Breast reconstruction or living flat – what are my options after surgery?
For people who have undergone breast cancer surgery, deciding between different forms of breast reconstruction can feel daunting. The good news is we live in a time of increased awareness and visibility into the many options available – including opting out of breast reconstruction, or “going flat.”
Adjusting to body changes after surgery is a personal and complex process. Our breast cancer specialists are here to inform patients of their options and support them every step of the way, before, during, and after treatment.
We asked Ellen LaFontaine, MSW, LICSW, OSW-C, an oncology social worker at the M Health Fairview cancer centers in Burnsville and Edina what you should know about reconstruction and going flat.
What options do I have after a mastectomy?
Breast reconstruction: The reconstruction of the breast using implants (silicone or saline) or living tissue (fat, skin, or muscle). Breast reconstruction often involves a few surgeries over several months. Choosing between an implant or. living tissue also has a significant effect on recovery time, as well as the need for ongoing monitoring and future replacements.
Nipple reconstruction: This procedure uses your body’s own tissue to create the shape of a nipple.
Going flat: This is also called aesthetic flat closure (AFC). It involves chest wall reconstruction to create a smooth appearance with no extra skin left behind. Some people who go flat choose to use prostheses available in various shapes, sizes, and weights to temporarily give the appearance of breasts. Others opt to not use prostheses, and instead “live flat.”
Why might someone opt against reconstruction?
There are many reasons why people opt against reconstruction, some of which may include: recognizing that a person does not need to have two breasts to be a whole person, wanting to reduce the need for future surgical interventions, desiring a faster return to daily life and activities, or wishing to avoid the potential side effects that can come with reconstruction.Who can I talk with on my care team about this decision?
A breast surgeon and plastic surgeon are two important and knowledgeable people to consult with about the risks and benefits of different surgeries. It can be helpful to prepare a list of questions to bring to these appointments to ensure that your questions are answered, and that your goals are clearly communicated.The American Cancer Society has a list of prepared questions to ask a breast surgeon if considering reconstruction. If you are considering going flat, explicitly ask your surgeon about their experience performing AFC surgery and to see photos of their work. Not Putting on a Shirt, an AFC advocacy group, has several resources on this topic and provides medically reviewed and easily downloadable flyers, including “Flat is Beautiful” for you to reference in a conversation with your surgeon.
What resources are available to me if I decide to live flat?
There are many services within M Health Fairview and the community to support you, whether you choose reconstruction or to go flat.
Many patients find working with our Breast Cancer Rehabilitation team to be especially helpful to support range of motion, pain, swelling, balance, and weakness after breast surgery.
The Institute for Sexual and Gender Health at the University of Minnesota also specializes in supporting people who are experiencing changes in their intimacy and sexual health, and you can meet individually with an expert for additional support in this area.
Just as physical well-being is an important part of one’s care plan, so is emotional well-being, and we recognize the potential effects of surgery on self-esteem and body image. Many people find it helpful to connect with oncology social workers who are skilled in both emotional support and resource connection. Our social workers can help patients connect with others who had the same surgery or find more information on these important topics, so they feel more informed and less alone during and after breast cancer treatment.
We recognize that the breast cancer journey can be difficult and navigating decisions around surgical intervention can be overwhelming. Our breast cancer care team is here with you to provide the knowledge, physical and emotional support you need to achieve the best outcomes for your care. You’re not alone.
To schedule an appointment with one of our breast cancer experts, call 855-486-7226.
