Natalie experienced her mother’s breast cancer diagnosis and treatment, and shortly thereafter was diagnosed with a genetic predisposition to the disease. She chose to have a prophylactic double mastectomy to reduce her risk. She was not presented with all of her reconstructive options, but was able to do her own research and confidently choose AFC. Her surgeon respected her decision and gave her a great AFC. Natalie wants other women facing mastectomy to know that while it has its challenges, life on the other side of surgery can be really great!
In the summer of 2023, freshly in the wake of my mother’s breast cancer diagnosis, my life was upended for a second time when I learned I carry the same genetic mutation that caused my mom’s disease. Because of my age, my risk percentage and the fact that the type of breast cancer I’m susceptible to is known for evading imaging detection, it was recommended I undergo a prophylactic bilateral mastectomy as soon as I was ready. So in March of this year – after countless hours spent consulting with clinicians, researching and soul-searching, I went forward with that surgery, making the life-changing and life-saving decision to say goodbye to both of my breasts, forgoing implant-based reconstruction and opting instead for an Aesthetic Flat Closure (AFC).
While the decision to have the double mastectomy felt relatively straightforward, the decision on what to do about reconstruction was entirely overwhelming. Initially I was scheduled for an implant-based surgery as it was THE option presented to me. Though I was assured my results would be beautiful, there was little talk about the potential health risks and long-term implications of living with implants, or even the full range of reconstructive options available — common gaps in these types of discussions between women and their doctors, I’ve since come to learn.
Fortunately, I had time – a privilege I do not take lightly – to educate myself in the months leading up to my surgery date. While waiting I read two definitive books on mastectomy and reconstruction, scoured social media groups filled with women’s personal accounts of their experience with all types of reconstruction, pored over medical research papers and even reviewed video footage of congressional testimony regarding the health risks of implants.
What I learned completely reshaped my understanding of the procedures I was scheduled for. For example, I discovered that the common misconception of a mastectomy being a “free boob job” is grossly naive and, frankly, insulting. Far from simple augmentation, a more accurate description would be amputation followed by various surgical techniques used to create the appearance of breasts; while the end result of an implant-based reconstruction might look familiar, I now understood that my natural breasts would be gone entirely, replaced with hypesthetic (i.e. mostly numb) breast mounds full of health risks and complications at worst and years of ongoing monitoring and maintenance at best.
I was shocked, disappointed and at a loss for what to do. I wanted the look of breasts but I did not want to put my body through multiple surgeries – essentially a guarantee with implants. I strongly dislike MRIs and would prefer to never have another – implants have a shelf life and require ongoing integrity screening via MRI due to the possibility of degradation and rupture. And then there’s Breast Implant Illness (BII). As someone with an inflammatory condition driven by immune dysfunction, nothing I came across in medical literature, personal accounts or congressional testimony led me to feel confident I would be perfectly safe from ever developing BII – quite the opposite, actually.
All that I learned eventually set me on the path to Aesthetic Flat Closure (AFC) which – with typically half the recovery time of other reconstructive surgeries and a lower risk of complication and discomfort – is generally considered to be the safest, healthiest approach to reconstruction. It also happens to be under-presented, overlooked and even denied by surgeons – this in spite of the fact that a growing number of us undergoing mastectomy choose it and are content with the choice.
… it seems, that we expect women to maintain that buxom image at all cost…
While my instincts pointed me toward AFC very early on, fully arriving at the decision took some work. I’m not immune to the fact that we live in a world that hangs a woman’s value heavily on her appearance – with much of that weight being tied to the tissue attached to our chests. So much so, it seems, that we expect women to maintain that buxom image at all cost:
Even when we’re fighting for our lives
Even if it means multiple surgeries and an exhaustive list of potential health risks
Even though it means we won’t be able to breastfeed with the replacement
Even if we won’t be able to feel sexual pleasure from them
With this top of mind, I found myself asking: Who, exactly, would I be putting my body through an implant-based reconstruction for? Was it for me alone, as I felt it should be?
