights organization that advocates for optimal surgical outcomes for patients going flat.

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