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  • Writer's pictureSurviving Breast Cancer

Going Flat and Explant Surgery

Within Breast Cancer Awareness Month throughout October, there are several specific awareness days. Yesterday, October 7th, for example, was Going Flat Day. This day arose to recognize the choice to go flat (as opposed to having reconstructive breast surgery) following a mastectomy as a valid option for those diagnosed with breast cancer. Additionally, some women who originally had breast reconstruction after their mastectomy may choose to have their implants removed later on. This is known as an “explant” surgery. There are numerous reasons someone may choose to go flat from the beginning or to have their implants removed at some point. Read on for stories from patients who have chosen this route, the importance of using the correct language to describe your desired outcome, i.e, aesthetic flat closure, pros and cons of going flat or removing current implants, and whether this could be a good option for you.

Podcast Episode #48 Radical Mastectomy and Going Flat - Interview with Alicia Duncan

In this episode, the surviving breast cancer team discusses Alicia’s struggle with her stage III breast cancer diagnosis and the loss of her breasts. The team highlights how a fast cancer diagnosis can take a toll on one’s mental health along with the PTSD that may come in the aftermath of being cured of cancer. Lastly, Alicia explains her tattoos and both Alicia and Angela discuss the strength needed to be a caregiver. Listen Now.

Informed Decision Making About Going Flat

In 2019, Devorah had a double mastectomy after a local recurrence. She always knew she did not want breast reconstruction, and feels fortunate that her breast surgeon – who told her about the flat movement – honored her choice. Devorah is also on the Board of Not Putting on a Shirt, a 501(c)(3) organization whose mission is to promote optimal surgical outcomes for women who choose to go flat after mastectomy and full disclosure of all post-mastectomy options. Read More.

Meghan's Call To Trust You Instincts

After her double mastectomy, Meghan initially opted for reconstruction. But after issues with her expanders and later the implants shifting, she also had unpleasant side effects. Known as breast implant illness (BII), she experienced fatigue, dizziness, vision problems, sleep problems and more. While little is currently known about BII, she chose to remove her implants. Read more for her story and how she shares the importance of speaking up if you're noticing any of these symptoms. Read More.


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Some women prefer to go flat because the recovery time after a mastectomy is typically shorter than with reconstruction. “If you have immediate reconstruction (reconstruction at the same time as surgery), the recovery time is longer than it is with no reconstruction. Depending on the type of procedure you have, there may be some muscle weakness and/or mobility issues as well, although some of the newer flap procedures minimize this risk by preserving the muscle structure at the tissue donor site. Generally, immediate reconstruction does lead to the most cosmetically pleasing results.

If you choose delayed reconstruction — reconstruction 6 or 12 months or more after mastectomy — your recovery from mastectomy should be a bit easier. If you choose implant reconstruction, your doctor may need to use a device called a tissue expander, which is used to create a pocket under the skin where the implant will eventually go. If you have a tissue flap reconstruction, the skin that was removed at mastectomy will be replaced with the skin that comes with the flap (if reconstruction is performed at the time of mastectomy, this skin replacement may not be necessary).”

Some patients who opt for no reconstructive surgery still want the look of their natural breasts and wear prosthetic breasts. If you’ve been using a prosthesis and are considering going without, but are uncomfortable about the idea of it, try not wearing the prosthesis while at home. Then try working your way up to going without it for short errands and see how you feel. You may realize most people don’t even notice!

“If you like the idea of going flat but are worried about looking lopsided in form-fitting clothing, choose styles that draw attention away from your chest area. BreastFree has some great clothing tips:

  • fabrics with busy, irregular patterns that aren’t too small, such as florals and paisleys, keep the eye moving

  • dark colors, especially black, camouflage the lack of shadow underneath the flat part of your chest

  • crisp shirts with breast pockets mask your contours

  • jackets and sweaters layered over form-fitting t-shirts draw attention away from your chest and hide any unevenness

  • scarves and shawls can be used to cover part of your chest

  • instead of plunging necklines, choose styles that show off your other assets, such as high necklines that bare your back or shorter/slit skirts that highlight your legs” Read More.

Some common reasons that women may choose to have their breast implants removed include:

  • An MRI has revealed a problem with your implant(s): All women with silicone breast implants should periodically undergo MRI testing to make sure their implants haven’t ruptured. Though silicone isn’t toxic, ruptured implants can cause pain, irritation, and infection if left untreated.

  • Your Lifestyle or Preferences Have Changed: If you feel like your breast implants are too large or too heavy, they can be replaced with smaller implants or removed entirely.

  • Health Concerns That Make Explant Surgery Necessary: Breast implant removal is medically necessary for women who have received a diagnosis of breast cancer as they can interfere with treatment. Some women choose to have their breast implants removed because they’re experiencing non-specific symptoms, like fatigue and unexplained fevers, and they think their symptoms are related to having breast implants. This condition is known as breast implant illness, and while it’s poorly understood at present, researchers think it may be caused by an autoimmune reaction.

A few options after removing implants:

  • Implant Exchange: The original implants are removed and new implants of your choice are replaced into the existing “pocket.” The recovery time is similar to that of the original reconstruction surgery.

  • Breast Lift with Implants: “Like large natural breasts, surgically augmented breasts often sag over time. If you’ve had breast implants for many years, normal aging and the effects of gravity may have created loose, stretched skin around your implants. To make sure your new implants sit in the correct position, surgeons may combine your implant exchange with a breast lift. They’ll remove excess skin from your breasts, insert new implants, and adjust the position of your nipples, as needed.”

  • Implant Removal: You may choose to remove your implants altogether. Note: while this article shares that a few months after implant removal, the breasts will fill out to their natural shape, this only applies to women who have had augmentation of their existing breasts, not a mastectomy and reconstruction. Read More.

Because of a family history of breast cancer, personal history of thyroid cancer, and being BRCA1+, Samantha decided to undergo a prophylactic double mastectomy. She did not want to worry about another cancer diagnosis and wanted to know she would be there for her new daughter. “Reconstruction with silicone implants was the only option I remembered being presented with any great support or detail. ... I recall someone encouraging the implants, so as to “look normal” for my daughter and to “go as big as possible” (the infamous “reconstruction is a boob job” view). I ended up with arguably perfect, gorgeous and quite large reconstructed breasts, but was never comfortable in my body.” Eight years later she had explant surgery. “I had not been feeling well for years and hoped the explant would help, which it did. Equally importantly, I did not feel whole, sexy or connected to my implanted chest. It always felt foreign to me. The most important aspect of my decision to remove my implants was not a gallant act of bravery, nor a rejection of boobs, foobs or anything in between. It was an act of self-love and self-honoring ... Even when we are overwhelmed, scared and often rushed, it is incredibly important to ask the questions, be informed, do our homework, take our time (when possible) to digest and react, own our own bodies and make our decisions based on our own voice and not the (often negative) internal and external ones that chime in.” Read More.

Not Putting On A Shirt is one of the organizations that spearheaded Going Flat Day a few years ago. Going Flat Day is all about advocating for flat closure as a valid choice post-mastectomy, and to encourage doctors to present it as an option to their patients. By increasing awareness about the option to go flat, they hope to improve the aesthetic outcomes for women who go flat and empower them to make informed decisions about their surgery. Not Putting On A Shirt celebrates women who have chosen to go flat and helps them embrace their beauty and sensuality without their breasts. They share photos of women proudly showing off their surgery scars, and offer resources for patients and providers about this option. Read More.

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