Most breast cancer patients satisfied ‘going flat’ after mastectomy

In In The News by Barbara Jacoby

By: Chris Melore


A mastectomy can be a life-changing decision for women dealing with or at high-risk for breast cancer. While many women opt for breast reconstruction, a new study finds more women are “going flat” after surgery. Researchers from UCLA say although most of these women are happy with their choice, nearly a quarter feel unsupported by one important person — their own doctor.

A team from the UCLA Jonsson Comprehensive Cancer Center surveyed 931 women who had a unilateral or bilateral mastectomy and opted not to have breast mound reconstruction. Researchers wanted to see why some patients choose to forgo the cosmetic procedure. They also examined how much information women received about their post-surgical options.

The results reveal 74 percent of mastectomy who go flat express satisfaction with the choice. Another 22 percent of the poll however, say they experienced “flat denial” during the medical process. This term refers to doctors not initially offering a mastectomy, the surgeon not supporting the patient’s decision, or a surgeon intentionally leaving additional skin in the area in case the patient “changes her mind.”

What are the benefits of ‘going flat’ after a mastectomy?

One of the biggest reasons respondents gave for avoiding reconstruction after a mastectomy is it cuts down their recovery time. Patients also wanted to avoid putting foreign objects in their body and say breast reconstruction isn’t important to their self image.

Undergoing a mastectomy with or without reconstruction is often a very personal choice,” says senior study author Dr. Deanna Attai in a university release. “We found that for a subset of women, ‘going flat’ is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance.”

Researchers add their findings challenge previous studies which conclude women undergoing breast mound reconstruction have a better quality of life. Attai’s team contends the surveying tools in those studies show bias in favor of getting breast implants.

Surgeries not meeting patients’ expectations

The new study partnered with patient advocates to design a survey which tries to avoid bias for or against surgery. Researchers assessed a patient’s motivation for going flat, happiness with the decision, and the reasons their choice satisfied them.

While three in four women express satisfaction with their surgery outcome, the survey finds 27 percent were unhappy with the appearance of their chest. For some patients this wasn’t about what the procedure took away, but what their surgeon left on, allegedly without consent.

“Some patients were told that excess skin was intentionally left — despite a preoperative agreement to perform a flat chest wall closure — for use in future reconstruction, in case the patient changed her mind,” Attai explains. “We were surprised that some women had to struggle to receive the procedure that they desired.”

The UCLA team suspects some surgeons may be hesitant to recommend a mastectomy without reconstruction because they don’t believe they can make the chest look cosmetically acceptable after removing the breast.

“We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option,” Attai concludes. “We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”

The study appears in the journal Annals of Surgical Oncology.