Certainly, I loved having breasts, and losing them felt terrifying—especially with the messaging that reconstruction might be “the only way I’d feel whole” (a common phrase in surgical consults). While choosing reconstruction based on that concern—or any concern—would be valid for anyone in my position, I eventually concluded that it wasn’t the right choice for me. I realized that what I loved most about having breasts would be gone no matter what, that the price for cleavage felt too high, and that much of my fear about being breastless was, metaphorically speaking, coming from outside the house. Once that clicked, I knew the most compassionate, loving thing I could do for myself was to reduce my risk with the surgery I understood to be the safest and healthiest. So, I canceled the plastic surgeon and had my oncology team schedule me for AFC. Societal messaging be damned.
I canceled the plastic surgeon and had my oncology team schedule me for AFC. Societal messaging be damned.
For all the daring of that last sentence, the pressure I felt to conform to society’s narrow view of feminine beauty and the fear of stepping outside of that box was very real and could have easily swayed me from the path I knew was right for me. I’m forever grateful to the women who brazenly and brilliantly counter the culture by openly sharing their flat chests online – they showed me that an absence of breasts doesn’t diminish joy, beauty, sexuality, identity, LIFE or anything I don’t allow it to, really. It’s with great thanks to them that I write this with my whole, flat, chest.
I’m deeply thankful, too, at my good fortune in receiving unwavering, unbiased support from my husband, my family and my friends, along with excellent care from a compassionate surgeon skilled in AFC who honored my wishes. Sadly, many women considering or choosing AFC are not met with this level of support—a fact that fills me with no small amount of grief and rage.
AFC is as valid a choice as any other—one that every woman facing breast cancer or heightened risk should be free to make with her health and happiness as her only priorities. If women were valued as we should be—with our humanity above all else—it’s easy to imagine that the decision to go flat would face far fewer, if any, barriers. Certainly, AFC would be a standard part of those early conversations with our surgeons, and flat denial—a disturbingly common occurrence of surgeons denying and even botching AFC—along with any stigma, judgment, or second-guessing of those choosing to go flat, would disappear. Furthermore, perhaps healthy reconstructive options that honor both form and feeling (they do exist!) would become more easily accessible. A girl can dream.
I grieve the loss of my breasts, but I would grieve them no matter which path I chose. I’m grateful to share that I woke up from my surgery smiling and content with my breastless body—a feeling that remains these many months later. My surgeon gave me a very good flat closure and I see my chest and scars as a testament to my strength and my commitment to self-love and self-compassion. Most importantly, my breast cancer risk is reduced from nearly 80% to almost nothing.
My surgeon gave me a very good flat closure and I see my chest and scars as a testament to my strength and my commitment to self-love and self-compassion.
And: I’m still me. Maybe more than ever. I feel very “whole” just as I am.
Even still, losing my breasts has been an adjustment. While I find my flat chest beautiful (I’m excitedly adorning it with a stunning floral chest piece) and “going flat” freeing, I also like to wear prostheses. Breast forms have helped ease me into my new body and I love that they’re an option for those of us who chose flat but still want the familiar appearance of a body with breasts. My favorite pair are insurance-covered, contact forms (stick on!) that look, feel and move like natural breasts. They’re honestly kind of fun—a silver lining. One of many.
Without question, this path is deeply personal. Choosing the type of reconstruction that best suits us — like any decision regarding a woman’s health — should ultimately be ours alone, made with the support and guidance of a compassionate healthcare team. In making that choice, we deserve to be fully informed of all available options, along with their risks and benefits. We also deserve unwavering, unbiased support from our families, friends, and healthcare providers.
For any woman facing breast cancer, genetic risk and any of the related treatments and surgeries that go with these diagnoses, I’m so sorry you’re on this journey. It’s not fair that you’re here, but I hope you can take comfort in knowing you’re not alone. You are part of an immense community filled with kind and generous people who will meet you with understanding and support the moment you reach out. My wish for you is good health, good healing, good support, and to trust yourself in your decision making process.
For any woman considering Aesthetic Flat Closure, I want you to know that life can be really good on the other side of surgery. Somewhat different. Sometimes hard. But overall really, really good.
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