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Introduction to Living Flat
There is beauty in simplicity.
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.
“Flat can lead to freedom! I don’t miss having my boobs flopping around while trying to exercise, or the agony of trying to find a good fit in a swimsuit. The first time I went topless on at the beach and felt the sun on my chest, I felt like my authentic self. Nothing was missing, I was whole.” Amy Middleton (Fierce, Flat, Forward)
“Be gentle with yourself both physically and emotionally. I think we are too hard on ourselves and demand perfection from ourselves too often. We give care to others but when it comes to ourselves as women we demand too much of ourselves. So my advice would be: be gentle with yourself.” Kathy Ruscher (Fierce, Flat, Forward)
“Some people ask why so many photos of shirtless women who are flat? We show our scars because: we are both brave and beautiful, women of any age and stage of life can be diagnosed with breast cancer, we want to be the stepping stones of hope for those who come after us on this challenging journey.” Kathy Ritz (Fierce, Flat, Forward)
MORE Click to read more from women who are happily living flat.
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!
Something missing? Add your group to this page!
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.
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:
MORE Click here to see more flat fashion resources
Body Image & Sexuality
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 (source). 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:
MORE Click here to see more flat & body-positive projects
Questions or concerns? Something missing? Add your project/resource to this page!
Sexuality & Intimacy
Mastectomy will invariably impact a woman’s sex life, because it impacts the body she inhabits. To the extent that your natural breasts were a source of sexual pleasure for you, you will have adjustments to make as you get used to your post-mastectomy chest. Beyond the change in appearance, you will notice that you no longer have the same level of sensation there that you had with your natural breasts. Remember that the loss of sensation is not due to going flat – it’s a result of the mastectomy itself. Some women retain some sensation, while others are completely numb – and this can change over time as well.
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 Empower Pads, AnaOno’s F(oo)Bs), to knitted/crocheted products (Knitted Knockers, Awesome Breast Forms), to integrated products (Busted Tank) – 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 Tattoo: a tattoo that is drawn on top of the mastectomy site, usually to cover mastectomy scars – includes both restorative tattoos (restoring the nipple/areola) and decorative pieces (non-anatomic).
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 Click here for more mastectomy tattoo resources
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.
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!
“Going Flat” Articles, Videos and Blog Posts
News & Magazine Articles
- “Bold and Breastless: A Double Mastectomy Saved My Life” Shondia McFadden-Sabari (Essence) 2013
- “Breastless and braless by choice” Pat Sealy, RN, PhD (Canadian Nurse) 2013
- “Most Patients Don’t Opt for Breast Reconstruction and They Don’t Regret It” Christina Izzo (Oncology Nursing News) 2014
- “Monokinis allow women to go breastless” Annie Stevens (Stuff NZ)
- “Breast Cancer Survivors Rock ‘Flat Tops’ in Powerful Underwear Ads” Melissa McGlensey (The Mighty) 2015
- “Breast Cancer Survivor Stories” Liz Brody (Glamour) 2015
- “My Story: Bold And Breastless (How A Double Mastectomy Saved Me)” Shondia McFadden-Sabari (BlackDoctor.org) 2016
- “Offered Breast Reconstruction, More Women Opt to Go Flat” Roni Rabin (New York Times) 2016
- “The Women Who Showed Their Breast Cancer Scars” Roni Caryn Rabin (The New York Times) 2016
- “Leave Me Breastless: Cancer survivor’s fashion tips inspire the world” Bern Young (ABC News) 2016
- “Cancer Survivor Proudly Bares Mastectomy Scars in Powerful Equinox Campaign” (People.com) 2017
- “How I Learned to Love My Body After Double Mastectomy” Catherine Guthrie (Oprah Magazine) 2017
- “I Was Fighting Breast Cancer as an Underinsured Woman, and I Couldn’t Get the Care I Needed to Live” Lynya Floyd (Glamour) 2017
- “Why I Went Flat” Catherine Guthrie (Cancer Health Magazine) 2018
- “Topless protest alleges malpractice over breast-cancer surgery: ‘Paternalism at its finest‘” Beth Greenfield (Yahoo Lifestyle) 2018
- “Flat Out: Rejecting Breast Reconstruction” Catherine Guthrie (New York Times) 2018
- “Why More Breast Cancer Survivors Are Going Flat” Catherine Guthrie (Oprah Magazine) 2018
- “Why some breast cancer survivors are getting their implants removed” Beth Greenfield (Yahoo Life) 2018
