Living Flat

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Introduction to Living Flat

Going flat and living flat is a journey, not a destination. You will adjust, you will grow, and you will make peace with your new body – but it will take time. Now is the time to give yourself space, and grace. Your physical healing is just the beginning.

Community & Support

When you’re new to living flat, it can be a relief to find a community of like-minded women who have been through this transition. Share your experience, get support and advice, and crowd-source information and resources using one (or more) of the many Facebook groups founded for women like you! We recommend Fierce, FLAT, Forward which was founded by our VP, Christy Avila, and there are many others as well.

You can also find community support on forums like BreastCancer.org on the web, or #BCSM on Twitter. National organizations like SHARE Cancer Support and the Breast Cancer Resource Center offer phone & video conferencing support groups. You can also find local resources with Triage Cancer’s search tool, Cancer Care’s search tool, or contact your national cancer society [American Cancer Society] [Canadian Cancer Society].

If you find yourself struggling, don’t be afraid to reach out for professional support. Ask your oncologist, oncology social worker or nurse navigator for a referral to a psychologist or therapist who can help you manage your feelings in a healthy way. Hester Schnipper LICSW, BCD, OSW-C (Healing Garden Cancer Support) has written a great article on how to find a cancer therapist here. You can also call Cancer Care’s Hopeline, or search for an oncology social worker near you using the Association of Oncology Social Work’s online tool.

Flat Fashion

Dressing your post-mastectomy body is all about YOU – what you feel comfortable in, what you like and don’t like, and your personal sense of style. Some women living flat wear form fitting clothes that draw attention to their flat chest, while others prefer to wear clothing that distracts from or conceals the chest contour. And of course, there’s always the option to wear prosthetics.

There are several flat-specific fashion projects, groups and blogs online where you can find fashion tips, community, support and inspiration:

Body Image & Sexuality

Body Image

No matter what your reconstructive choice, when you wake up from your mastectomy, your body will be forever changed – and it can be a big adjustment. Even when you’ve seen photos of flat closures and tried to prepare yourself for the “big reveal,” it can be a shock to see your flat chest the first time. Rest assured, it won’t always be this difficult. Be gentle with yourself and allow yourself to experience the grieving process – and don’t hesitate to seek out the support you need and deserve.

Some women experience positive benefits from being breast-free, particularly women who had large breasts. Many of these women report feeling “slimmer,” “lighter,” and “free,” especially when running and swimming. Even when you’re feeling less than confident, you can try to appreciate your body for what it can do rather than what it looks like. It can be challenging to shift your focus like this, but you may discover that you’re more resilient than you ever thought possible.

For body-positive inspiration, check out the flat visibility movement on social media, and the professional photography projects that serve to support women facing breast cancer:

Sexuality & Intimacy

Your sense of yourself as a sexual being, and a sexually attractive woman, may be impacted by your mastectomy as well. Since this is so individual and variable, and your relationship with your partner is as well, the most helpful strategy is to focus on communication.

“The key is communication – the biggest sexual tool with your partner is to talk to them. Tell them what you want, what you don’t want, what’s different and to try to explore different issues… the key issue in developing a positive sex life after cancer is communication.”

Professor Jane Ussher, Western Sydney University

The Australian charity Cancer Council NSW has the following excellent tips for resuming intimacy after mastectomy:

• Be gentle with yourself and acknowledge how you are feeling.
• Look at and touch your scars so you get used to the changes.
• Give yourself time to get used to any physical changes. Some changes may be temporary and will improve with time.
• Focus on yourself as a whole person and not just the part of you that has changed.
• Remember that sexual attraction is based on a mix of emotional and physical factors, not on a single body part or another physical characteristic.
• Dim the lights and/or wear a comfortable top when you have sex until you feel more confident about your body.

In addition to the impacts on your sex life from the mastectomy, you may also be dealing with changes to your body from chemotherapy, radiation, and/or hormone therapy which negatively affect your sexual anatomy and libido. Early menopause, in particular, can present a major challenge, especially because its associated physical and emotional changes can be sudden and drastic.

