Ruth had a family history of breast cancer and was eventually diagnosed with the BRCA2 gene. She decided to have a prophylactic double mastectomy to reduce her risk of developing breast cancer. She was not presented with flat as an option, and her experience with the plastic surgeon felt dehumanizing, but decided with her husband that no reconstruction was right for her. She wants people to know that being flat is an option and to not be afraid to challenge societal expectations!
My first memory of breast cancer came with the news that a distant cousin in Canada had been diagnosed. I was young and could not comprehend the enormity of this. As an adolescent, my Mum’s older sister was similarly diagnosed and subsequently had a lumpectomy. In 2012, my world changed with the news that my cousin had been diagnosed with stage 2 breast cancer and was later advised, through genetic testing, that she was a BRCA2 carrier. My cousin had radiotherapy treatment and breast reconstruction following a bilateral mastectomy. I, along with my cousins, faced a new journey to find out whether I carried this destructive gene.
Throughout a five-year period, I met with various medical practitioners and genetic counselors, who dissected my family history and ultimately prepared me for the test. Complications arose, however, with my mum. With long-standing mental health problems, she struggled to understand the complexities of genetic testing and the potential impact of a positive result. Faced with the thought of not only revealing my fate but also my mum’s fate, a decision was made by medical practitioners in both my mum’s and my best interest that I continue with the test. My result returned positive and I remember feeling shell-shocked. I carefully considered my options and a few months later I attended a number of appointments at the local breast care centre to discuss the next steps. I decided to have a preventative bilateral mastectomy.
I met with my consultant who was also the surgeon carrying out my procedure and the information she provided reassured me. However, my meeting with the plastic surgeon was awkward. I recall him giving me two options; a silicone implant or tissue from a skin graft to reconstruct my breasts. At the time, I ran regularly as a way of nurturing my mental health. I was training for a half marathon and this was very important to me. The plastic surgeon drew all over my body highlighting where skin would be removed. I felt very undignified and as if he was highlighting the areas of fat on my body. He indicated the area where he was most likely to remove skin was my thighs and I immediately asked how long it would be until I could run again after the operation. He estimated at least a couple of months, this threw me. I have never agreed or liked the idea of a foreign object being in my body, so the option of silicone implants seemed an alien concept. I saw many consultants throughout this period and the option of a flat closure was not discussed in any depth. It was only in the car on the way home from one appointment did my husband say ‘you know there is a third option …. don’t have any reconstruction’. We discussed this at length, highlighting the pros and cons and ultimately decided this was the best option. At the time, I did not know anyone else who was flat and struggled to find support in the local community to give me a sense of what it might feel like post-operation, however, I trusted my intuition. In February 2018 I underwent a bilateral mastectomy and surprisingly was home the same day. I spent a few weeks at home recovering. I returned to work a couple of months later and gradually acquainted myself with a new ‘normal’.
It has taken me a long time to come to terms with being flat, my body shape has changed and the way I think about myself has changed. I used to be afraid of how people perceived my flat appearance, but through acceptance and time this is no longer a fear. I have created a new identity and I am very proud of who I am. For those who are faced with a decision about whether to go ahead with reconstruction or remain flat, my advice is to decide what’s right for YOU and no-one else. Don’t be afraid to challenge expectations and attitudes. Societal attitudes are changing and with greater awareness, being flat is an option.
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