- “‘Breastless’ play recounts double mastectomy” Keith O’Connor (MassLive) 2019
- “4 Moving Stories Of Breast Cancer Survival” Tish Weinstock (Vogue UK) 2020
- “Breast Reconstruction or ‘Go Flat’? What 8 Women Chose” Risa Kerslake (Healthline) 2020
- “Spreading A Different Awareness During ‘Pinktober’” Marissa Holzer (CURE Today) 2020
- “Beauty of mastectomy tattoos revealed in powerful photo project” Jacqui Palumbo (CNN) 2020
- “More breast cancer survivors are forgoing reconstruction to ‘go flat’” Kevyn Burger (Star Tribune) 2020
- “Love Your Body 2020: Baring all for body positivity” (NOW Toronto) 2020
- “Breast cancer survivors make strides in showing the world that ‘going flat’ after mastectomy is ‘both beautiful and valid’” Beth Greenfield (Yahoo Life!) 2020
- “To Reconstruct or Not: After Mastectomy, Two Women Take Very Different Paths” Sonya Collins (SurvivorNet) 2020
- “Comedian Tig Notaro Beat Breast Cancer & Says She’s ‘In the Healthiest, Strongest Place I’ve Been in Years’” (SurvivorNet) 2020
- “Women Who’ve Gone ‘Flat’ After Mastectomies Are Baring Their Chests — & Their Truths” (Yahoo! Life) 2020
- “Radical Empowerment? How Women Are Taking Control Of Their Breasts” (Forbes) 2020
- “Why She Went Topless at Age 53” (Whoa! Network) 2013
- “Bold and Breastless: A Survivor’s Story” (CNN) 2015
- “Going Flat: Why I Refused Breast Reconstruction” (BBC Outside Source) 2016
- “A matter of choice: Mastectomies without reconstruction” (CBS News) 2017
- “3 Breast Cancer Survivors Who Decided Against Breast Reconstruction After Mastectomies” Joan Lunden (Today Show) 2017
- “Breast Cancer survivor photographed by a Breast Cancer Survivor” Jen Rozenbaum 2017
- “Grace” (SELF) 2018
- “I am Whole” Danielle Siegel & Emily Hernandez (2018)
- “Charise Isis Helps Breast Cancer Survivors with Beautiful Portraits” Today Show (2018)
- “Unapologetically 40” ((note: adult content)) Shay Sharpe (Shay Sharpe’s Pink Wishes) 2018
- “Breast cancer survivor encourages living ‘flat‘” WFXR NEWS 2018
- “Embracing Mastectomy Scars” Dove campaign
- “You’re Still You After Cancer: Chiara D’Agostino’s Survivor Story” SurvivorNet
- “The Beautiful Self Diaries: Chapter Marianne” (BeautifulSelf.org) 2019
- “Short End (Music Video Short)” Ms. Rosewater 2019
- FLAT Movement (WCVB Your Health) 2019
- “You don’t need breasts to feel beautiful: B.C. stylist empowering cancer survivors to love their new bodies” Luisa Alvarez (CTV News) 2020
- “Why I am Boobless After Breast Implant Illness” Lacey Marie (TEDX Idaho Falls) 2020
- “Skin Stories – Juliet (Video)” (Dove) 2020
- “Breast Implant Illness & Going Flat after Mastectomy With Breast Cancer Survivor Melissa Patterson” (The Breast Podcast Ever) 2020
- “Israeli breast cancer survivor celebrates scars topless” (Reuters) 2020
- “Self-confident without breasts ” (DW News) 2020
Podcasts & Podcast Episodes
FLAT is where it’s at (Stephanie Astalos-Jones)
Oben Ohne?! (AMSOB, Germany – first episode in English)
“Not Putting on a Shirt, with Devorah Vester” (Guest Devorah Vester) MindBloom, 2020
“Flat Closure Zoom with Kim & Stacie-Rae: Informed Consent and Advocacy” (Guest Kim Bowles) Stacie-Rae Weir, 2020
“Aesthetic Flat Closure” (Guest Melanie Testa) The Healthqueer Advocate, 2020
- “Mastectomy Tattoos” Cristen Conger (Stuff Mom Never Told You) 2014
- “‘Beautiful is a woman being her true self’: Why I declined reconstruction after my double mastectomy” Kerri Sandberg (Salon) 2016
- “To Have or Have Not: Breast Reconstruction and ‘Going Flat’” Amie Newman (Our Bodies, Ourselves) 2016
- “Choosing Between Reconstruction and ‘Going Flat’ After Breast Cancer” Marisa C. Weiss, M.D. (US News) 2016
- “Going Flat: Why an Increasing Number of Breast Cancer Survivors Are Foregoing Reconstructive Surgery” Dr. Gary Breslow (Zwivel) 2017
- “Why Some Women Are Choosing to ‘Go Flat‘” Starre Vartan (Treehugger) 2017
- “Reconstruction Decisions: “Living Flat” After Breast Cancer” Stacy Verner (Cure Today) 2017
- “Going Flat: How the Questions Started” Catherine Guthrie (LBBC) 2019
- “Full Reconstruction to Flat: My Decision to Explant Eight Years Later” Samantha Paige (AnaOno)
- “Acceptance: Truly feeling breastless and beautiful!” Genevieve Esgate (Leave Me Breastless) 2019
- “Going Flat After Mastectomy” Pankaj Tiwari, MD (Midwest Breast & Aesthetic Surgery) 2019
- “To the Bra I Loved the Most” Alanna Kibbe (ReThink Breast Cancer) 2020
- “Why our scars are beautiful and society’s views are not.” Shannon Rock (Preserve Studio) 2020
- “FLATTIES: Our Bodies Are Beautiful!” Charise Isis (The Grace Project Blog) 2020
- “Flat and Fashionable: How Casey Became a Flattie” (Bright Pink) 2020
- “My Body, My Choice: Aesthetic Flat Closure after Mastectomy” (Our Bodies Ourselves) 2020
- “Informed Decision Making About Going Flat” Devorah Anne Vester (SurvivingBreastCancer.org) 2020
- “Feature Friday: Going Flat” (SurvivingBreastCancer.org) 2020
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