Talk to your medical oncologist about your symptoms. Don’t be shy – be specific, and advocate for yourself. Your sexual well-being is important for your quality of life! Your oncologist may be able to refer you to a women’s sexual health specialist, or recommend products or treatments tailored to your situation. And you can find a wealth of information and resources on sexuality after cancer online at the American Cancer Society and the Cancer Council NSW.

Prosthetics (Breast Forms)

“Living flat” usually means that after your mastectomy with flat closure, you don’t wear prosthetics which are external accessories that are worn under clothing to give the appearance of breasts. But many women who choose flat closure do wear prosthetics, some or all of the time. Your preferences about prosthetics can change over time, too – many women wear them at first, then find that they wear them less often as time goes on and they feel more at ease with their breastless body. One of the benefits of flat closure is you can choose to appear flat or breasted at will!

You should know that prosthetics are almost never medically necessary, for posture or any other functional reasons. Unless you are single-breasted and your remaining breast is very large, you’re unlikely to benefit physically from wearing a prosthetic. It’s an issue of aesthetics – how you want to look, both for your own self-image and confidence and for presenting yourself to the world in a way you feel comfortable with.

Prosthetics can be purchased prefabricated from many different retailers, in different shapes, sizes and materials. From traditional silicone prosthetics which are fairly heavy (Amoena and others), to special swim prosthetics, to lightweight foam alternatives (Athleta’s Empower Pads, Busted Tank, AnaOno’s F(oo)Bs), to knitted/crocheted products (Knitted Knockers, Awesome Breast Forms), to integrated products (Complete Shaping) – there’s a prosthetic available for everyone and every occasion. Prosthetics can also be custom-made for your body.

Insurance generally does cover the cost of prostheses, but not always, and you may need a prescription. Visit BreastFree.org, BreastCancer.org, or the American Cancer Society for more detailed information about prosthetics.

Mastectomy Tattoos

Tattoos can be an important component of healing for many women following their mastectomy surgery – both those who chose to reconstruct their breasts AND those who chose to go flat. Tattooing can be a way for women to take back ownership over their bodies, having had so little control during breast cancer treatment.

For some, tattoos can restore the appearance of their lost nipple/areola (restorative, or reconstructive tattoos). Others choose mastectomy tattoos that are decorative (also called artistic, or “scar covering”) rather than anatomic, and that hold special meaning for them – flowers, vines, words, and designs of every shape and color. Women going flat typically choose decorative tattoos rather than restorative tattoos, but both are an option.

Unfortunately, many insurance companies do not provide coverage for mastectomy tattoos. Those that do, only cover restorative (not decorative) tattooing as part of the “breast reconstruction” process. However, there are at least two nonprofit organizations that provide financial assistance to mastectomy patients to cover part or all of the cost of their desired tattoo: Personal Ink and Pink Ink Fund.

Patients considering mastectomy tattoos should also be aware that not all tattoo artists will produce optimal artwork, because tattooing is a largely unregulated field, and particularly for restorative tattoos should seek out a licensed artist specializing in this area who can display a portfolio of previous work.

(More about mastectomy tattoo logistics and risks.)

What If I Change My Mind?

Some women who initially reconstruct end up going flat later on, either because their reconstruction failed or because of serious medical complications or dissatisfaction with cosmesis (appearance). Some of these women choose to pursue a different type of breast mound reconstruction instead of going flat. And some women who initially choose to go flat end up reconsidering reconstruction later on.

It’s ok to re-evaluate your initial decision. None of us can know with perfect certainty how we will feel living with our initial reconstructive choice – or how our initial surgery will pan out. In the United States, the federal legislation requiring insurance companies to cover breast reconstruction doesn’t impose time limits on your right to seek reconstruction (or “deconstruction” – explant, etc.).

Keep in mind that after a mastectomy, no matter what your surgical outcome, there will be an adjustment period. Losing your natural breasts due to breast cancer is a loss, and most women grieve that loss – a process that can take some time and may look different for different individuals.

If after living flat for some time, you feel you are ready to re-evaluate your reconstructive options, the next step is to find a qualified plastic surgeon who will assist you through the process. A good overview of how to find a surgeon can be found at BreastCancer.org. You can also use a decision aid like the Breast Advocate App to help you think through your options before your consult.

Remember, this is your body and your choice. You deserve to have a surgical outcome that supports your emotional and physical well-being!

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